7/9/2024
WEST VIRGINIA MEDICAID PROGRAM
STATE PLAN AMENDMENT 24-0004 REGARDING NURSING FACILITIES REIMBURSEMENT
Pursuant to 42 U.S.C. §1396a(a)(13)(1997) and 42 C.F.R. §447.205, the Department of Human Services
(“Department”), Bureau for Medical Services (“BMS”) provides notice of the filing of a state plan amendment (SPA), identified as SPA 24-0004, regarding changes to the reimbursement structure for nursing facilities.
This SPA, if approved by the Centers for Medicare & Medicaid Services (CMS), will transition the historical West Virginia-specific nursing facility acuity-based reimbursement system to one based on the Patient-Driven Payment Model (PDPM). Utilizing PDPM allows for an acuity-based reimbursement system to continue, as CMS has stopped collecting the necessary data elements to support the current West Virginia-specific acuity-based reimbursement system.
This SPA will have an effective date of October 1, 2024, pending CMS approval. The changes proposed in the SPA are estimated to increase Medicaid Expenditures by $22,631,331 in Fiscal Year (FY) 2025 and $35,307,929 in FY 2026.
This notice will be available for public inspection between July 9, 2024, and August 9, 2024. Written comments may be sent between the above referenced dates to the West Virginia Department of Human Services, Bureau for Medical Services, 350 Capitol Street, Suite 251, Charleston, WV 25301-3706, or by email at SPAComments@wv.gov. Any written comments received will be available for review at the above address during normal business hours, 8:30 a.m. to 4:30 p.m.
SPA 24-0004 Nursing Facilities Reimbursement
Contact Information:
For more information, please contact the Bureau for Medical Services (BMS) at 304-558-1700.
