PUBLIC NOTICE
WEST VIRGINIA
MEDICAID PROGRAM
STATE PLAN
AMENDMENT 19-003
REGARDING
ALTERNATIVE BENEFIT PLAN PURSUANT TO THE PATIENT
PROTECTION AND
AFFORDABLE CARE ACT
PHYSICAL AND
OCCUPATIONAL
THERAPY
In accordance with 42 CFR 440.386, the Department of Health and Human Resources, Bureau for Medical Services (“Bureau”) provides notice of its intent to file a state plan amendment (SPA), identified as SPA 19-003, with the Centers for Medicare and Medicaid Services (CMS) to modify the delivery system for Medicaid members receiving the Alternative Benefit Plan (ABP) in accordance with Patient Protection and Affordable Care Act (ACA). West Virginia expanded Medicaid on January 1, 2014 to individuals aged 19-64 with income up to 133{4ceb532c6f579389df471c6c1e832caf2346b74dc60fcbf6aabd4d29df3baf9c} of the federal poverty level.
The SPA changes the standards for physical and occupational therapy under the ABP by removing the current standards reflecting the benchmark plan and instead using the same ones as in the regular Medicaid State Plan. If the companion SPA under the regular State Plan is approved by CMS, would clarify that physical therapists and occupational therapists are “practitioners of the healing arts” and may prescribe physical and occupational therapy. Also, it would that for up to 20 visits of physical therapy or occupational therapy, no referral is required. The SPA is a result of changes to the Opioid Reduction Act of 2018, which were made in HB 2768, enacted during the 2019 regular legislative session and signed into law. The SPA will be made effective on July 1, 2019, or as soon as CMS approves the SPA, whichever is later. The expected fiscal impact for fiscal years 2019 and 2020 cannot be determined at this time.
Consistent with 42 CFR 440.345, the Bureau assures that there will be full access to EPSDT services for people under 21 years of age. This Notice is intended to satisfy 42 CFR 440.386 and all other Federal and State notice requirements.
Documents detailing these proposed actions will be available for public inspection in each county office of the Department of Health and Human Resources during normal business hours, 8:30 a.m. to 4:30 p.m., beginning Tuesday, May 7, 2019 until Friday, June 7, 2019, and on the web at:
www.dhhr.wv.gov
/bms
under “Public Notices”. Written comments may be sent any time between the above stated dates to the West Virginia Department of Health and Human Resources, Bureau for Medical Services, 350 Capitol Street, Suite 251, Charleston, WV 25301- 3706, or by email at
SPACOMMENTS@
wv.gov.
Int. May 7, 2019
N.R. May 7, 2019