What’s happening: DMAS has officially posted the nursing facility Medicaid rates for each provider effective July 1, 2024.

• In the aggregate, the new operating rates for SFY 2025 reflect a year-to-year increase of over 6 percent (3 percent from inflation, the rest due to the rebasing), after removing the Medicaid Value-Based Purchasing (VBP) Program add-on from the 2024 rates (that amount remains in the system as VBP metric-based funding for 2025.

Additional VBP update: Also, the second round of 2024 VBP payments are scheduled to process to the managed care organizations (MCOs) on July 5.

• Payment to nursing facilities by the assigned MCOs should occur sometime from the second week of July through the first full week of August. DMAS is requesting that the MCOs expedite payment due to the delay but there is no guarantee that will occur; the MCOs are required to pay within 30-days of receipt of the funding from DMAS.

July 1 traditionally marks the effective date for new legislation, however VHCA-VCAL’s priority bills on LTSS Screenings and Medicaid aides passed earlier this year have different implementation timelines.

The LTSS Screening legislation included an emergency clause making it effective upon approval by the governor.

• On June 3, DMAS published the Medicaid Bulletin with implementation guidance on the VHCA-VCAL legislation modifying the LTSS screening process to remove all hospital discharges to skilled care from the requirement for the hospital screening team to conduct the LTSS screening. DMAS has also provided updated information on entering “Change in Level of Care” in the MES Portal.

The VHCA-VCAL-backed legislation to develop a regulatory pathway for medication aides to administer drugs at certified nursing facilities directs state agencies to take several steps before allowing such a change effective July 1, 2025. VHCA-VCAL will be actively engaged in the process to develop the new curriculum and related regulations.

• The legislation directs the Board of Nursing (BON) to create a workgroup to determine the educational requirements and criteria to be used to enable advanced registered medication aides to administer drugs to residents in certified nursing facilities. The BON has scheduled an initial meeting with association stakeholders for July.
• The Department of Health is required to promulgate regulations to authorize such medication aides to administer prescription drugs to residents in certified nursing facilities effective July 1, 2025.

• The new curriculum and registration process would be more stringent than the current registered medication aide (RMA) curriculum used by RMAs in assisted living.
• Medication aides authorized to work in nursing facilities would be able to work in assisted living facilities, but assisted living trained medication aides would not be able to work in nursing facilities.
• The workgroup will help the BON determine distinctions between the two types of medication aides.

Specific to assisted living: DSS issued a memo on June 5 advises assisted living facilities (ALFs) on three legislative measures passed in the 2024 General Assembly session affecting them. The highlighted legislation covers:

• the addition of ALFs to the list of employers allowing properly authorized ALF administrators to temporarily practice for one 90-day period in Virginia if they have an offer of employment in Virginia;
• the renaming of “adult day care centers” to “adult day centers;” and
• the medication aide legislation.