Virginia Department of Medical Assistance Services

This document details the Virginia Department of Medical Assistance Services' (DMAS) Value-Based Purchasing (VBP) program methodology for State Fiscal Year (SFY) 2026. It outlines updates to the program, which is designed to improve the quality of care furnished to Medicaid members. The methodology focuses on six performance measures related to staffing and the avoidance of negative care events, defining payment tiers for both attainment and improvement, and specifying payment timing and responsibilities for the program's implementation.

This Quality Strategy outlines the long-term direction for the Commonwealth of Virginia Department of Medical Assistance Services (DMAS) from 2026 to 2028. The plan is designed to improve the health and well-being of Virginians by enhancing member care experiences, promoting access to safe and gold-standard patient care, supporting efficient and value-driven care, strengthening the health of families and communities, and providing whole-person care for vulnerable populations. Key initiatives include behavioral health enhancement through the 'Right Help, Right Now' program, increasing access to healthcare, and an enhanced managed care delivery system. The strategy emphasizes continuous quality improvement, data-driven decision-making, and stakeholder collaboration to achieve its goals.

The Board of Medical Assistance Services held a meeting where they welcomed new member Dr. Jeffrey Rich. They nominated and approved Jason Brewster as Chair, Basim Khan as Co-Chair, and Brooke Barlow as Board Secretary. Director Roberts presented Medicaid program updates, including Dental (Cardinal Care Smiles), Behavioral Health (Governor's Right Help, Right Now), Department of Justice Settlement, Maternal and Child Health, and Program Integrity. Chief Deputy Jeff Lunardi provided an overview of DMAS Legislative Role, 2025 GA Statistics, and a recap of the 2025 Legislation and Budget Amendments. Truman Horwitz presented budget updates, noting spending is on track with the forecast. The board was also provided with updated Regulatory activity.

The Board of Medical Assistance Services meeting included the introduction of a new board member and the election of officers. Updates were presented on Medicaid programs, including Dental (Cardinal Care Smiles), Behavioral Health (Governor's Right Help, Right Now), Department of Justice Settlement, Maternal and Child Health, and Program Integrity. The board also received updates on the Virginia General Assembly, DMAS legislative role, 2025 GA Statistics, 2025 Legislation, Budget Amendments, and regulatory activity. Budget updates were also provided, indicating that spending is on track with the forecast.

This is a behavioral health enhancement stakeholder update session. It discusses proposed enhancements for medicaid behavioral health services, which have been placed on hold due to COVID-19. The update emphasizes the commitment to evidence-based solutions, supporting members and providers, and working closely with the Department of Behavioral Health and Developmental Services. It highlights the vision of building a full continuum of behavioral health care, focusing on prevention, early intervention, and trauma-informed care, while also ensuring cost-effectiveness.