8 General Notices/Errata

GENERAL NOTICES/ERRATA

Vol. 26 Iss. 21 - June 21, 2010

GENERAL NOTICES/ERRATA

BOARD OF AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY

Notice of Periodic Review

18VAC30-20, Regulations of the Board of Audiology and Speech-Language Pathology.

The Board of Audiology and Speech-Language within the Department of Health Professions is preparing to conduct a periodic review of its regulations.

The comment period begins on July 5, 2010, and ends on August 4, 2010.

The regulations may be viewed online at http://regulations.legis.virginia.gov (Title 18, Agency 30, Chapter 20) or http://www.dhp.virginia.gov/aud/aud_laws_
regs.htm, or copies will be sent upon request.

If any member of the public would like to comment on these regulations, please send comments by the close of the comment period to Elaine J. Yeatts, Agency Regulatory Coordinator, Department of Health Professions, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, FAX [phone], or email [e-mail].

STATE CORPORATION COMMISSION

Bureau of Insurance

May 26, 2010

Administrative Letter 2010-05

To: All Insurers Licensed to Write Workers' Compensation Insurance In Virginia

Re: Revised Form WCLC VA for Insurer Expense Multiplier Filings, Related Rules, and Tiered Rating; Withdrawal of Administrative Letter 2005-03

This administrative letter introduces a revised adoption form, WCLC-VA (05/10), for use in filing insurer expense multipliers, related rules, and supplementary rate information for workers' compensation insurance. In addition, this administrative letter introduces the use of tiered rating plans for workers' compensation insurance. Administrative Letter 2005-03, which included the original adoption form, WCLC-VA (05/05), is hereby withdrawn.

The National Council on Compensation Insurance (NCCI) files loss costs for the voluntary workers' compensation insurance market on behalf of all insurers licensed to write this coverage in Virginia. Such loss costs supersede previously-approved loss costs and must be used by all insurers for policies effective on or after the effective date prescribed in the State Corporation Commission's approval order. A given insurer's workers' compensation rates will then be the approved NCCI loss costs modified by that insurer's filed expense multiplier. Expense multiplier filings are accepted on a file-and-use basis and apply to policies effective on or after the requested effective date or the date received by the Bureau, whichever is later. Insurers may not file to delay or change the implementation date of the approved NCCI loss costs.

In addition to its expense multiplier, each insurer must also file any expense constant, premium discount table, or minimum premium formula that will be used in rating workers' compensation policies. Insurers using the NCCI small deductible plan must file the variable expense multiplier and safety factor that will be used to calculate deductible credits. Insurers writing retrospectively-rated policies must file the values used in premium calculation, including expected loss ratios, tax multipliers, table of expense ratios, excess loss premium factors, and loss development factors. Each insurer must also file a drug-free workplace premium discount rule in compliance with § 65.2-813.2 of the Code of Virginia. These filings are accepted on a file-and-use basis. Any exceptions to the approved NCCI manual of rules must also be filed. Insurers should not re-file rules already filed on their behalf by NCCI.

Pricing programs reflecting tiered rating are also permitted. However, certain requirements must be met in order to comply with §§ 38.2-1904 and 38.2-1906 of the Code of Virginia. If an insurer wishes to use tiered rating, the insurer must file the multiplier(s) it will use for each tier. In addition, the insurer is required to file eligibility criteria applicable to new and renewal policies for each tier. The criteria for assignment must be objective and mutually exclusive, allowing a risk to qualify for only one rating tier.

In addition to filing eligibility criteria, insurers are required to re-evaluate each policy at renewal to ensure that the appropriate rates are applied in accordance with the filed eligibility criteria. The filed rules must reflect this requirement.

Insurers are required to use the attached form WCLC-VA (05/10) to file new or revised expense multipliers in combination with any of the other rating elements outlined above. If filing amendments to exception pages on file, the insurer should file only the pages being changed. Pages not being amended need not be re-filed. If filing exception pages only with no change in multipliers, use of the WCLC-VA form is not necessary. The insurer should simply submit its exception pages with a clear explanation of the changes. Rate certification form COF-1 (05/05) must also be completed and submitted with each filing (see Administrative Letter 2005-01).

An insurer electing to file expense multipliers that vary by classification code may file its primary multiplier and up to 27 exceptions by listing the primary multiplier and exceptions on page 1 of form WCLC-VA (05/10). Any insurer electing to file more than 27 exceptions should attach a schedule of its multipliers when submitting the WCLC VA (05/10). A separate WCLC VA (05/10) must be filed for each tier.

Any modification of, or deviation from, the approved NCCI loss costs (other than the filed expense multiplier) is deemed to be a filing of independent workers' compensation insurance rates and is, therefore, subject to the 60-day delayed-effect provisions of § 38.2-1912 of the Code of Virginia. If the indicated multiplier meets or exceeds unity (1.00), any selected multiplier less than unity will be considered a deviation from loss costs, subjecting the insurer's filing to the delayed-effect provisions. Filings reflecting modifications or deviations from loss costs require the submission of final rates in lieu of a multiplier. Exceptions to NCCI rules that impact premiums will also be deemed to be independent rate filings subject to the delayed-effect statute. In addition, large deductible plans for workers' compensation insurance are subject to the 60-day delayed-effect provisions of § 38.2-1912 unless exempted from filing requirements by § 38.2-1903. Section 38.2-1903 also sets forth exemption criteria for certain retrospective rating plans.

Filings subject to § 38.2-1912 must include actuarial support of the filing and the insurer must certify that it has notified the Division of the Consumer Counsel of the Office of the Attorney General that the filing has been made. The filing should propose an effective date which is at least sixty days after the date the filing is received by the Bureau of Insurance. Under Virginia statute the filing is not deemed made until all necessary data requested from the insurer is furnished. If the initial submission does not include all necessary data, the earliest the filing can be approved is 60 days from the date the filing is deemed complete.

Any questions related to this administrative letter may be directed to Sandra Mawyer, Principal Insurance Market Examiner, Commercial Casualty Rates and Forms Section, Property and Casualty Division, telephone (804) 371-9197, or email [e-mail].

/s/ Alfred W. Gross

Commissioner of Insurance

DEPARTMENT OF ENVIRONMENTAL QUALITY

Proposed Consent Order for George W. Kemper IV

An enforcement action has been proposed for George W. Kemper IV for alleged violations in Rockingham County. Mr. Kemper is a poultry grower who failed to have his poultry waste transfer records available for inspection and stored poultry waste on the ground outside, uncovered, and unprotected from storm water runoff, wind, and precipitation. A consent order with Mr. Kemper will collect a civil charge. A description of the proposed action is available at the Department of Environmental Quality (DEQ) office named below or online at http://www.deq.virginia.gov. David Robinett will accept comments by email at [e-mail], FAX at [phone], or postal mail at Department of Environmental Quality, Valley Regional Office, P.O. Box 3000, Harrisonburg, VA 22801, from June 21, 2010, to July 21, 2010.

Proposed Consent Special Order for Rahim Corp.

An enforcement action has been proposed for Rahim Corp., for alleged violations in Powhatan County. The State Water Control Board proposes to issue a consent special order to Rahim Corp. to address noncompliance with underground storage tank regulations. A description of the proposed action is available at the Department of Environmental Quality (DEQ) office named below or online at http://www.deq.virginia.gov. Jennifer Hoeffner will accept comments by email at [e-mail], FAX at [phone], or postal mail at Department of Environmental Quality, Piedmont Regional Office, 4949-A Cox Road, Glen Allen, VA 23060, from June 21, 2010, to July 23, 2010.

Restore Water Quality in the Clinch River Including Plum Creek, Middle Creek, and Coal Creek

Announcement of an effort to restore water quality in the Clinch River including Plum Creek, Middle Creek, and Coal Creek in Tazewell County, Virginia.

Public meeting location: Cedar Bluff Town Hall, 115 Central Avenue, Cedar Bluff, VA on July 8, 2010, from 6 p.m. to 8 p.m.

Purpose of notice: The Virginia Department of Environmental Quality (DEQ), Department of Mines, Minerals and Energy and the Department of Conservation and Recreation are announcing a study to restore water quality, a public comment opportunity, and public meeting.

Meeting description: First public meeting on a study to restore water quality.

Description of study: DEQ is working to identify sources of pollutants affecting the aquatic organisms and sources of bacteria contamination in the waters of the Clinch River including Plum Creek, Middle Creek, and Coal Creek in Tazewell County, Virginia. The Clinch River is impaired for failure to meet the recreational use because of fecal coliform bacteria violations, as well as violation of the E. coli standard from the Lincolnshire Branch confluence downstream to the Pounding Mill Branch confluence and from the Dry Branch confluence downstream to the Mill Creek confluence. Plum Creek, Middle Creek, and Coal Creek are also impaired for failure to meet the recreational use because of bacteria violations. Coal Creek is impaired for failure to meet the aquatic life use based on violations of the general standard for aquatic organisms as well.

During the study, the pollutants impairing the aquatic community will be identified and total maximum daily loads, or TMDLs, developed for the impaired waters. A TMDL is the total amount of a pollutant a water body can contain and still meet water quality standards. DEQ will also determine the sources of bacteria contamination and develop a TMDL for bacteria. To restore water quality, contamination levels must be reduced to the TMDL amount.

How a decision is made: The development of a TMDL includes public meetings and a public comment period once the study report is drafted. After public comments have been considered and addressed, DEQ will submit the TMDL report to the U.S. Environmental Protection Agency for approval.

How to comment: DEQ accepts written comments by email, fax, or postal mail. Written comments should include the name, address, and telephone number of the person commenting and be received by DEQ during the comment period, July 9, 2010, to August 10, 2010. DEQ also accepts written and oral comments at the public meeting announced in this notice.

To review fact sheets: Fact sheets are available on the impaired waters from the contacts below or on the DEQ website at http://www.deq.virginia.gov/tmdl.

Contact for additional information: Shelley D. Williams, SWRO/TMDL Coordinator, Department of Environmental Quality, Southwest Regional Office, 355 Deadmore Street, P.O. Box 1688, Abingdon, VA 24212-1688, telephone [phone], FAX [phone], or email [e-mail].

Restore Water Quality for Portions of Fontaine Creek

Public meetings: Public meetings will be held on Monday, June 28, 2010, from 2 p.m. to 4 p.m. and 6 p.m. to 8 p.m. at the Richardson Memorial Library located at 100 Spring Street, Emporia, VA 23847. Both meetings are open to the public.

Purpose of notice: The Virginia Department of Environmental Quality (DEQ) and the Department of Conservation and Recreation are announcing the draft water quality study to restore water quality for portions of Fontaine Creek which stretches across portions of Brunswick and Greensville Counties. This notice also announces the final public meetings and a public comment opportunity.

Meeting description: Summary of the study's conclusions on the water quality impairments of the recreation use for portions of Fontaine Creek which are impaired due to bacterial violations.

Description of study: Virginia agencies have been working to identify sources of the bacterial contamination for portions of Fontaine Creek. This impairement spans approximately 32 miles. These waterways are impaired for failure to meet the recreational designated use due to exceedances of the bacterial water quality standard.

Waterbody	Location	Impaired Length (mi)	Impairment
Fontaine Creek (K11R-01-BAC)	Rt 633 Bridge to the tributary between Rts 627 and 639 Greensville Co.	9.87	Recreational  Use
Fontaine Creek (K11R-04-BAC)	I-95 Bridge to Rt 301 Bridge Greensville Co.	9.12
Fontaine Creek  (K12R-01-BAC)	Route 301 Bridge to confluence with Meherrin River Greensville Co.	13.29
Total Impairment Length		32.28

The study reports on the current status of the river and its tributaries via sampling performed by DEQ and the possible sources of bacterial contamination. The study recommends total maximum daily loads, or TMDLs, for the above impairments. A TMDL is the total amount of a pollutant a water body can contain and still meet water quality standards. To restore water quality the bacteria levels have to be reduced to the TMDL amount.

How to comment: DEQ accepts written comments by email, fax, or postal mail. Written comments should include the name, address, and telephone number of the person commenting and be received by DEQ during the comment period, which begins June 29, 2010, and expires July 30, 2010. DEQ also accepts written and oral comments at the public meeting announced in this notice.

Contact for additional information: Margaret Smigo, TMDL Coordinator, Department of Environmental Quality, Piedmont Regional Office, 4949A Cox Road, Glen Allen, VA 23060, telephone [phone], FAX [phone], or email [e-mail].

Revised Results of a Water Quality Restoration Study for the James River and Tributaries

Public meeting: Department of Environmental Quality, Piedmont Regional Office, 4949-A Cox Road, Richmond, Virginia 23060. Public meetings will be held on Wednesday, June 30, 2010, at 2 p.m. and 6 p.m. In addition, an informal question and answer session will be held a half hour prior to each meeting, the first at 1:30 p.m. and the second at 5:30 p.m. Both meetings and question and answer sessions are open to the public.

Purpose of notice: The Virginia Department of Environmental Quality (DEQ) and the Department of Conservation and Recreation are presenting a revised draft report of a study to restore water quality, a public comment opportunity, and two public meetings.

Meeting description: Public meetings on a study to restore water quality along the James River and tributaries in and around Richmond City and Chesterfield, Henrico, and Powhatan Counties. Meetings will highlight the revisions which have been made to the document (a document summarizing these changes will be available). The main topic of discussion will address the challenge of meeting attainment in Gillie Creek and Almond Creek and the ongoing collaboration of DEQ with the City of Richmond concerning combined sewer overflows (CSOs). The DEQ proposes to utilize the TMDL report as a technical support document for the future purpose of a use attainability analysis (UAA) of the concreted portion of Gillie Creek, should one be necessary.

Description of study: Virginia agencies have been working to identify sources of the bacterial contamination in the waters of the James River and it's tributaries in the following jurisdictions.

Stream	County/City	Length (mi.)	Impairment
Bernards Creek	Chesterfield, Powhatan	6.95	Bacteria (Primary Contact Use)
Powhite Creek	Chesterfield, Richmond City	8.13
Reedy Creek	Richmond City	3.69
James River	Richmond City	2.99
Gillie Creek	Richmond City, Henrico	5.75
Almond Creek	Henrico	2.08
Goode Creek	Richmond City	1.22
Falling Creek	Chesterfield	3.10
No Name Creek	Chesterfield	2.07
James River	Chesterfield, Henrico, Richmond City	6.75

These streams are impaired for failure to meet the primary contact (recreational) designated use because of bacteria standard violations. The study reports the sources of bacterial contamination and recommends total maximum daily loads, or TMDLs, for the impaired waters. A TMDL is the total amount of a pollutant a water body can contain and still meet water quality standards. To restore water quality, bacterial levels have to be reduced to the TMDL amount.

How a decision is made: The development of a TMDL includes a public comment period, including public meetings. After public comments have been considered and addressed, DEQ will submit the TMDL report to the U.S. Environmental Protection Agency and the State Water Control Board for approval.

How to comment: DEQ accepts written comments by email, fax, or postal mail. Written comments should include the name, address, and telephone number of the person commenting and be received by DEQ during the comment period, which will begin on July 1, 2010, and end on August 2, 2010.

Contact for additional information: Margaret Smigo, TMDL Coordinator, Department of Environmental Quality, Piedmont Regional Office, 4949 A Cox Road, Glen Allen, VA 23060, telephone [phone], Fax [phone], or email [e-mail].

Total Maximum Daily Load for Hunting Creek, Cameron Run, and Holmes Run

Announcement of a total maximum daily load (TMDL) study to restore water quality in the bacteria impaired waters of Hunting Creek, Cameron Run, and Holmes Run.

Purpose of notice: The Virginia Department of Environmental Quality (DEQ) and the Virginia Department of Conservation and Recreation (DCR) announce the final Technical Advisory Committee (TAC) meeting for the Hunting Creek, Cameron Run, and Holmes Run Bacteria TMDL Studies.

Technical advisory committee meeting: Friday, June 25, 2010, 10:30 a.m. to 12:30 p.m., City of Alexandria, Charles E. Beatley Central Library, Main Community Room, 5005 Duke Street, Alexandria, VA 22304-2903.

Meeting description: This is the third meeting of the TAC. The purpose of the TAC will be to provide technical input and insight for the project and to assist with stakeholder and public participation.

Description of study: Portions of Hunting Creek, Cameron Run, and Holmes Run have been identified as impaired on the Clean Water Act § 303(d) list for not supporting the primary contact recreation use due to elevated levels of E. coli bacteria. Virginia agencies are working to identify the sources of bacteria contamination in these stream segments. The Hunting Creek, Cameron Run, and Holmes Run watersheds are located within Arlington County, the City of Alexandria, the City of Falls Church, and Fairfax County. Below are descriptions of the impaired segments that will be addressed in this study:

Stream Name	Impairments	Area	Upstream Limit	Downstream  Limit
Hunting Creek (Tidal)	Recreational use Impairment due to E. coli bacteria	0.53 square miles	Route 241 (Telegraph Road) Bridge Crossing	Confluence with the Potomac River
Cameron Run (Non-Tidal)	Recreational use Impairment due to E. coli bacteria	2.08 miles	Confluence with Backlick Run	Route 241 (Telegraph Road) Bridge Crossing
Holmes Run (Non-Tidal)	Recreational use Impairment due to E. coli bacteria	3.58 miles	Mouth of Lake Barcroft	Confluence with Backlick Run

During this study, DEQ will develop a TMDL for each of the impaired stream segments. A TMDL is the total amount of a pollutant a water body can receive and still meet water quality standards. To restore water quality, pollutant levels have to be reduced to the TMDL allocated amount.

How to comment: The public comment period on the materials presented at the TAC meeting will extend from June 25, 2010, to July 26, 2010. DEQ accepts written comments by email, fax, or postal mail. Written comments should include the name, address, and telephone number of the person commenting, and be received by DEQ during the comment period. Please send all comments to the contact listed below.

Contact for additional information: Katie Conaway, Department of Environmental Quality, 13901 Crown Court, Woodbridge, VA 22193, telephone [phone], or email [e-mail].

Total Maximum Daily Load for Hunting Creek, Cameron Run, and Holmes Run

Announcement of a total maximum daily load (TMDL) study to restore water quality in the bacteria impaired waters of Hunting Creek, Cameron Run, and Holmes Run.

Purpose of notice: The Virginia Department of Environmental Quality (DEQ) and the Virginia Department of Conservation and Recreation (DCR) announce a Public Meeting regarding the Hunting Creek, Cameron Run, and Holmes Run Bacteria TMDL Studies.

Public meeting: Wednesday, June 30, 2010, 7 p.m. to 8 p.m., City of Alexandria, Charles E. Beatley Central Library, Main Community Room, 5005 Duke Street, Alexandria, VA 22304-2903.

Meeting description: This is the final meeting for this project. The purpose of this meeting is to discuss the study with community members and present the project results.

Description of study: Portions of Hunting Creek, Cameron Run, and Holmes Run have been identified as impaired on the Clean Water Act § 303(d) list for not supporting the primary contact recreation use due to elevated levels of E. coli bacteria. Virginia agencies are working to identify the sources of bacteria contamination in these stream segments. The Hunting Creek, Cameron Run, and Holmes Run watersheds are located within Arlington County, the City of Alexandria, the City of Falls Church, and Fairfax County. Below are descriptions of the impaired segments that will be addressed in this study:

Stream Name	Impairments	Area	Upstream Limit	Downstream  Limit
Hunting Creek (Tidal)	Recreational use Impairment due to E. coli bacteria	0.53 square miles	Route 241 (Telegraph Road) Bridge Crossing	Confluence with the Potomac River
Cameron Run (Non-Tidal)	Recreational use Impairment due to E. coli bacteria	2.08 miles	Confluence with Backlick Run	Route 241 (Telegraph Road) Bridge Crossing
Holmes Run (Non-Tidal)	Recreational use Impairment due to E. coli bacteria	3.58 miles	Mouth of Lake Barcroft	Confluence with Backlick Run

During this study, DEQ will develop a TMDL for each of the impaired stream segments. A TMDL is the total amount of a pollutant a water body can receive and still meet water quality standards. To restore water quality, pollutant levels have to be reduced to the TMDL allocated amount.

How to comment: The public comment period on materials presented at the public meeting will extend from June 30, 2010, to July 30, 2010. DEQ accepts written comments by email, fax, or postal mail. Written comments should include the name, address, and telephone number of the person commenting, and be received by DEQ during the comment period. Please send all comments to the contact listed below.

Contact for additional information: Katie Conaway, Department of Environmental Quality, 13901 Crown Court, Woodbridge, VA 22193, telephone [phone], or email [e-mail].

STATE LOTTERY DEPARTMENT

Director's Orders

The following Director's Orders of the State Lottery Department were filed with the Virginia Registrar of Regulations on June 4, 2010. The orders may be viewed at the State Lottery Department, 900 East Main Street, Richmond, VA, or at the office of the Registrar of Regulations, 910 Capitol Street, 2nd Floor, Richmond, VA.

Director's Order Number Fifty-One (10)

Virginia's Instant Game Lottery 1178; "Super Blackjack" Final Rules for Game Operation (effective June 4, 2010)

Director's Order Number Fifty-Two (10)

Virginia's Instant Game Lottery 1182; "Diamond Bingo" Final Rules for Game Operation (effective June 4, 2010)

Director's Order Number Fifty-Three (10)

Virginia's Instant Game Lottery 1184; "Winning Fever" Final Rules for Game Operation (effective June 4, 2010)

Director's Order Number Fifty-Four (10)

Virginia's Instant Game Lottery 1193; "Lucky 8's" Final Rules for Game Operation (effective June 4, 2010)

Director's Order Number Fifty-Six (10)

Virginia's Instant Game Lottery 1200; "Winfall" Final Rules for Game Operation (effective June 4, 2010)

DEPARTMENT OF MEDICAL ASSISTANCE SERVICES

Legal Notice

Notice of Intent to Amend

(Pursuant to § 1902(a)(13) of the Social Security Act (42 USC § 1396a(a)(13))

Virginia State Plan for Medical Assistance

2010 Appropriation Act Mandated Reimbursement Changes

The Virginia Department of Medical Assistance Services (DMAS) hereby affords the public notice of its intention to amend the Virginia State Plan for Medical Assistance to provide for changes to the Methods and Standards for Establishing Payment Rates-Inpatient Hospital Services (12VAC30-70); Methods and Standards for Establishing Payment Rates-Other Types of Care (12VAC30-80); and Methods and Standards for Establishing Payment Rates-Long Term Care (12VAC30-90). DMAS intends to implement a number of changes in reimbursement methodology on July 1, 2010, pursuant to Item 297 of Chapter 874 of the 2010 Appropriation Act (Act). These are cost savings measures arising from the need for budget reductions statewide. If Congress extends through June 30, 2011, the increased federal funds matching rates, which otherwise will end December 31, 2010, the Act directs DMAS not to implement some of these changes.

Reimbursement Changes Affecting Hospitals (12VAC30-70)

12VAC30-70-50 is being amended to eliminate the inflation adjustment for long-stay hospitals for State Fiscal Year (SFY) 2011 and SFY 2012 and to freeze ceilings in SFY 2011 and SFY 2012 at the same level as the ceilings for long-stay hospitals with Fiscal Year Ends (FYEs) of June 30, 2010. This change is mandated by Item 297 AAA of the Act.

12VAC30-70-351 is being amended to rebase hospital diagnosis-related group (DRG) weights, case rates, psychiatric and rehabilitation per diem rates except that 2008 base year costs shall only be increased 2.58% in SFY 2011. No inflation adjustment shall be applied to hospital operating rates in SFY 2012. This change is mandated in Item 297 BBB 1 a of the Act.

12VAC30-70-221, 12VAC30-70-301, and 12VAC30-70-391 are being amended to change the inpatient hospital Medicaid utilization percentage from 15 to 14 to determine disproportionate share hospital (DSH) eligibility. DSH reimbursement is to be rebased for all hospitals with the final calculation being reduced by a uniform percentage so that SFY 2011 expenditures do not exceed SFY 2010 expenditures. No inflation adjustment shall be applied to hospital DSH payments in SFY 2012. This change is mandated by Item 297 BBB 1 b of the Act.

12VAC30-70-351 is being amended to eliminate inflation for graduate medical education per resident amounts in SFY 2011 and SFY 2012 as directed by Item 297 BBB 1 c of the Act.

12VAC30-70-351 and 12VAC30-70-391 are being amended to eliminate rebasing in SFY 2011 and inflation in SFY 2011 and SFY 2012 for freestanding psychiatric hospital facilities as directed in Item 297 CCC of the Act.

12VAC30-70-291 is being amended to exclude certain out-of-state hospitals from receiving indirect medical education payments and 12VAC30-70-301 is being amended to reduce DSH payments to certain out-of-state hospitals. These changes are mandated in Item 297 TTT of the Act.

Reimbursement Changes Affecting Other Providers (12VAC 30-80)

12VAC30-80-180 is being amended to eliminate the SFY 2011 and SFY 2012 inflation adjustments for home health agencies. This change is mandated in Item 297 FFF of the Act.

12VAC30-80-190 is being amended to reduce rates for procedure codes determined under resource based relative value system (RBRVS) (these codes are billed by physicians and other practitioners) by 3% in SFY 2011. In SFY 2012, rates will be reduced by 4% from what they would have been without the 3% reduction (an additional 1% reduction). This change is mandated in Item 297 CCCC of the Act.

12VAC30-80-200 is being amended to eliminate the SFY 2011 and SFY 2012 inflation adjustments for outpatient rehabilitation agencies as mandated by Item 297 GGG of Chapter 874 of the Act.

Reimbursement Changes Affecting Nursing Facilities (12VAC 30-90)

12VAC30-90-41 is being amended to eliminate rebasing in SFY 2011 and inflation in SFY 2011 and SFY 2012 as directed by Item 306 DDD1 a of the Act. Nursing facility and specialized care ceilings shall be frozen at the same level as providers with fiscal year ends of June 30, 2010.

The American Recovery and Reinvestment Act (ARRA) (P.L. 111-5)

In addition to the above-described changes, the 2010 General Assembly also required DMAS to implement on July 1, 2010, the changes listed below. These changes, however, are dependent upon whether additional federal stimulus money will be available to state Medicaid programs. These actions will not be implemented if federal medical assistance percentages under ARRA are extended to June 30, 2011.

Reimbursement Changes Affecting Hospitals (12VAC30-70)

Eliminate the efficiency incentive for long-stay hospitals. (Item 297 AAA of the Act).

Reduce inpatient capital reimbursement from 75% to 72% of cost and 71% in SFY 2012 with corresponding changes for Type One hospitals and Virginia hospitals with Medicaid utilization greater than 50%. (Item 297 HHHH of the Act).

Reduce the hospital adjustment factor from 78% to 75% for acute and rehab services and from 84% to 81% for psychiatric services and 74% and 80% respectively in SFY 2012. Corresponding changes for Type One hospitals. (Item 297 AAAA of the Act).

Reduce outpatient hospital reimbursement from 80% to 77% of cost and to 76% in SFY 2012. Corresponding changes for Type One hospitals. (Item 297 BBBB of the Act).

Reimbursement Changes Affecting Other Providers (12VAC30-80)

12VAC30-80-40 (Fee-for-service providers: pharmacy) is being amended per Item 297 SSS of Chapter 874 of the Act to decrease the maximum reimbursement for pharmaceutical products to the average wholesale price minus 13.1%, effective July 1, 2010.

Reduce physician rates by 3% with an additional 1% reduction in SFY 2012. (Item 297 CCCC of the Act).

Reduce dental fees by 3% with an additional 1% reduction in SFY 2012. (Item 297 DDDD of the Act).

Reimbursement Changes Affecting Nursing Facilities (12VAC30-90)

Reduce nursing facility operating rates by 3% in SFY 2011 and 2012. (Item 297 DDD 1 b of the Act).

Reduce nursing facility capital rental rate floor from 9% to 8.75% in SFY 2011 and to 8.5% in SFY 2012. (Item 297 DDD 1 c of the Act).

This notice is intended to satisfy the requirements of 42 CFR 447.205 and § 1902(a)(13) of the Social Security Act, 42 USC § 1396a(a)(13). A copy of this notice is available for public review from William Lessard, Provider Reimbursement Division, DMAS, 600 Broad Street, Suite 1300, Richmond, VA 23219, and this notice is available for public review on the Regulatory Town Hall (http://www.townhall.virginia.gov). Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Mr. Lessard and such comments are available for review at the same address.

Contact Information: William Lessard, Department of Medical Assistance Services, Provider Reimbursement Division, 600 East Broad Street, Richmond, VA 23219, telephone [phone], FAX [phone], or email [e-mail].

Legal Notice

Notice of Intent to Amend

(Pursuant to § 1902(a)(13) of the Social Security Act (42 USC § 1396a(a)(13))

The Virginia State Plan for Medical Assistance

Changes and Clarifications in Reimbursement Methodology Effective July 1, 2010

The Virginia Department of Medical Assistance Services (DMAS) hereby affords the public notice of its intention to amend the Virginia State Plan for Medical Assistance to provide for changes to the Methods and Standards for Establishing Payment Rates-Inpatient Hospital Services (12VAC30-70); Methods and Standards for Establishing Payment Rates-Other Types of Care (12VAC30-80); and Methods and Standards for Establishing Payment Rates-Long Term Care (12VAC30-90). The Department intends to implement a number of changes and clarifications in reimbursement methodology effective July 1, 2010.

Reimbursement Changes Affecting Hospitals (12VAC30-70)

The State Plan for Medical Assistance is being amended to clarify that reimbursement to facilities operated by the Department of Behavioral Health and Developmental Services (DBHDS) is based on costs. In addition, the formula for disproportionate share hospital (DSH) payments to DBHDS facilities will be revised to maintain the same level of total reimbursement even if some of the facilities exceed the hospital specific DSH limit.

Reimbursement Changes Affecting Other Providers (12VAC30-80)

The State Plan for Medical Assistance is being amended to make a supplemental payment for hospital outpatient services to Type One hospitals (state teaching hospitals) to fully cover its costs.

Reimbursement Changes Affecting Nursing Facilities (12VAC30-90)

The State Plan for Medical Assistance is being amended to clarify that reimbursement to nursing facilities and intermediate care facilities operated by the DBHDS and nursing facilities operated by the Department of Veterans Affairs is based on costs.

The State Plan for Medical Assistance is being amended to clarify that DMAS may grant an exception to the minimum occupancy requirement for reimbursement purposes for beds taken out of service for renovation.

This notice is intended to satisfy the requirements of 42 CFR 447.205 and of § 1902(a)(13) of the Social Security Act, 42 USC § 1396a(a)(13). A copy of this notice is available for public review from William Lessard, Provider Reimbursement Division, DMAS, 600 Broad Street, Suite 1300, Richmond, VA 23219, and this notice is available for public review on the Regulatory Town Hall (http://www.townhall.virginia.gov). Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Mr. Lessard and such comments are available for review at the same address.

Contact Information: William Lessard, Provider Reimbursement Division, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone [phone], FAX [phone], or email [e-mail].

STATE BOARD OF SOCIAL SERVICES

Notice of Periodic Review

22VAC40-400, Funding Limitation for the Refugee Resettlement Program.

Pursuant to Executive Order Number 107 (2009), the Department of Social Services (DSS) is currently reviewing this regulation to determine if it should be terminated, amended, or retained in its current form. The review will be guided by the principles listed in Executive Order Number 107 (2009) and in DSS's Plan for Review of Existing Agency Regulations.

DSS seeks public comment regarding the regulation's interference in private enterprise and life, essential need of the regulation, less burdensome and intrusive alternatives to the regulation, specific and measurable goals that the regulation is intended to achieve, and whether the regulation is clearly written and easily understandable.

Written comments may be submitted until July 12, 2010, to Penelope Boyd, Refugee Program Consultant, Office of Newcomer Services, Virginia Department of Social Services, 801 East Main Broad Street, Richmond, VA 23219, or by facsimile to [phone].

DEPARTMENT OF TRANSPORTATION

Notices of Periodic Review

Pursuant to Executive Order Number 107 (09), the Virginia Department of Transportation (VDOT) has scheduled the five regulations listed below for review. VDOT will conduct these reviews to determine whether the regulations should be amended, or retained as written, and will file the necessary documentation to comply with applicable statutes or other directives.

Contact information and duration of the collection of comment are shown at the end of this notice.

Regulation Title: 24VAC30-50. Rules and Regulations for the Administration of Waysides and Rest Areas.

Subject: This regulation sets forth rules concerning the use of waysides and rest areas, including prohibited actions, and those allowed with a permit.

APA Exemption: None

VDOT seeks public comment to determine whether the regulation meets the following goals:

1. To protect the public's health, safety, and welfare with the least possible intrusiveness to the citizens and businesses of the Commonwealth.

2. To ensure maximum utility of facilities to users.

3. Is the regulation written clearly and understandably?

Regulation Title: 24VAC30-61. Rules and Regulations Governing the Transportation of Hazardous Materials through Bridge-Tunnel Facilities.

Subject: This regulation sets forth the rules for users of state-owned bridge-tunnel facilities, including those for transporting hazardous materials.

APA Exemption: None

VDOT seeks public comment to determine whether the regulation meets the following goals:

1. To protect the public's health, safety, and welfare with the least possible cost and intrusiveness to the citizens and businesses of the Commonwealth.

2. Is the regulation written clearly and understandably?

Regulation Title: 24VAC30-100. Rules and Regulations for the Administration of Parking Lots and Environs.

Subject: This regulation sets forth rules concerning the use of CTB-controlled parking lots and their surrounding vicinity, including prohibited actions, and those allowed with a permit.

APA Exemption: None

VDOT seeks public comment to determine whether the regulation meets the following goals:

1. To protect the public's health, safety, and welfare with the least possible cost and intrusiveness to the citizens and businesses of the Commonwealth.

2. To ensure maximum utility of parking lots and environs to users.

3. Is the regulation written clearly and understandably?

Regulation Title: 24VAC30-490. Roads in the Grounds of State Institutions.

Subject: This regulation establishes the minimum design standards that roads within the grounds of state institutions must meet to be included in the primary system.

APA Exemption: § 2.2-4002 B 3 of the Code of Virginia

VDOT seeks public comment to determine whether the regulation meets the following goals:

1. To protect the public's health, safety, and welfare with the least possible intrusiveness to the citizens and businesses of the Commonwealth.

2. Is the regulation written clearly and understandably?

Regulation Title: 24VAC30-500. Roads in the Grounds of State Parks.

Subject: This regulation establishes the policy under which state secondary system routes located completely within state parks, government parks, reservations, and recreational areas may be closed or turned over for maintenance and construction to the various authorities in charge of such parks, areas, etc., if they so request.

APA Exemption: § 2.2-4002 B 3 of the Code of Virginia

VDOT seeks public comment to determine whether the regulation meets the following goals:

1. To protect the public's health, safety, and welfare with the least possible intrusiveness to the citizens and businesses of the Commonwealth.

2. Is the regulation written clearly and understandably?

Contact: David Roberts, Program Administration Specialist III, Virginia Department of Transportation, Policy Division, 1401 E. Broad St., Richmond, VA 23219, telephone [phone], FAX [phone], or email [e-mail].

Comments may be submitted from June 21, 2010, to July 12, 2010, to the contact referenced above.

VIRGINIA CODE COMMISSION

Notice to State Agencies

Mailing Address: Virginia Code Commission, 910 Capitol Street, General Assembly Building, 2nd Floor, Richmond, VA 23219.

Cumulative Table of Virginia Administrative Code Sections Adopted, Amended, or Repealed

Beginning with Volume 26, Issue 1 of the Virginia Register of Regulations dated September 14, 2009, the Cumulative Table of Virginia Administrative Code Sections Adopted, Amended, or Repealed will no longer be published in the Virginia Register of Regulations. The cumulative table may be accessed on the Virginia Register Online webpage at http://register.dls.virginia.gov/cumultab.htm.

Filing Material for Publication in the Virginia Register of Regulations

Agencies are required to use the Regulation Information System (RIS) when filing regulations for publication in the Virginia Register of Regulations. The Office of the Virginia Register of Regulations implemented a web-based application called RIS for filing regulations and related items for publication in the Virginia Register. The Registrar's office has worked closely with the Department of Planning and Budget (DPB) to coordinate the system with the Virginia Regulatory Town Hall. RIS and Town Hall complement and enhance one another by sharing pertinent regulatory information.

The Office of the Virginia Register is working toward the eventual elimination of the requirement that agencies file print copies of regulatory packages. Until that time, agencies may file petitions for rulemaking, notices of intended regulatory actions and general notices in electronic form only; however, until further notice, agencies must continue to file print copies of proposed, final, fast-track and emergency regulatory packages