Medicaid Memo #1 – Rate Setting for FY23

June 29, 2022

Timelines for the publication of the rates were released by DMAS late yesterday:

“The purpose of this bulletin is to notify providers that DMAS is diligently working on the implementation of new rates set forth in the 2023 Appropriation Act approved by Governor Youngkin June 22, 2022. The new fiscal year 2023 rates will not be posted online before July 1, 2022. Fee-for­ Service (FFS) rates and Capitated rates are currently being developed. All FFS rates will be loaded by July 15, 2022. Capitated rates will be loaded by September 1, 2022. DMAS will distribute additional memos to update providers on the status of rate development and loading.”

“At this time providers have the option to bill immediately under old rates, and later adjust their claims or delay billing until rates are updated. Additionally, Managed Care Organizations (MCOs) are working to update their rate systems, but providers will need to work with their MCO partners to determine billing procedures. Providers will also need to work with DMAS’s Behavioral Health FFS Contractor (Magellan Behavioral Health) to determine billing procedures as well.”

is a version of the Memo you can print!  DMAS has been charged with “the authority to update the rates for DD waiver services using the most recent rebasing estimates, based on their review of the model assumptions as appropriate and consistent with efficiency, economy, quality and sufficiency of care and reported no later than July 1, 2022.” [Item 304 KKKK 2]  This is a little different from the way DD Waiver rates have been handled in the past when the oversight was provided by DBHDS.    Since there is other budget language directing the rate setting process to be moved from DBHDS to DMAS [Item 311 KK] effective July 2023; this exercise will give them (and us) a start on that process.