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The purpose of this bulletin is to notify providers that effective July 1, 2024, DMAS established new Ambulatory Surgical Center (ASC) Enhanced Ambulatory Patient Group (EAPG) weights and an updated base rate in accordance with 12VAC30-80-35. DMAS has implemented the EAPG version 3.18 grouper and will use the national weights developed by 3M. The updated statewide base rate is calculated to ensure budget neutrality of total ASC expenditures.

The ASC base rate and ASC EAPG weights effective July 1, 2024 may be found on the DMAS website at https://dmas.virginia.gov/for-providers/rates-and-rate-setting/ in the Ambulatory Surgical Centers section under the Institutional heading.

If you have any questions regarding ASC reimbursement, please contact the DMAS Helpline at 1-800-552-8627.

Appeals Information

If you believe an error was made for payment rates or totals, you can file an appeal. The appeal must be filed with the DMAS Appeals Division through one of the following methods:

• Through    the     Appeals    Information     Management     System at https://www.dmas.virginia.gov/appeals/. From there you can fill out an informal appeal request, submit documentation, and follow the process of your appeal.

• Through mail, email, or fax. You can download a Medicaid Provider Appeal Request form at https://www.dmas.virginia.gov/appeals/. You can use that form or a letter to file the informal appeal. The appeal request must identify the issues being appealed. The request can be submitted by:

Mail or delivery to: Appeals Division, Department of Medical Assistance Services, 600 E. Broad Street, Richmond, VA 23219;

Email to appeals@dmas.virginia.gov; or

Fax to (804) 452-5454.

The appeal must be received by the DMAS Appeals Division within 30 days of the payment rate or total being published by DMAS. The notice of appeal is considered filed when it is date stamped by the DMAS Appeals Division. The normal business hours of DMAS are from 8:00 a.m. through 5:00 p.m. on dates when DMAS is open for business. Documents received after 5:00 p.m. on the deadline date shall be untimely.