Changes in Medicaid Affect Virginia Nursing Facilities

Several important changes to Medicaid reimbursement rules and regulations in Virginia have recently taken effect.  Along with the normal updates in reimbursement rates, the additional changes, effective July 1, 2013, are outlined below.

Reimbursement Rate Increase

Thanks to the efforts of the Virginia Health Care Association (VHCA), nursing facilities in Virginia received critical increases in funding of approximately 2.2%.  This translates into an average increase of $2.00 per day.  As always though, the amount that each provider receives will be determined based on its individual circumstances and cost structure. 

Minimum Occupancy Threshold Lowered

Additionally, effective July 1, 2013, the minimum occupancy threshold was reduced from 90% to 88%.  This change is estimated to result in an additional increase in funding of $1.8 million to nursing facilities in Virginia.  And as occupancy percentages have been trending lower in recent years, this change will likely affect more providers and provide a larger economic impact over the next few years.    

Certificate of Public Need Rules

After several years of discussions and negotiations between legislators, the Virginia Department of Health, and representatives from the provider community, the General Assembly passed legislation that establishes a procedure for acceptance and review (by the Commissioner of Health) of applications for:

  • The transfer of nursing facility beds from one planning district to another planning district in the absence of a Request for Application.
  • An open admissions period for nursing home beds of a continuing care retirement community.

These changes to the law should encourage the movement of nursing home beds and possibly the development of new and/or replacement facilities throughout the state.

Affordable Care Act (ACA) Reforms

The General Assembly also approved the establishment of a special, 10-member legislative commission, The Medicaid Innovation and Reform Commission (MIRC).  MIRC will likely be a key player in political negotiations over, and the implementation of, the ACA in Virginia.  Its actions should be closely monitored by everyone in the provider community.

For more information about the changes outlined above, contact the expert listed below at PYA, (800) 270-9629.

 

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Doug Arnold

Doug Arnold

Principal

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