2022 Session

Budget Amendments - HB30 (Member Request)

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Chief Patron: Coyner
Develop Medicaid Value Based Purchasing Program for Primary Care Providers

Item 304 #19h

Item 304 #19h

First Year - FY2023 Second Year - FY2024
Health and Human Resources
Department of Medical Assistance Services FY2023 $18,932,867 FY2024 $45,212,687 GF
FY2023 $20,389,322 FY2024 $64,256,526 NGF

Page 313, line 47, strike "$18,732,988,737" and insert "$18,772,310,926".
Page 313, line 47, strike "$19,820,607,534" and insert "$19,930,076,747".

Page 340, after line 10, insert:

"PPPP. The Department of Medical Assistance Services (DMAS) shall work with the appropriate primary care stakeholders and Medicaid managed care organizations to develop a unified, value-based purchasing (VBP) program for primary care providers (PCP) that includes enhanced funding for PCPs that meet or exceed performance and/or improvement thresholds as developed, reported, and measured by DMAS in cooperation with participating providers.  As part of this effort, DMAS shall define the structures for PCP accountability and disbursement of earned financial incentives. For the purposes of the Virginia PCP VBP program, DMAS shall use the definition of primary care providers and services developed by the Governor's Task Force on Primary Care with allowance for any modifications necessary for implementation. PCP performance evaluation under the program shall prioritize avoidance of negative care events, management of chronic conditions, and other relevant domains of care indicative of the quality of care furnished to Medicaid members. Enhanced funding under this program shall be increased to 100 percent of the federal fiscal year 2021 Medicare equivalent as calculated by the department and consistent with the appropriation available for this purpose. This enhanced funding shall only be available to PCPs that actively provide care for Medicaid members and the program structure shall give consideration to any current VBP arrangements in place between Medicaid managed care organizations and PCPs. The Virginia PCP VBP program shall begin no later than January 1, 2024. The department shall implement the necessary regulatory changes and other necessary measures to be consistent with federal approval of any appropriate changes to state plan or relevant waivers thereof, and prior to the completion of any regulatory process undertaken to effect such change."


(This amendment adds $18.9 million the first year and $45.2 million the second year from the general fund and $20.4 million from the nongeneral fund the first year and $64.3 million from the nongeneral fund the second year from matching federal Medicaid funds and other nongeneral funds to implement a reimbursement increase for primary care providers to 100% of the federal fiscal year 2021 Medicare equivalent and to implement a value-based purchasing program. A value-based payment model provides the flexibility and support providers need to adjust practice patterns and invest in enhancements necessary to focus om population health management, increase members' access to lower-acuity settings, preventive care, complex care management services, and chronic disease management.)