The Budget in a Bit More Detail

June 20, 2026

This is what I see this morning:

  • 271#1c – Limits the increase in the private day educational services per student/per diem to no more than 2.5% per year (CSA)
  • 271#2c – Clarifies that for Special Ed wrap-around services  children must meet one of the criteria outlined in §2.2-5211 of the Code
  • 288#4c – This language extends the workgroup convened in 2025 to assess under what conditions it may be appropriate for Clinical Psychologists to have prescriptive authority
  • 291#7c -Eff ective January 1, 2028,  the Department of Medical Assistance Services shall increase the rates for agency and consumer-directed personal care, respite and companion services in the home and community based services waivers and Early Periodic Screening, and Diagnosis and Treatment (EPSDT) program by 8.1 percent. 
  • 291#8c – Effective July 1, 2026, the Department of Medical Assistance Services shall have the authority to update the rates for Developmental Disability waiver services using the 2025 DD Waiver Rate Study conducted pursuant to the Permanent Injunction (Civil Action No. 3:12CV59-JAG). Rates shall be increased according to the methodology included in the rate study for the following services: Community Coaching (T2013), Community Engagement (T2021), Independent Living Supports (T2032), In-Home Support Services (H2014), Therapeutic Consultation (97139 and 97530), and Workplace Assistance (H2025). The department shall have the authority to implement these changes prior to the completion of any regulatory process to effect such change. (We hope to have an actual “rate chart” by the beginning of next week – in the meantime, please don’t ask!)
  • Effective July 1, 2026, the Department of Medical Assistance Services shall have the authority to increase the rates by two percent for the following services: Group Day Support (97150), Group Day Support Customized Rate (T2025), Community Guide (H2015), Peer Monitoring (H0038), Supported Employment Individual (H2023), Supported Employment Enclave (H2024), Group Home Residential 4 or fewer (H2022-UA), Group Home Residential 5 or more (H2022), Group Home Customized Rate (T2016), Sponsored Residential (T2033), Supported Living Residential (H0043), Shared Living (T1020), and Benefits Planning (T1023). The department shall have the authority to implement these changes prior to the completion of any regulatory process to effect such change. (Slightly less than we asked for, and no preplanned increase in Year 2, but an increase!)
  • Effective July 1, 2026, the Department of Medical Assistance Services shall have the authority to increase the rates for the following services: 3.8 percent for Skilled Nursing RN (S9123), 4.5 percent for Skilled Nursing, LPN (S9124), 5.0 percent for Private Duty Nursing, RN (T1002), and 5.0 percent for Private Duty Nursing, LPN (T1003). The department shall have the authority to implement these changes prior to the completion of any regulatory process to effect such change. 
  • 291#9c = The language defers implementation of the BH Redesign for an additional six months to July 2027 (Not everything we asked for, but a step in the right direction!)
  • 291#13c – The Department of Medical Assistance Services (DMAS) shall convene an ABA benefit Utilization Workgroup for the purpose of examining Medicaid expenditures and utilization trends for this service and identifying strategies to control costs while still preserving access to care for those in need of the therapy. The workgroup shall: (i) identify utilization trends, including trends among those with different diagnosis acuity levels; (ii) examine different delivery methods of ABA services and their impact on utilization; (iii) review utilization and service authorization criteria including standard assessment tools and diagnostic criteria taking into account differing service intensity and duration requirements; (iv) evaluate utilization management tools that align with national clinic practice guidelines promulgated by independent national nonprofit organizations; (v) define medical necessity criteria taking into account behavioral factors, ability to learn, age and development, and skills development including clear criteria for eligibility, scope of services and documentation requirements; (vi) review provider qualification recommendations related to ABA practitioner certification and licensing; and current supervision requirements and standards to help ensure appropriate clinical oversight; (vii) evaluate the appropriateness of ABA services for children with diagnoses other than ASD; and (viii) review the MCO annual reporting data to identify any areas of potential improvement to the delivery of services and any needed changes in regulations or policies from DMAS. The workgroup shall include stakeholders, including ABA service providers, including center-based models and home-based models, representatives from managed care organizations serving Medicaid patients, Virginia licensed behavioral analysts, and a child or adolescent psychiatrist. The workgroup meetings shall be open to the public and offer opportunities for public input.
  • 291 #18c – As we requested – This amendment restores funding and modifies language in the introduced budget to allow for a provisional diagnosis of autism spectrum disorder for children age 5 or younger for one year using a protocol designated by the Department of Medical Assistance Services in order to receive Applied Behavioral Analysis (ABA) services. The introduced budget included language requiring a diagnosis of autism spectrum disorder in order to receive ABA services. A final diagnosis of autism spectrum in young children is often difficult. However, services are critical in assisting with communication, social interaction, daily routines, and managing challenging behaviors at a time when foundational skills are forming and the brain is developing rapidly. These services can have a major impact on later development.
  • 298#1c – This amendment provides for legislative oversight for both funding and compliance with the DOJ Permanent Injunction
  • 300#4c – The Department of Behavioral Health and Developmental Services shall report on provider capacity for Developmental Disability Waiver services across the Commonwealth, including service and geographic gaps, workforce challenges, and trends affecting access to services. The Department shall submit its report to the Chairs of the House Appropriations and Senate Finance and Appropriations Committees by December 1, 2026. 
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