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The Carroll News

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Tri-Area Community Health is Seeking Court Review of Virginia Medicaid Reimbursement Decision

Tri-Area Community Health (TACH), a Federally Qualified Health Center serving Carroll, Floyd, Franklin, Grayson, and Patrick counties and the City of Galax, has asked a Virginia circuit court to review a Final Agency Decision related to Medicaid reimbursement issued by the Virginia Department of Medical Assistance Services (DMAS). The dispute concerns how DMAS calculated Medicaid reimbursement owed to TACH after the health center expanded services and locations over several years. TACH’s position is straightforward: when a safety-net health center expands services for Medicaid patients, Medicaid reimbursement should be calculated fairly and in accordance with the laws and regulations governing Federally Qualified Health Centers, and that, at the end of each fiscal year, reconciliation should be conducted to ensure TACH receives adequate reimbursement from DMAS to cover the costs of TACH providing services to Medicaid patients. An independent Hearing Officer who presided over TACH’s formal administrative appeal agreed with TACH on the central reimbursement issues. After reviewing the evidence and testimony, the Hearing Officer recommended that TACH met its burden to show that DMAS’s reimbursement calculations were erroneous and recommended that DMAS pay TACH approximately $7.48 million in additional reimbursement to make up for over a decade of underpayment. DMAS Director