{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2026\/code-json\/32.1-331.02.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2026\/code-text\/32.1-331.02.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2026\/code-xml\/32.1-331.02.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2026\/code-html\/32.1-331.02.html"}],"law_id":359532,"edition_id":2,"section_id":359532,"structure_id":51418,"section_number":"32.1-331.02","catch_line":"Health Care Provider Payment Rate Assessment Fund","history":"2018, Sp. Sess. I, c. 2.","full_text":"A\n\nAs used in this section:\n\t\t\t“Covered hospital” means any in-state private acute care hospital other than a hospital classified as a public hospital, freestanding psychiatric and rehabilitation hospital, children’s hospital, long stay hospital, long-term care hospital, or critical access hospital.\n\n\t\t\t“Managed care organization hospital payment gap” means the difference between the amount included in rates for inpatient and outpatient services provided by covered hospitals, based on historical paid claims, and the amount that would be included when hospital services are priced according to the existing State Plan methodology but using 100 percent of the adjustment factors, including the capital reimbursement percentage, and full inflation subject to approval by the Centers for Medicare and Medicaid Services pursuant to 42 C.F.R. § 438.6(c).\n\n\t\t\t“State Plan” means the state plan for medical assistance under Title XIX (42 U.S.C. § 1396 et seq.) of the Social Security Act.\n\n\t\t\t“Upper payment limit” means the amount equal to the maximum amount of payment for inpatient services for recipients of medical assistance services established in accordance with 42 C.F.R § 447.272 and outpatient services for recipients of medical assistance services pursuant to 42 CFR § 447.321.\n\nB\n\nThere is hereby created in the state treasury a special nonreverting fund to be known as the Health Care Payment Rate Assessment Fund, referred to in this section as “the Fund.” The Fund shall be established on the books of the Comptroller. All revenues collected or received as a result of imposition of a health care payment rate assessment on covered hospitals and any other such moneys, public or private, received for the administration of the health care payment assessment shall be paid into the state treasury and credited to the Fund. Interest earned on moneys in the Fund shall remain in the Fund and be credited to it. Any moneys remaining in the Fund, including interest thereon, at the end of each fiscal year shall not revert to the general fund but shall remain in the Fund. Moneys deposited to the Fund shall be used solely for the nonfederal share of the cost of payment rate actions associated with the payment rate assessment as provided in the general appropriation act and the administrative costs of collecting the assessment and of implementing and operating the associated payment rate actions. Such moneys shall be appropriated as provided in the general appropriation act. Expenditures and disbursements from the Fund shall be made by the State Treasurer on warrants issued by the Comptroller upon written request signed by the Director of the Department of Medical Assistance Services.\n\n","order_by":null,"text":{"0":{"id":1337657,"text":"As used in this section:\n\t\t\t“Covered hospital” means any in-state private acute care hospital other than a hospital classified as a public hospital, freestanding psychiatric and rehabilitation hospital, children’s hospital, long stay hospital, long-term care hospital, or critical access hospital.\t\t\t“Managed care organization hospital payment gap” means the difference between the amount included in rates for inpatient and outpatient services provided by covered hospitals, based on historical paid claims, and the amount that would be included when hospital services are priced according to the existing State Plan methodology but using 100 percent of the adjustment factors, including the capital reimbursement percentage, and full inflation subject to approval by the Centers for Medicare and Medicaid Services pursuant to 42 C.F.R. § 438.6(c).\t\t\t“State Plan” means the state plan for medical assistance under Title XIX (42 U.S.C. § 1396 et seq.) of the Social Security Act.\t\t\t“Upper payment limit” means the amount equal to the maximum amount of payment for inpatient services for recipients of medical assistance services established in accordance with 42 C.F.R § 447.272 and outpatient services for recipients of medical assistance services pursuant to 42 CFR § 447.321.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":1337658,"text":"There is hereby created in the state treasury a special nonreverting fund to be known as the Health Care Payment Rate Assessment Fund, referred to in this section as “the Fund.” The Fund shall be established on the books of the Comptroller. All revenues collected or received as a result of imposition of a health care payment rate assessment on covered hospitals and any other such moneys, public or private, received for the administration of the health care payment assessment shall be paid into the state treasury and credited to the Fund. Interest earned on moneys in the Fund shall remain in the Fund and be credited to it. Any moneys remaining in the Fund, including interest thereon, at the end of each fiscal year shall not revert to the general fund but shall remain in the Fund. Moneys deposited to the Fund shall be used solely for the nonfederal share of the cost of payment rate actions associated with the payment rate assessment as provided in the general appropriation act and the administrative costs of collecting the assessment and of implementing and operating the associated payment rate actions. Such moneys shall be appropriated as provided in the general appropriation act. Expenditures and disbursements from the Fund shall be made by the State Treasurer on warrants issued by the Comptroller upon written request signed by the Director of the Department of Medical Assistance Services.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A"}},"ancestry":[{"id":51418,"edition_id":2,"name":"General Provisions","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":51417,"metadata":{"child_laws":43,"child_structures":0},"date_created":"2026-08-02 02:42:13","date_modified":"2026-08-02 12:32:26","permalink":{"id":1428357,"object_type":"structure","relational_id":51418,"identifier":"1","token":"32.1\/10\/1","url":"\/32.1\/10\/1\/","edition_id":2,"permalink":0,"preferred":1}},{"id":51417,"edition_id":2,"name":"Department of Medical Assistance Services","identifier":"10","label":"chapter","depth":2,"order_by":14,"parent_id":51343,"metadata":{"child_laws":51,"child_structures":4},"date_created":"2026-08-02 02:42:13","date_modified":"2026-08-02 12:32:26","permalink":{"id":1428355,"object_type":"structure","relational_id":51417,"identifier":"10","token":"32.1\/10","url":"\/32.1\/10\/","edition_id":2,"permalink":0,"preferred":1}},{"id":51343,"edition_id":2,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":75,"parent_id":null,"metadata":{"child_laws":857,"child_structures":128},"date_created":"2026-08-02 02:40:53","date_modified":"2026-08-02 12:32:12","permalink":{"id":1428101,"object_type":"structure","relational_id":51343,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":2,"permalink":0,"preferred":1}}],"structure_contents":[{"id":359498,"structure_id":51418,"section_number":"32.1-323","catch_line":"Department of Medical Assistance Services","url":"\/32.1-323\/","token":"32.1\/10\/1\/32.1-323","metadata":false},{"id":359494,"structure_id":51418,"section_number":"32.1-323.1","catch_line":"Department to submit forecast of expenditures","url":"\/32.1-323.1\/","token":"32.1\/10\/1\/32.1-323.1","metadata":false},{"id":359495,"structure_id":51418,"section_number":"32.1-323.2","catch_line":"Elimination of waiting lists for certain waivers","url":"\/32.1-323.2\/","token":"32.1\/10\/1\/32.1-323.2","metadata":false},{"id":359496,"structure_id":51418,"section_number":"32.1-323.3","catch_line":"Dependents of foreign service members; waiting lists for certain waivers","url":"\/32.1-323.3\/","token":"32.1\/10\/1\/32.1-323.3","metadata":false},{"id":359497,"structure_id":51418,"section_number":"32.1-323.4","catch_line":"Department to facilitate transition of persons between certain waiver programs","url":"\/32.1-323.4\/","token":"32.1\/10\/1\/32.1-323.4","metadata":false},{"id":359502,"structure_id":51418,"section_number":"32.1-324","catch_line":"Board of Medical Assistance Services","url":"\/32.1-324\/","token":"32.1\/10\/1\/32.1-324","metadata":false},{"id":359499,"structure_id":51418,"section_number":"32.1-324.1","catch_line":"Authority to administer oaths, conduct hearings; obtaining relevant documents and other information","url":"\/32.1-324.1\/","token":"32.1\/10\/1\/32.1-324.1","metadata":false},{"id":359500,"structure_id":51418,"section_number":"32.1-324.2","catch_line":"Director to facilitate communication","url":"\/32.1-324.2\/","token":"32.1\/10\/1\/32.1-324.2","metadata":false},{"id":359501,"structure_id":51418,"section_number":"32.1-324.3","catch_line":"Uninsured Medical Catastrophe Fund established","url":"\/32.1-324.3\/","token":"32.1\/10\/1\/32.1-324.3","metadata":false},{"id":359514,"structure_id":51418,"section_number":"32.1-325","catch_line":"Board to submit plan for medical assistance services to U.S. Secretary of Health and Human Services pursuant to federal law; administration of plan; contracts with health care providers","url":"\/32.1-325\/","token":"32.1\/10\/1\/32.1-325","metadata":false},{"id":359503,"structure_id":51418,"section_number":"32.1-325.001","catch_line":"Repealed","url":"\/32.1-325.001\/","token":"32.1\/10\/1\/32.1-325.001","metadata":false},{"id":359504,"structure_id":51418,"section_number":"32.1-325.01","catch_line":"Certain term life insurance considered resources","url":"\/32.1-325.01\/","token":"32.1\/10\/1\/32.1-325.01","metadata":false},{"id":359505,"structure_id":51418,"section_number":"32.1-325.02","catch_line":"Determinations of assets; disclaimers of interests to be considered uncompensated transfers of assets for Medicaid eligibility purposes under certain circumstances","url":"\/32.1-325.02\/","token":"32.1\/10\/1\/32.1-325.02","metadata":{"court_decisions":{"0":{"name":"Commonwealth v. Puckett","case_number":"1220596","citation":null,"date":"2023-11-22","url":"https:\/\/www.courtlistener.com\/opinion\/9443890\/commonwealth-v-puckett\/","abstract":" .\u202f.\u202f. PRESENT: Goodwyn, C.J., Powell, Kelsey, McCullough, Chafin, and Mann, JJ., and Millette, .\u202f.\u202f. ","court_html":"SCV<\/abbr>"},"1":{"name":"Toulson v. Ampro Fisheries, Inc.","case_number":"Civ. No. 3:94CV433","citation":"872 F. Supp. 271","date":"1995-01-10","url":"https:\/\/www.courtlistener.com\/opinion\/8728394\/toulson-v-ampro-fisheries-inc\/","abstract":" .\u202f.\u202f. MEMORANDUM .\u202f.\u202f. ","court_html":"District Court, E.D. Virginia"},"2":{"name":"Children's Hospital of the King's Daughters, Inc. v. Price","case_number":"ACTION NO. 2:17cv139","citation":"258 F. Supp. 3d 672","date":"2017-06-20","url":"https:\/\/www.courtlistener.com\/opinion\/7326023\/childrens-hospital-of-the-kings-daughters-inc-v-price\/","abstract":" .\u202f.\u202f. OPINION AND ORDER .\u202f.\u202f. ","court_html":"District Court, E.D. Virginia"}}}},{"id":359506,"structure_id":51418,"section_number":"32.1-325.03","catch_line":"Legal presence required for certain state and local public benefits; exceptions; definitions; proof of legal presence","url":"\/32.1-325.03\/","token":"32.1\/10\/1\/32.1-325.03","metadata":false},{"id":359507,"structure_id":51418,"section_number":"32.1-325.04","catch_line":"Eligibility for medical assistance; individuals confined in state correctional facilities","url":"\/32.1-325.04\/","token":"32.1\/10\/1\/32.1-325.04","metadata":false},{"id":359508,"structure_id":51418,"section_number":"32.1-325.1","catch_line":"Appeals of agency determinations","url":"\/32.1-325.1\/","token":"32.1\/10\/1\/32.1-325.1","metadata":false},{"id":359509,"structure_id":51418,"section_number":"32.1-325.1:1","catch_line":"Definitions; recovery of overpayment for medical assistance services","url":"\/32.1-325.1_1\/","token":"32.1\/10\/1\/32.1-325.1_1","metadata":false},{"id":359510,"structure_id":51418,"section_number":"32.1-325.2","catch_line":"Department is payor of last resort","url":"\/32.1-325.2\/","token":"32.1\/10\/1\/32.1-325.2","metadata":false},{"id":359511,"structure_id":51418,"section_number":"32.1-325.3","catch_line":"Disclosure or use of information for purpose not connected with medical assistance program; Department not subject to certain disclosure","url":"\/32.1-325.3\/","token":"32.1\/10\/1\/32.1-325.3","metadata":{"court_decisions":""}},{"id":359512,"structure_id":51418,"section_number":"32.1-325.4","catch_line":"Penalty for violation","url":"\/32.1-325.4\/","token":"32.1\/10\/1\/32.1-325.4","metadata":{"court_decisions":""}},{"id":359513,"structure_id":51418,"section_number":"32.1-325.5","catch_line":"State pharmacy benefits manager","url":"\/32.1-325.5\/","token":"32.1\/10\/1\/32.1-325.5","metadata":false},{"id":359518,"structure_id":51418,"section_number":"32.1-326","catch_line":"Director may make payments to or for eligible persons in state-owned medical facilities","url":"\/32.1-326\/","token":"32.1\/10\/1\/32.1-326","metadata":false},{"id":359515,"structure_id":51418,"section_number":"32.1-326.1","catch_line":"Department to operate program of estate recovery","url":"\/32.1-326.1\/","token":"32.1\/10\/1\/32.1-326.1","metadata":{"court_decisions":""}},{"id":359516,"structure_id":51418,"section_number":"32.1-326.2","catch_line":"Pilot school\/community health centers","url":"\/32.1-326.2\/","token":"32.1\/10\/1\/32.1-326.2","metadata":false},{"id":359517,"structure_id":51418,"section_number":"32.1-326.3","catch_line":"Special education health services; memorandum of agreement between the Department of Education and the Department of Medical Assistance Services","url":"\/32.1-326.3\/","token":"32.1\/10\/1\/32.1-326.3","metadata":false},{"id":359519,"structure_id":51418,"section_number":"32.1-327","catch_line":"Claim against indigent's estate for payments made","url":"\/32.1-327\/","token":"32.1\/10\/1\/32.1-327","metadata":{"court_decisions":""}},{"id":359520,"structure_id":51418,"section_number":"32.1-328","catch_line":"Repealed","url":"\/32.1-328\/","token":"32.1\/10\/1\/32.1-328","metadata":false},{"id":359521,"structure_id":51418,"section_number":"32.1-329","catch_line":"Repealed","url":"\/32.1-329\/","token":"32.1\/10\/1\/32.1-329","metadata":false},{"id":359530,"structure_id":51418,"section_number":"32.1-330","catch_line":"Long-term services and supports screening required","url":"\/32.1-330\/","token":"32.1\/10\/1\/32.1-330","metadata":false},{"id":359523,"structure_id":51418,"section_number":"32.1-330.01","catch_line":"Reports related to long-term services and supports","url":"\/32.1-330.01\/","token":"32.1\/10\/1\/32.1-330.01","metadata":{"court_decisions":""}},{"id":359524,"structure_id":51418,"section_number":"32.1-330.02","catch_line":"Average hourly payment rates; 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A.<\/span> As used in this section:\n\t\t\t“Covered hospital<\/span>” means any in-state private acute care hospital other than a hospital classified as a public hospital, freestanding psychiatric and rehabilitation hospital, children’s hospital, long stay<\/span> hospital, long-term care hospital, or critical access hospital.

\t\t\t“Managed care organization hospital payment gap<\/span>” means the difference between the amount included in rates for inpatient and outpatient services provided by covered hospitals<\/span>, based on historical paid claims, and the amount that would be included when hospital services are priced according to the existing State Plan<\/span> methodology but using 100 percent of the adjustment factors, including the capital reimbursement percentage, and full inflation subject to approval by the Centers for Medicare and Medicaid Services pursuant to 42 C.F.R. § 438.6(c).

\t\t\t“State Plan<\/span>” means the state plan<\/span> for medical assistance under Title XIX (42 U.S.C. § 1396 et seq.) of the Social Security Act.

\t\t\t“Upper payment limit<\/span>” means the amount equal to the maximum amount of payment for inpatient services for recipients of medical assistance services established in accordance with 42 C.F.R § 447.272 and outpatient services for recipients of medical assistance services pursuant to 42 CFR § 447.321. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> There is hereby created in the state treasury a special nonreverting fund to be known as the Health Care Payment Rate Assessment Fund, referred to in this section as “the Fund.” The Fund shall be established on the books of the Comptroller. All revenues collected or received as a result of imposition of a health care payment rate assessment on covered hospitals<\/span> and any other such moneys, public or private, received for the administration of the health care payment assessment shall be paid into the state treasury and credited to the Fund. Interest earned on moneys in the Fund shall remain in the Fund and be credited to it. Any moneys remaining in the Fund, including interest thereon, at the end of each fiscal year shall not revert to the general fund but shall remain in the Fund. Moneys deposited to the Fund shall be used solely for the nonfederal share of the cost of payment rate actions associated with the payment rate assessment as provided in the general appropriation act and the administrative costs of collecting the assessment and of implementing and operating the associated payment rate actions. Such moneys shall be appropriated as provided in the general appropriation act. Expenditures and disbursements from the Fund shall be made by the State Treasurer on warrants issued by the Comptroller upon written request signed by the Director of the Department<\/span> of Medical Assistance Services. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nHEALTH CARE PROVIDER PAYMENT RATE ASSESSMENT FUND (\u00a7 32.1-331.02)\n\nA. As used in this section:\n\t\t\t“Covered hospital” means any in-state private acute care hospital\nother than a hospital classified as a public hospital, freestanding psychiatric\nand rehabilitation hospital, children’s hospital, long stay hospital,\nlong-term care hospital, or critical access hospital.\t\t\t“Managed care\norganization hospital payment gap” means the difference between the amount\nincluded in rates for inpatient and outpatient services provided by covered\nhospitals, based on historical paid claims, and the amount that would be\nincluded when hospital services are priced according to the existing State Plan\nmethodology but using 100 percent of the adjustment factors, including the\ncapital reimbursement percentage, and full inflation subject to approval by the\nCenters for Medicare and Medicaid Services pursuant to 42 C.F.R. §\n438.6(c).\t\t\t“State Plan” means the state plan for medical assistance\nunder Title XIX (42 U.S.C. § 1396 et seq.) of the Social Security\nAct.\t\t\t“Upper payment limit” means the amount equal to the maximum\namount of payment for inpatient services for recipients of medical assistance\nservices established in accordance with 42 C.F.R § 447.272 and outpatient\nservices for recipients of medical assistance services pursuant to 42 CFR §\n447.321.\n\nB. There is hereby created in the state treasury a special nonreverting fund to\nbe known as the Health Care Payment Rate Assessment Fund, referred to in this\nsection as “the Fund.” The Fund shall be established on the books of\nthe Comptroller. All revenues collected or received as a result of imposition of\na health care payment rate assessment on covered hospitals and any other such\nmoneys, public or private, received for the administration of the health care\npayment assessment shall be paid into the state treasury and credited to the\nFund. Interest earned on moneys in the Fund shall remain in the Fund and be\ncredited to it. Any moneys remaining in the Fund, including interest thereon, at\nthe end of each fiscal year shall not revert to the general fund but shall\nremain in the Fund. Moneys deposited to the Fund shall be used solely for the\nnonfederal share of the cost of payment rate actions associated with the payment\nrate assessment as provided in the general appropriation act and the\nadministrative costs of collecting the assessment and of implementing and\noperating the associated payment rate actions. Such moneys shall be appropriated\nas provided in the general appropriation act. Expenditures and disbursements\nfrom the Fund shall be made by the State Treasurer on warrants issued by the\nComptroller upon written request signed by the Director of the Department of\nMedical Assistance Services.\n\nHISTORY: 2018, Sp. Sess. I, c. 2.","edition":{"id":2,"name":"2026","slug":"2026","date_created":"2026-07-16 18:40:23","date_modified":"2026-08-02 15:14:36","current":1,"order_by":2,"last_import":"2026-08-02 12:37:30"}}