PUBLIC NOTICE
WEST VIRGINIA
MEDICAID PROGRAM STATE PLAN AMENDMENT REGARDING ALTERNATIVE BENEFIT PLAN AS PROVIDED FOR BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT
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) 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 delivery system for these Medicaid members beginning July 1, 2015, will be provided by a Managed Care System.
The ACA requires the establishment of an Alternative Benefit package for the Medicaid Expansion populations. The ABP must cover the ten (10) Essential Health Benefits (EHB) as described in section 1302(b) of the ACA. The ABP will include:
*ambulatory patient services
*emergency services
*hospitalization
*maternity and newborn care
*mental health and substance use disorder services, including behavioral health treatment
*prescription drugs
*rehabilitative and habilitative services and devices
*laboratory services
*preventive and wellness services and chronic disease management
*pediatric services, including oral and vision care.
Limits will be placed on certain services.
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.
As these populations are to be covered with 100{4ceb532c6f579389df471c6c1e832caf2346b74dc60fcbf6aabd4d29df3baf9c} federal funding through September 2016, there is no immediate state fiscal impact as a result of the establishment of the aforementioned alternative benefit package.
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 March 27, 2015 to May 15, 2015 and on the web at:
www.dhhr.wv.
gov/bms
under “Public Notices”
Written comments may be sent to the West Virginia Department of Health and Human Resources, Bureau for Medical Services, 350 Capitol Street, Suite 251, Charleston, WV 25301-3706 or submitted through the previously referenced website.
Int. March 27, 2015
N.R. March 27, 2015
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