This report fulfills the mandate outlined in Item 288.QQQQQ.1 of the 2025 Appropriation Act, which directs Virginia’s Department of Medical Assistance Services (“DMAS") to establish performance standards for acute care hospitals that are receiving private acute care hospital enhanced payments.

These standards are designed to ensure that supplemental payments lead to measurable improvements in Medicaid service delivery, particularly in access to care and behavioral health coordination. The following are the three performance measures selected by DMAS:

• Network Adequacy Safeguard for Critical Service Transitions

• Acute Bed Registry Attestation

• Substance Use Disorder - Screening, Brief Intervention and Referral to Treatment (SBIRT) and Training

This report outlines the framework for monitoring hospital compliance, including a phased corrective action process, and provides a roadmap for implementation leading up to the January 2026 launch. Through this report, DMAS affirms its commitment to transparency, accountability, and improved outcomes for Medicaid members.

The three core objectives of the performance measures:

• Improve services for Medicaid members;

• Ensure access to care, particularly through network adequacy safeguards; and

• Enhance coordination of care for behavioral health patients, including continued participation in the acute psychiatric bed registry.

To guide the development of these measures, DMAS is required to consult with impacted stakeholders and implement a process for monitoring compliance and enforcing corrective actions. Private acute care hospitals that fail to meet the established benchmarks and do not complete the required corrective actions within the designated timeframe will risk losing eligibility for enhanced payments for the applicable period.