Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 100 - STATE PROGRAMS › Part II - State/Local Hospitalization Program › Section 12VAC30-100-70 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
The following words and terms, when used in this part,
					 shall have the following meaning unless the context clearly indicates
					 otherwise:
"Allocation process" means the process described in §
					 32.1-345B of the Code of Virginia, which is used annually to allocate funds
					 appropriated by the General Assembly for this program to counties and cities of
					 the Commonwealth.
"Board of Medical Assistance Services" or "BMAS" means that
					 board established by § 32.1-324 et seq. of the Code of Virginia.
"Bona fide resident" means an individual who has been
					 determined by the local department of social services to be residing in the
					 city or county where making application at the time of or immediately prior to
					 medical treatment with the intent of remaining permanently in that locality and
					 who did not establish residency for the purposes of obtaining benefits.
"Covered ambulatory surgical center services" means those
					 services which are provided by any distinct licensed and certified entity,
					 established by 42 CFR
					 416.2, that operates exclusively for the
					 purpose of providing surgical services to patients not requiring
					 hospitalization, which do not exceed in amount, duration, and scope those
					 available to recipients of medical assistance services as provided in the State
					 Plan for Medical Assistance established by Chapter 10 (§ 32.1-323 et seq.)
					 of Title 32.1 of the Code of Virginia; and which are rendered by providers who
					 have signed agreements to participate in the SLH program and who are enrolled
					 providers in the MAP.
"Covered inpatient services" means inpatient services that
					 do not exceed in amount, duration, and scope those available to recipients of
					 medical assistance services as provided in the State Plan for Medical
					 Assistance established by Chapter 10 (§ 32.1-323 et seq.) of Title 32.1 of
					 the Code of Virginia and that are rendered by providers who have signed
					 agreements to participate in the SLH program and who are enrolled providers in
					 the MAP.
"Covered local public health services" means services
					 provided by local health departments that do not exceed in amount, duration and
					 scope those available to recipients of medical assistance services as provided
					 in the State Plan for Medical Assistance established by Chapter 10 of Title
					 32.1 of the Code of Virginia and that are rendered by providers who have signed
					 agreements to participate in the SLH program and who are enrolled providers in
					 the MAP.
"Covered outpatient services" means outpatient services, as
					 performed in an outpatient hospital setting, that do not exceed in amount,
					 duration and scope those available to recipients of medical assistance services
					 as provided in the State Plan for Medical Assistance established by Chapter 10
					 of Title 32.1 of the Code of Virginia and that are rendered by providers who
					 have signed agreements to participate in the SLH program and who are enrolled
					 providers in the MAP.
"Claim" means a request for payment for services
					 rendered.
"Department" or "DMAS" means the Department of Medical
					 Assistance Services established by § 32.1-323 of the Code of
					 Virginia.
"Director" means the Director of the Department of Medical
					 Assistance Services established by § 32.1-323 of the Code of
					 Virginia.
"DRG" means diagnostic related group of codes to define the
					 severity or intensity of illness.
"Enrolled provider" or "providers" means inpatient or
					 outpatient hospitals, free-standing ambulatory surgical centers and local
					 public health departments which have signed agreements to participate in the
					 SLH program and are enrolled providers in the MAP.
"Indigent person" means a person who is a bona fide
					 resident of the county or city, whether gainfully employed or not and who,
					 either by himself or by those upon whom he is dependent, is unable to pay for
					 required hospitalization or treatment. Residence shall not be established for
					 the purpose of obtaining the benefits of this program. Aliens illegally living
					 in the United States and migrant workers shall not be considered bona fide
					 residents of the county or city for purposes of the SLH program.
"Locality" means any city or county which is required by
					 law to participate in the SLH program.
"MAP" or "Medicaid" means the Medical Assistance Program as
					 administered by the Department of Medical Assistance Services.
"Medical emergency" means that a delay in obtaining
					 treatment may cause death or serious impairment of the health of the patient.
					 See 42 CFR
					 440.170(e).
"Net countable income" means the value of income using the
					 current budget methodology of the Virginia Aid to Families with Dependent
					 Children Program.
"Net countable resources" means the countable value of an
					 applicant's resources using the current budget methodology of the Virginia Aid
					 to Families with Dependent Children Program.
"Payable claim" means a claim for a covered service
					 rendered to an eligible individual with a date of service in the current SLH
					 payment year provided that the claim is submitted for payment before the last
					 payment processing cycle in June and provided there are funds available in the
					 allocation for the locality of residence of the eligible individual.
"SLH payment year" means a year beginning May 1 of any year
					 and ending April 30 of the following year.
"SLH program" means the State/Local Hospitalization
					 Program.
"State Plan" means the State Plan for Medical Assistance
					 for the Commonwealth.
Statutory Authority
§ 32.1-325 of the Code of Virginia.