This amendment allows the West Virginia Bureau of Medical Services to provide payments to private or public, non-state government hospitals on behalf of Medicaid individuals with a substance use disorder who are awaiting placement effective June 1, 2022.

This SPA establishes an Alternative Payment Methodology (APM) for qualifying Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to pay a per visit add payment to providers that are providing additional level of engagement to integrate, coordinate health care, and manage the array of beneficiary health complexities.

This amendment extends coverage for inpatient hospital services to include rehab services for chemical dependency to align with Ohio's current payment policy for SUD treatment facilities. In addition, this SPA proposes to delete 3 older sections from the state plan and incorporate the language from those sections into the amended Attachment 3.1-A and 4.19-A pages with no policy changes.

The proposed amendment is an annual rebasing update.

This SPA proposes to allow for certain medications to be filled in 90-day supplies. This is a change the state made during the COVID-19 Public Health Emergency (PHE) period, and this SPA seeks to extend the provision beyond the PHE timeframe.

Approves the removal of the five percent (5%) reimbursement reduction for physician administered drugs.

This amendment clarifies the reimbursement methodology for Intermediate Care Facilities (ICFs) also applies to facilities with more than 16 beds, updates the annual reporting criteria, clarifies the frequency by which per diem rates are set and adds a provisional per diem reimbursement methodology for new facilities.

This amendment provides for an inflationary increase of .25 percent for inpatient hospital services, updates the All Patient Refined Diagnosis Related Grouper to version 39 and updates the cost outlier methodology.

This SPA removed the fifteen (15) day limit that an individual identified for inclusion in the Pharmacy Lock-in Program has to submit a request for a hearing on the lock-in decision from the state plan pages.

Continues the funding of multiple classes of inpatient disproportionate share hospital (DSH) payments and an
additional class of supplemental payments to Medical Assistance enrolled, qualifying inpatient acute care general hospitals.