The West Virginia Department of Human Service's (DoHS) Office of Accountability and Management Reporting (OAMR) has supported the West Virginia Medicaid program with a number of Medicaid rate setting activities for the past several years, including certain fee-schedule reimbursed services as well as rate setting for home health agencies, hospice, and ambulatory surgical centers. In recent months, the DoHS and the Bureau for Medical Services (BMS) have been evaluating agency priorities and staffing, along with Medicaid rate setting processes and communications, to identify areas where enhancements could be made to Medicaid rate setting functions. Due to the complexity of many aspects of Medicaid rate setting, and in an effort to bring a national perspective and best practices to Medicaid rate setting, the DoHS has engaged the services of Myers and Stauffer to assume a number of Medicaid rate setting functions. These include the following areas that were previously the responsibility of OAMR:
- Ambulance transportation (ground and air)
- Ambulatory surgical centers
- Children with Disabilities Community Service Program limits
- Clinical laboratory
- Dental
- Durable medical equipment and medical supplies
- Home health agency
- Hospice
- Hospital graduate medical education payments
- Hospital reimbursement calculators
- Hospital Rates for non-diagnosis related group (DRG) hospitals (critical access, behavioral health, rehabilitation, long-term acute care)
- Intermediate care facilities for individuals with intellectual disabilities
- Physician administered drugs
- School Based Health Services and State-owned Nursing Facilities federal medical assistance percentage (FMAP)
- State owned Nursing Facility Rate Letters
- Telehealth Originating Site Fee
- Vaccines
- Vision
The OAMR will continue to support the BMS with audit services, including cost report audits for hospitals, nursing facilities, and psychiatric residential treatment facilities (PRTFs); disproportionate share hospital (DSH) payment calculations; school-based services; residential childcare facilities, among other tasks.
Myers and Stauffer is a certified public accounting (CPA) and consulting firm that currently supports the West Virginia DoHS in a variety of areas, including assisting with rate setting services for institutional and physician providers for more than 15 years. They have the expertise and resources to fold these additional rate setting activities into their existing team and workflows. The BMS and Myers and Stauffer have developed a transition plan and have worked with the OAMR to transition rate files, processes, and communications. Medicaid rate setting communications that were previously issued by the OAMR will be issued by the BMS.
The West Virginia DoHS and the BMS thank the OAMR team for their Medicaid rate setting assistance and support during the transition.