This SPA was submitted based on enacted legislation to list a payment increase to minimum wages for Assisted Living Programs (ALPS) program sufficient enough to enlist enough providers for care.

This SPA replaces the current Level of Functioning (LOF) survey with the Virginia Individual Developmental Disabilities Eligibility Survey standards for individuals seeking Intermediate Care Facilities for Individuals with Intellectual Disabilities services. By using the VIDES standards for institutional care, the Commonwealth is restoring the consistency of applied functional standards for these individuals regardless of whether they obtain their care in the communities via a waiver or in ICF/IID institutions.

This SPA proposes to permit residents of nursing facilities to deduct the costs of limited specific dental procedures from their payments towards the costs of their nursing facility care. Nursing facility residents shall be limited to deducting the following dental procedures: (i) routine exams and xrays, and dental cleansing twice yearly; (ii) full mouth x-rays once every three years; and (iii) deductions for extractions and fillings shall be permitted only if medically necessary as determined by the department.

Change the Programs of All-Inclusive Care for the Elderly (PACE) rate development methodology from a percent of fee-for-service (FFS) costs to an experience-based rate methodology that uses PACE organization cost experience, encounter data and other data to set rates.

Revises cost sharing participation for disabled Medicaid consumers who are employed.

This SPA proposes to modify the nursing facility reimbursement by adding respiratory therapy expenses as an allowable cost.

Revises cost sharing for disabled employed individuals under the Balanced Budget Act.

Reimbursement update for Inpatient Hospital, Institutional Reimbursement 4.19A Page.

Reimbursement update for DME Reimbursement Method for Incontinence Supplies.

Reimbursement update for Reimbursement 4.19B Introduction Page of Several Medicaid Services.