State Plan Amendment (SPA) 25-0001 and 25-0002, Regarding Services for Eligible Juveniles as Required by Section 5121 of the Consolidated Appropriations Act of 2023 (CAA, 2023) Public Notice!

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WEST VIRGINIA MEDICAID PROGRAM

STATE PLAN AMENDMENTS 25-0001 and 25-0002

REGARDING

SERVICES FOR ELIGIBLE JUVENILES AS REQUIRED BY SECTION 5121 OF THE CONSOLIDATED APPROPRIATIONS ACT OF 2023 (CAA, 2023)

Pursuant to 42 U.S.C. §1396a(a)(13)(1997) and 42 C.F.R. §447.205, the West Virginia Department of Human Services (“Department"), Bureau for Medical Services (“BMS") provides notice of the filing of two SPAs, identified as SPA 25-0001 to attest to providing screening and diagnostic services and SPA 25-0002 to include Targeted Case Management (TCM) for eligible juveniles as part of the West Virginia Medicaid program.

These SPAs, if approved by the Centers for Medicare & Medicaid Services (CMS), will provide coverage for screening and diagnostic services and TCM for eligible juveniles, as required by the CAA, 2023, which includes pre- and post-release TCM for eligible juveniles who are incarcerated.

West Virginia has been planning for the implementation of screening and diagnostic services and TCM for eligible juveniles and expects to submit SPAs by March 31, 2025, as required per federal legislation and guidance. The screening and diagnostic services SPA will not include any reimbursement rate changes as the SPA will only attest to services already covered and reimbursed under the West Virginia Medicaid program. The TCM SPA will propose reimbursement rates for TCM for eligible juveniles to be the same as the rates currently paid for TCM for other target populations. As BMS' implementation of the mandatory Section 5121 services for eligible juveniles is not expected until July 1, 2026, no fiscal impact is expected for Calendar Year 2025.

In November 2024, CMS published unofficial SPA pre-prints for public comment related to the Paperwork Reduction Act; however, the official pre-prints have not yet been formally distributed by CMS to State Medicaid Agencies. The BMS will continue to monitor federal legislative and regulatory updates for further guidance from CMS on 5121 requirements and related resources.

For purposes of this notice, BMS will make the screening and diagnostic services attestation pre-print and TCM SPA pre-print available for public inspection between December 26, 2024, and January 09, 2025. Written comments may be sent between the above referenced dates to the West Virginia Department of Human Services, Bureau for Medical Services, 350 Capitol Street, Suite 251, Charleston, WV 25301-3706, or by email at SPAComments@wv.gov.

Any written comments received will be available for review at the above address during normal business hours, 8:30 a.m. to 4:30 p.m.

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