Current through Register Vol. 41, No. 3, September 23, 2024
A. Direct medical
education costs of nursing schools and paramedical programs shall continue to
be paid on an allowable cost basis.
1.
Payments for these direct medical education costs shall be made in estimated
quarterly lump sum amounts and settled at the hospital's fiscal year
end.
2. Final payment for these
direct medical education (DMedEd) costs shall be the sum of the fee-for-service
DMedEd payment and the managed care DMedEd payment. Fee-for-service DMedEd
payment is the ratio of Medicaid inpatient costs to total allowable costs,
times total DMedEd costs. Managed care DMedEd payment is equal to the managed
care days times the ratio of fee-for-service DMedEd payments to fee-for-service
days.
B. Effective with
cost reporting periods beginning on or after July 1, 2002, direct graduate
medical education (GME) costs for interns and residents shall be reimbursed on
a per-resident prospective basis, subject to cost settlement as outlined in
this subsection except that on or after April 1, 2012, payment for direct GME
for interns and residents for Type One hospitals shall be 100% of allowable
costs as outlined in subsection C of this section.
1. The methodology provides for the
determination of a hospital-specific base period per-resident amount to
initially be calculated from cost reports with fiscal years ending in state
fiscal year 1998 or as may be rebased in the future and provided to the public
in an agency guidance document. The per-resident amount for new qualifying
facilities shall be calculated from the most recently settled cost report. This
per-resident amount shall be calculated by dividing a hospital's Medicaid
allowable direct GME costs for the base period by its number of interns and
residents in the base period yielding the base amount.
2. The base amount shall be updated annually
by the moving average values in the Virginia-Specific Hospital Input Price
Index as described in
12VAC30-70-351.
The updated per-resident base amount will then be multiplied by the weighted
number of full-time equivalent (FTE) interns and residents as reported on the
annual cost report to determine the total Medicaid direct GME amount allowable
for each year. Payments for direct GME costs shall be made in estimated
quarterly lump sum amounts and settled at the hospital's fiscal year end based
on the actual number of FTEs reported in the cost reporting period. The total
Medicaid direct GME allowable amount shall be allocated to inpatient and
outpatient services based on Medicaid's share of costs under each
part.
C. Effective April
1, 2012, Type One hospitals shall be reimbursed 100% of Medicaid allowable
fee-for-service (FFS) and managed care organization (MCO) GME costs for interns
and residents.
1. Type One hospitals shall
submit annually separate FFS and MCO GME cost schedules, approved by the
agency, using GME per diems and GME ratios of cost to charges (RCCs) from the
Medicare and Medicaid cost reports and FFS and MCO days and charges. Type One
hospitals shall provide information on managed care days and charges in a
format similar to FFS.
2. Interim
lump sum GME payments for interns and residents shall be made quarterly based
on the total cost from the most recently audited cost report divided by four
and will be final settled in the audited cost report for the fiscal year end in
which the payments are made.
D. Direct medical education shall not be a
reimbursable cost in freestanding psychiatric facilities licensed as
hospitals.
E. The Department of
Medical Assistance Services (DMAS) shall make supplemental payments to
hospitals for qualified graduate medical residencies. Residency programs and
hospital partners shall submit applications for this funding each year.
Applications are available on the DMAS website at
http://leg1.state.va.us/000/noc/www.dmas.virginia.gov/%23/gmefunding.
The applications shall be scored, and the top applicants shall receive funding.
The supplemental payment for each new qualifying residency slot will be
$100,000 annually and will be made for up to four years . Payments shall be
made quarterly . Additional criteria include:
1. Sponsoring institutions or the primary
clinical site must be:
a. Physically located
in Virginia;
b. An enrolled
hospital provider in Virginia Medicaid and continue as a Medicaid-enrolled
provider for the duration of the funding;
c. Not subject to a limit on Medicaid
payments by the Centers for Medicare and Medicaid Services; and
d. Accredited through either the American
Osteopathic Association or the American Council for Graduate Medical
Education.
2.
Applications must:
a. Be complete and
submitted by the posted deadline;
b. Request funding for primary care, such as
general pediatrics, general internal medicine, or family practice, or high-need
specialty residencies; and
c.
Provide substantiation of the need for the requested primary care or specialty
residency.
3. Programs
that are awarded funding in the fall must attest by June 1 that the residents
have been hired for the start of the academic year and have continued
employment with the program each year thereafter.
Statutory Authority: §
32.1-325
of the Code of Virginia;
42 USC §
1396 et
seq.
