Medicaid State Plan Amendments

This plan amendment the updates the rates for Substance Use Disorder Treatment.

This plan amendment will update payment for physician-administered drugs. It will also allow the Department of Health Care Finance to reimburse the entire class of physician-administered drugs at one hundred percent (100%) of Medicare rates.

This state plan amendment increases EPSDT/Private Duty Nursing and Personal Care rates.

This Amendment allows for the changes in the practitioners qualified to perform the services and minor language updates.

This amendment adds new coverage and payment methodologies for mental health centers.

This amendment is to update the section of the Medicaid State Plan that ensures compliance and enforcement for Intermediate Care Facilities for People with Developmental Disabilities (ICF/IID).

Allows the Virginia Medicaid program to comply with the 21st Century Cures Act requirement to implement an Electronic Visit Verification System for Home Health Care Services.

To include a self-directed model for some Community First Choice (CFC) services, implement changes to the current Electronic Visit Verification (EVV) requirements for CFC, and better align the State Plan with current practice regarding CFC covered services, limitations, and the program’s quality improvement strategy. CMS conducted the review of the state’s submittal according to statutory requirements in Title XIX of the Social Security Act and relevant federal regulations.

Extends the expiration date of the out of state children's hospital reimbursement methodology from July 1, 2023 to July 1, 2025.

This Alternative Benefit Plan (ABP) adds Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT) and Paramedic provider types to ensure coverage authority for ambulance treatment without transport.  This aligns the state’s ABP with approved SPA 23-0037.