reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-540 - Inspection of care in intermediate care facilities for persons with intellectual and developmental disabilities, facilities providing inpatient psychiatric services for individuals younger than 21 years of age, and mental hospitals

Current through Register Vol. 40, No. 24, July 15, 2024
All applicable requirements of 42 CFR 456, Subpart I are
					 met with respect to periodic inspections of care and services.
Inspection of care in intermediate care facilities for
					 persons with intellectual and developmental disabilities is completed through
					 contractual arrangements with the Virginia Department of
					 Health.
Statutory Authority: §
												32.1-325
						of the Code of Virginia,
						42 USC §
													1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-550 - Relations with state health and vocational rehabilitation agencies and Title V grantees

Current through Register Vol. 40, No. 24, July 15, 2024
The Medicaid agency has cooperative arrangements with
					 State health and vocational rehabilitation agencies and with Title V grantees,
					 that meet the requirements of
					 42 CFR
					 431.615.
12VAC30-20-120 describes the
					 cooperative arrangements with the health and vocational rehabilitation
					 agencies.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-560 - Liens and recoveries

Current through Register Vol. 40, No. 24, July 15, 2024
Liens are not imposed against an individual's
					 property.
A. Adjustments or recoveries
				  for Medicaid claims correctly paid are as follows: See
				  12VAC30-20-141.
1. For permanently institutionalized
				  individuals, adjustments or recoveries are made from the individual's
				  estate.
2. For any individual who
				  received medical assistance at age 55 or older, recovery of payments are made
				  for nursing facility services, home- and community-based services, and related
				  hospital and prescription drug services.
Payments are recovered for all services covered under the
					 plan which are provided to individuals at age 55.
3. If an individual covered under a qualified
				  long-term care partnership insurance policy pursuant to § 32.1-325 of the
				  Code of Virginia received benefits for which assets or resources were
				  disregarded as provided for in
				  12VAC30-40-290 G, the Commonwealth
				  does not seek adjustment or recovery from the individual's estate for the
				  amount of assets or resources disregarded.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-580 - Payment for services

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Medicaid agency meets the requirements of 42 CFR 447, Subpart C, and §
				  1902(a)(13) and 1923 of the Act with respect to payment for inpatient hospital
				  services.
Chapter 70,
					 12VAC30-70-10 et seq., describes
					 the methods and standards used to determine rates for payment for inpatient
					 hospital services.
Inappropriate level of care days are not covered.
B. In addition to the services
				  specified in paragraphs A, D, K, L and M, the Medicaid agency meets the
				  following requirements:
1. Section
				  1902(a)(13)(E) of the Act regarding payment for services furnished by federally
				  qualified health centers (FQHCs) under § 1905(a)(2)(C) of the Act. The
				  agency meets the requirements of § 6303 of the State Medicaid Manual
				  (HFCA-Pub. 45-6) regarding payment for FQHC services. Chapter 80,
				  12VAC30-80-10 et seq., describes
				  the method of payment and how the agency determines the reasonable costs of the
				  services (for example, cost reports, cost or budget reviews, or sample
				  surveys).
2. Sections
				  1902(a)(13)(E) and 1926 of the Act, and 42 CFR 447, Subpart D, with respect to
				  payment for all other types of ambulatory services provided by rural health
				  clinics under the plan.
Chapter 80,
					 12VAC30-80-10 et seq., describes
					 the methods and standards used for the payment of each of these services except
					 for inpatient hospital, nursing facility services and services in intermediate
					 care facilities for the mentally retarded that are described in other
					 attachments.
12VAC30-80-170 describes the
					 general methods and standards used for establishing payment for Medicare Part A
					 and B deductible/coinsurance.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-590 - Direct payments to certain recipients for physicians' or dentists' services

Current through Register Vol. 40, No. 24, July 15, 2024
No direct payments are made to
					 recipients.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-600 - Prohibition against reassignment of provider claims

Current through Register Vol. 40, No. 24, July 15, 2024
Payment for Medicaid services furnished by any provider
					 under this plan is made only in accordance with the requirements of
					 42 CFR
					 447.10.
In the case of services furnished (during periods that do
					 not exceed 14 continuous days in the case of an informal reciprocal arrangement
					 or 90 continuous days (or such longer period as the Secretary may provide) in
					 the case of an arrangement involving per diem, or other fee-for-time
					 compensation) by or incident to the services of one physician to the patient of
					 another physician who submits the claim for such services, payment shall be
					 made to the physician submitting the claim (as if the services were furnished
					 by, or incident to, the physician's services), but only if the claim identifies
					 (in a manner specified by the Secretary) the physician who furnished the
					 services.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-610 - Third party liability

Current through Register Vol. 40, No. 24, July 15, 2024
A. The
				  Medicaid agency meets all requirements of:
1.
											42 CFR
				  433.138 and
				  433.139
2.
											42 CFR
				  433.145 through
				  433.148
3.
											42 CFR
				  433.151 through
				  433.154
4. Sections 1902(a)(25)(H) and (I) of the
				  Act.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-620 - Use of contracts

Current through Register Vol. 40, No. 24, July 15, 2024
The Medicaid agency has contracts of the type(s) listed in
					 42 CFR 434. All contracts meet the requirements of 42 CFR
					 434.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-631 - Standards for payment for nursing facility and intermediate care facility for the mentally retarded services

Current through Register Vol. 40, No. 24, July 15, 2024
With respect to nursing facilities and intermediate care
					 facilities for the mentally retarded, all applicable requirements of 42 CFR
					 Part 442, Subparts B and C are met.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-640 - Program for licensing administrators of nursing homes

Current through Register Vol. 40, No. 24, July 15, 2024
The state has a program that, except with respect to
					 religious nonmedical health care institutions, meets the requirements of 42 CFR
					 Part 431, Subpart N, for the licensing of nursing home
					 administrators.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-650 - Drug Utilization Review Program

Current through Register Vol. 40, No. 24, July 15, 2024
A.
1. The
				  Medicaid agency meets the requirements of § 1927(g) of the Social Security
				  Act for a drug use review (DUR) program for outpatient drug claims.
2. The DUR program assures that prescriptions
				  for outpatient drugs are:
a.
				  Appropriate.
b. Medically
				  necessary.
c. Are not likely to
				  result in adverse medical results.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-660 - Disclosure of survey information and provider or contractor evaluation

Current through Register Vol. 40, No. 24, July 15, 2024
The Medicaid agency has established procedures for
					 disclosing pertinent findings obtained from surveys and provider and contractor
					 evaluations that meet all the requirements in
					 42 CFR
					 431.115.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-670 - Appeals process

Current through Register Vol. 40, No. 24, July 15, 2024
A. The
				  Medicaid agency has established appeals procedures for NFs as specified in
				  42 CFR
				  431.153 and
				  431.154.
B. The state provides an appeals system that
				  meets the requirements of Subpart E of 42 CFR Part 431 ,
				  42 CFR
				  483.15, Subpart E of 42 CFR Part 483 , and
				  12VAC30-110-10 through
				  12VAC30-110-370 for residents who
				  wish to appeal a notice of intent to transfer or discharge from a NF and for
				  individuals adversely affected by the preadmission screening or annual resident
				  review requirements of Subpart C of 42 CFR Part 483.
Statutory Authority: §
												32.1-325 of the Code of
						Virginia; 42 USC §
													1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-680 - Conflict of interest provisions

Current through Register Vol. 40, No. 24, July 15, 2024
The Medicaid agency meets the requirements of §
					 1902(a)(4)(C) of the Act concerning the prohibition against acts, with respect
					 to any activity under the plan, that are prohibited by § 207 or § 208
					 of Title 18, United States Code.
The Medicaid agency meets the requirements of §
					 1902(a)(4)(D) of the act concerning the safeguards against conflicts of
					 interest that are at least as stringent as the safeguards that apply under
					 § 27 of the Office of Federal Procurement Policy Act ( 41 USC § 423
					 ).
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-690 - Exclusion of providers and suspension of practitioners and other individuals

Current through Register Vol. 40, No. 24, July 15, 2024
A. All of
				  the requirements of 42 CFR 1002, Subpart B are met.
In addition to meeting all federal requirements, the
					 agency, under the authority of state law, imposes broader sanctions.
B. The Medicaid agency meets the
				  requirements of:
1.
											§ 1902(p) of the Act
				  by excluding from participation:
a. At the
				  state's discretion, any individual or entity for any reason for which the
				  Secretary could exclude the individual or entity from participation in a
				  program under Title XVIII in accordance with § 1128, 1128A, or
				  1866(b)(2).
b. Any HMO (as defined
				  in § 1903(m) of the Act) or an entity furnishing services under a waiver
				  approved under § 1915(b)(1) of the Act, that:
(1) Could be excluded under § 1128(b)(8)
				  relating to owners and managing employees who have been convicted of certain
				  crimes or received other sanctions; or
(2) Has, directly or indirectly, a
				  substantial contractual relationship (as defined by the Secretary) with an
				  individual or entity that is described in § 1128(b)(8)(B) of the
				  Act.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-700 - Disclosure of information by providers and fiscal agents

Current through Register Vol. 40, No. 24, July 15, 2024
The Medicaid agency has established procedures for the
					 disclosure of information by providers and fiscal agents as specified in
					 42 CFR
					 455.104 through
					 455.106 and sections 1128(b)(9)
					 and 1902(a)(38) of the Act.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-710 - Income and eligibility verification system

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Medicaid agency has established a
				  system for income and eligibility verification in accordance with the
				  requirements of 42 CFR
				  435.940 through
				  435.960.
B.
										12VAC30-20-220 describes, in
				  accordance with 42 CFR 435.958(a)(6), the information that will be requested in
				  order to verify eligibility or the correct payment amount and the agencies and
				  the state or states from which that information will be requested.
C. The Commonwealth has an eligibility
				  determination system that provides for data matching through the Public
				  Assistance Reporting Information System (PARIS), or any successor system,
				  including matching with medical assistance programs operated by other states.
				  The information that is requested will be exchanged with states and other
				  entities legally entitled to verify Title XIX applicants and individuals
				  eligible for covered Title XIX services consistent with applicable PARIS
				  agreements.
Statutory Authority
§ 32.1-325 of the Code of Virginia; 42 USC §
						1396 et seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-720 - Medicaid eligibility cards for homeless individuals

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Medicaid agency has a method for
				  making cards evidencing eligibility for medical assistance available to an
				  individual eligible under the State's approved plan who does not reside in a
				  permanent dwelling or does not have a fixed home or mailing address.
B.
										12VAC30-20-230 specifies the
				  method for issuance of Medicaid eligibility cards to homeless
				  individuals.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-730 - Systematic alien verification for entitlements

Current through Register Vol. 40, No. 24, July 15, 2024
The State Medicaid agency has established procedures for
					 the verification of alien status through the Immigration & Naturalization
					 Service (INS) designated system, Systematic Alien Verification for Entitlements
					 (SAVE), effective October 1, 1988.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-751 - Enforcement of compliance for nursing facilities

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Commonwealth shall comply with the
				  Medicaid Program requirements of Subpart E of 42 CFR Part 488.
B. Notification of enforcement remedies. When
				  taking an enforcement action against a nonstate operated nursing facility, the
				  state provides notification in accordance with
				  42 CFR
				  488.402(f).
1. The notice (except for civil money
				  penalties and state monitoring) specifies:
a.
				  The nature of noncompliance;
b.
				  Which remedy is imposed;
c. The
				  effective date of the remedy; and
d. The right to appeal the determination
				  leading to the remedy.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-760 - Pharmacy services rebate agreement terms

Current through Register Vol. 40, No. 24, July 15, 2024
The Commonwealth conforms to § 1927(b) (2) with
					 regard to the reporting of information on the total number of dosage units of
					 each covered outpatient drug dispensed under the plan during the quarter, and
					 in such a manner as specified by the Secretary of HHS and also shall promptly
					 transmit a copy of such report to the Secretary. The Commonwealth also conforms
					 to § 1927(b) (3) (D) with regard to assuring the confidentiality of the
					 disclosure of the identity of a manufacturer or wholesaler and prices charged
					 for drugs by such manufacturer or wholesaler.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-770 - Required coordination between the Medicaid and WIC Programs

Current through Register Vol. 40, No. 24, July 15, 2024
The Medicaid agency provides for the coordination between
					 the Medicaid program and the Special Supplemental Food Program for Women,
					 Infants, and Children (WIC) and provides timely notice and referral to WIC in
					 accordance with § 1902(a)(53) of the Act.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-790 - Preadmission screening and annual resident review in nursing facilities

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Medicaid
				  agency has in effect a written agreement with the State mental health and
				  mental retardation authorities that meet the requirements of
				  42 CFR
				  431.621(c).
B. The State operates a preadmission
				  screening and annual resident review program that meets the requirements of 42
				  CFR 483.100-138.
C. The State does
				  not claim as "medical assistance under the State Plan" the cost of services to
				  individuals who should receive preadmission screening or annual resident review
				  until such individuals are screened or reviewed.
D. With the exception of NF services
				  furnished to certain NF residents defined in
				  42 CFR
				  483.118(c)(1), the State
				  does not claim as "medical assistance under the State plan" the cost of NF
				  services to individuals who are found not to require NF services.
E.
										12VAC30-20-260 specifies the
				  State's definition of specialized services.
F. Except for residents identified in
				  42 CFR
				  483.118(c)(1), the State
				  mental health authority makes categorical determinations that individuals with
				  certain mental conditions or levels of severity of mental illness would
				  normally require specialized services of such an intensity that a specialized
				  services program could not be delivered by the State in most, if not all, NFs
				  and that a more appropriate placement should be utilized.
G. The State describes an categorical
				  determinations it applies in
				  12VAC30-20-270.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-810 - Resident assessment for nursing facilities

Current through Register Vol. 40, No. 24, July 15, 2024
A. The state specifies the instrument to be
				  used by nursing facilities for conducting a comprehensive, accurate,
				  standardized, reproducible assessment of each resident's functional capacity as
				  required in § 1919(b)(3)(A) of the Act.
B. The state is using the resident assessment
				  instrument designated by CMS (Appendix R "Resident Assessment Instrument for
				  Long-Term Care Facilities" of the CMS State Operations Manual).
Statutory Authority: §
												32.1-325 of the Code of
						Virginia; 42 USC §
													1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Section 12VAC30-10-815 - Cooperation with Medicaid Integrity Program efforts

Current through Register Vol. 40, No. 24, July 15, 2024
The Medicaid agency assures it complies with such
					 requirements determined by the Secretary to be necessary for carrying out the
					 Medicaid Integrity Program established under § 1936 of the
					 Act.
Statutory Authority
§§ 32.1-324 and 32.1-325 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part IV - General Program Administration › Form - FORMS (12VAC30-10)

Current through Register Vol. 40, No. 24, July 15, 2024
SNAP
					 Information Collection Form (undated, filed July 23,
					 2019)
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part V - Personnel Administration › Section 12VAC30-10-850 - Standards of personnel administration

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Medicaid agency has established and
				  will maintain methods of personnel administration in conformity with standards
				  prescribed by the U.S. Civil Service Commission in accordance with § 208
				  of the Intergovernmental Personnel Act of 1970 and the regulations on
				  Administration of the Standards for a Merit System of Personnel Administration,
				  5 CFR 900, Subpart F. All requirements of
				  42 CFR
				  432.10 are met.
B. Affirmative Action Plan. The Medicaid
				  agency has in effect an affirmative action plan for equal employment
				  opportunity that includes specific action steps and timetables and meets all
				  other requirements of 5 CFR 900, Subpart F.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part V - Personnel Administration › Section 12VAC30-10-870 - Training programs; subprofessional and volunteer programs

Current through Register Vol. 40, No. 24, July 15, 2024
The Medicaid agency meets the requirements of 42 CFR 432,
					 Subpart B, with respect to a training program for agency personnel and the
					 training and use of subprofessional staff and volunteers.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part VI - Financial Administration › Section 12VAC30-10-900 - Fiscal policies and administration

Current through Register Vol. 40, No. 24, July 15, 2024
The Medicaid agency and, where applicable, local agencies
					 administering the plan, maintains an accounting system and supporting fiscal
					 records adequate to assure that claims for Federal funds are in accord with
					 applicable Federal requirements. The requirements of
					 42 CFR
					 433.32 are met.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part VI - Financial Administration › Section 12VAC30-10-910 - Cost allocation

Current through Register Vol. 40, No. 24, July 15, 2024
There is an approved cost allocation plan on file with the
					 Department in accordance with the requirements contained in 45 CFR 95, Subpart
					 E.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part VI - Financial Administration › Section 12VAC30-10-920 - State financial participation

Current through Register Vol. 40, No. 24, July 15, 2024
A. State funds are used in both assistance
				  and administration.
There is local participation. State funds are used to pay
					 not less than 40 percent of the non-Federal share of the total expenditures
					 under the plan. There is a method of apportioning Federal and State funds among
					 the political subdivisions of the State on an equalization or other basis which
					 assures that lack of adequate funds from local sources will not result in
					 lowering the amount, duration, scope, or quality of care and services or level
					 of administration under the plan in any part of the State.
B. State and Federal funds are apportioned
				  among the political subdivisions of the State on a basis consistent with
				  equitable treatment of individuals in similar circumstances throughout the
				  State.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part VI - Financial Administration › Section 12VAC30-10-930 - Hospital credit balance reporting

Current through Register Vol. 40, No. 24, July 15, 2024
Hospitals shall be required to report Medicaid credit
					 balances on a quarterly basis no later than 30 days after the close of each
					 quarter. For a credit balance arising on a Medicaid claim within three years of
					 the date paid by the DMAS, the hospital shall either submit a check for the
					 balance due or an adjustment claim with the Credit Balance Report. For credit
					 balances arising on claims over three years old, the hospital shall submit a
					 check for the balance due. Interest at the maximum rate allowed shall be
					 assessed for those credit balances (overpayments) that are identified on the
					 quarterly report but not reimbursed with the submission of the form. Interest
					 will begin to accrue 30 days after the end of the quarter and will continue to
					 accrue until the overpayment has been refunded or adjusted. A penalty shall be
					 imposed for failure to submit the form timely as follows:
1. Hospitals that have not submitted their
				  Medicaid credit balance data within the required 30 days after the end of a
				  quarter shall be notified in writing. If the required report is not submitted
				  within the next 30 days, there will be a 20% reduction in the DMAS
				  payment.
2. If the required report
				  is not submitted within the next 30 days (60 days after the due date), the DMAS
				  payments shall be reduced to -0- until the report is received.
3. If the credit balance has not been
				  refunded within 90 days of the end of a quarter, it shall be recovered, with
				  interest, through the use of a negative balance transaction on the weekly
				  remittance.
4. A periodic audit
				  shall be conducted of hospitals' quarterly submission of Medicaid credit
				  balance data. Hospitals shall maintain an audit trail back to the underlying
				  accounts receivable records supporting each quarterly report.
Statutory Authority
§§ 32.1-324 and 32.1-325 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part VII - General Provisions › Section 12VAC30-10-960 - Plan amendments

Current through Register Vol. 40, No. 24, July 15, 2024
The plan will be amended whenever necessary to reflect new
					 or revised Federal statutes or regulations or material change in State law,
					 organization, policy or State agency operation.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part VII - General Provisions › Section 12VAC30-10-970 - Nondiscrimination

Current through Register Vol. 40, No. 24, July 15, 2024
In accordance with Title VI of the Civil Rights Act of
					 1964 ( 42 USC 2000 d et. seq.), § 504 of the Rehabilitation Act of 1973 (
					 29 USC 70 b ), and the regulations at 45 CFR 80 and 84, the Medicaid agency
					 assures that no individual shall be subjected to discrimination under this plan
					 on the grounds of race, color, national origin, or handicap.
The Medicaid agency has methods of administration to
					 assure that each program or activity for which it receives Federal financial
					 assistance will be operated in accordance with Title VI regulations. These
					 methods for Title VI are described in
					 12VAC30-20-280.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part VII - General Provisions › Section 12VAC30-10-990 - State Governor's review

Current through Register Vol. 40, No. 24, July 15, 2024
The Office of the Governor does not wish to review
					 amendments, long-range program planning projections, and other periodic reports
					 thereon, excluding periodic statistical, budget and fiscal reports and has
					 designated the Secretary of Health and Human Resources to review Plan amendment
					 material per Executive Order 31 (94).
Statutory Authority
§ 32.1-325 of the Code of Virginia;
						42 CFR
						430.12(b).
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part VII - General Provisions › Section 12VAC30-10-1000 - General provider appeals

Current through Register Vol. 40, No. 24, July 15, 2024
These provisions shall apply to all provider types for
					 informal and formal administrative appeals.
12VAC30-20-500 (Attachment 7.5)
					 describes the process, procedures, and time frames for all provider informal
					 and formal administrative appeals.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 20 - ADMINISTRATION OF MEDICAL ASSISTANCE SERVICES › Part I - Miscellaneous Provisions › Section 12VAC30-20-10 - Attorney General's certification

Current through Register Vol. 40, No. 24, July 15, 2024
I certify that The Department of Medical Assistance
					 Services is the single state agency responsible for: administering the
					 plan.
The legal authority under which the agency administers the
					 plan on a Statewide basis is Title 32.1, Chapter 10 Section 32.1-325, Code of
					 Virginia (1950) as amended.
Date: Feb 14, 1985
Signature: /s/Gerald L. Baliles, Attorney
					 General
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 20 - ADMINISTRATION OF MEDICAL ASSISTANCE SERVICES › Part I - Miscellaneous Provisions › Section 12VAC30-20-60 - Definition of Medicaid state plan health maintenance organizations (HMOs)

Current through Register Vol. 40, No. 24, July 15, 2024
A. Definitions. A
				  Virginia Medicaid qualifying health maintenance organization (HMO) is defined
				  as an entity which has a license to operate as a health maintenance
				  organization issued by the Bureau of Insurance of the State Corporation
				  Commission.
B. Incorporation by
				  reference. The Bureau of Insurance of the State Corporation Commission, through
				  Insurance Regulation No. 28, Rules Governing Health Maintenance Organizations,
				  effective September 1, 1987, provides licensing only to health maintenance
				  organizations meeting the requirements of 43 CFR 434.20(c). The Department of
				  Medical Assistance Services hereby incorporates by reference Insurance
				  Regulation No. 28.
C. Organization
				  and description. Virginia Medicaid qualifying health maintenance organizations
				  shall be primarily organized for the purpose of providing health care services.
				  As provided for in Regulation 28, a health maintenance organization is an
				  organization which undertakes to provide or arrange for one or more health care
				  plans. A health care plan is any arrangement in which any health maintenance
				  organization undertakes to provide, arrange for, pay for, or reimburse any part
				  of the cost of any health care services.
D. Accessibility of services. Virginia
				  Medicaid qualifying health maintenance organizations shall make the services
				  they provide as accessible to Medicaid enrollees as those services are
				  available to non-enrolled Medicaid recipients within the area served by the
				  Virginia Medicaid qualifying health maintenance organization. As provided for
				  in Regulation 28, all Virginia Medicaid qualifying health maintenance
				  organizations must establish and maintain arrangements satisfactory to the
				  Medicaid Agency to assure both availability and accessibility of personnel and
				  facilities providing health care services including:
1. Reasonable hours of operation and
				  after-hours emergency health care,
2. Reasonable proximity to enrollees within
				  the service area, so as not to result in unreasonable barriers to
				  accessibility,
3. Sufficient
				  personnel, including health professionals, administrators, and support staff,
				  to reasonably assure that all services contracted for will be accessible to
				  enrollees on an appropriate basis without delays detrimental to the health of
				  the enrollee, and
4. Adequate
				  arrangements to provide inpatient hospital services for basic health
				  care.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 20 - ADMINISTRATION OF MEDICAL ASSISTANCE SERVICES › Part I - Miscellaneous Provisions › Section 12VAC30-20-80 - Coordination of Title XIX with Part A and Part B of Title XVIII

Current through Register Vol. 40, No. 24, July 15, 2024
The following method is used to provide benefits under Part
					 A and Part B of Title XVIII to the groups of Medicare-eligible individuals
					 indicated:
A. Part B buy-in agreements
				  with the Secretary of HHS. This agreement covers:
1. All individuals eligible under the state's
				  approved Title XIX plan except qualified disabled working
				  individuals.
2. Qualified Medicare
				  beneficiaries provided by § 301 of P.L. 100-360 as amended by § 8434
				  of P.L. 100-647.
3. Specified
				  low-income Medicare beneficiary (SLMB) provided by § 1905(p) of the
				  Act.
4. Qualifying Individuals-1:
				  The Medicaid agency pays Medicare Part B premiums under the State buy-in
				  process for individuals described in § 1902(a)(10)(E)(iv)(I) and subject
				  to § 1933 of the Act.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 20 - ADMINISTRATION OF MEDICAL ASSISTANCE SERVICES › Part I - Miscellaneous Provisions › Section 12VAC30-20-90 - Confidentiality and disclosure of information concerning Medicaid applicants and recipients

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Definitions. The following words and terms when used in these regulations shall
				  have the following meanings, unless the context clearly indicates otherwise:
"Agency" or "the Medicaid agency" means the Department of
					 Medical Assistance Services or its designee.
"Client" means an applicant for, or recipient of, Medicaid
					 benefits.
"Client information" or "client record" means any
					 information, including information stored in computer data banks or computer
					 files relating to a recipient or applicant, which was received in connection
					 with the performance of any function of the agency and which either identifies
					 a client or describes a client such that the client could be specifically
					 identified.
"Provider" means any individual or organization that
					 delivers a medical service to a recipient of, or applicant for, Medicaid
					 benefits.
"The Plan" means the State Plan for Medical
					 Assistance.
B. Purpose.
				  Section 1902(a)(7) of the Social Security Act and
				  42 CFR
				  431.300 et seq. require a State Plan for
				  Medical Assistance to provide safeguards to restrict the use or disclosure of
				  information concerning applicants and recipients to purposes directly connected
				  with the administration of the Plan. The rules herein are established to
				  protect the rights of clients to confidentiality of their Medicaid information.
				  Section 32.1-325.3 of the Code of Virginia requires the Board of Medical
				  Assistance Services to promulgate regulations consistent with the
				  foregoing.
C. Release of client
				  information. Except as otherwise provided in these rules, no person shall
				  obtain, disclose or use, or authorize, permit or acquiesce the use of any
				  client information that is directly or indirectly derived from the records,
				  files, or communications of the agency, except for purposes directly connected
				  with the administration of the Plan or as otherwise provided by federal and
				  state law. The agency can conduct all of the above administrative activities
				  itself or it can contract some or all of them to other state agencies or
				  private companies. These other entities must maintain client information
				  confidential in accordance with the terms of these regulations. Purposes
				  directly related to the administration of the Plan include; but are not limited
				  to:
1. Establishing eligibility;
2. Determining the amount of medical
				  assistance;
3. Providing services
				  for recipients; and
4. Conducting
				  or assisting in an investigation, prosecution or a civil or criminal proceeding
				  related to the administration of the Plan.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 20 - ADMINISTRATION OF MEDICAL ASSISTANCE SERVICES › Part I - Miscellaneous Provisions › Section 12VAC30-20-100 - Standards governing general and special hospitals and convalescent and nursing homes

Current through Register Vol. 40, No. 24, July 15, 2024
The Code of Virginia, Title 32, authorizes the State Board
					 of Health to adopt and promulgate reasonable rules and regulations as to
					 standards of health to be maintained and such other matters as will promote the
					 safety and insure proper attention and service to and care of patients and
					 inmates of private or public hospitals and institutions.
Rules and Regulations Governing General and Special
					 Hospitals and Convalescent and Nursing Homes in Virginia are published by the
					 Virginia Department of Health under the above legal authority. Only facilities
					 which meet the standards and requirements of these Rules and Regulations are
					 licensed for operation within the Commonwealth of Virginia. Compliance is
					 evaluated from scheduled and non-scheduled personal visits to each facility by
					 a highly qualified specially designated staff element (Bureau of Medical and
					 Nursing Facilities) Division of Licensure Certification of the Department of
					 Health. Rules and Regulations are available for review upon request.
Intermediate care facilities in mental institutions are
					 licensed by the State Department of Mental Health and Mental Retardation as a
					 condition for certification as an ICF facility by the Department of Health's
					 Bureau of Medical and Nursing Facilities.
Mental Hospitals and Institutions for Mentally Retarded,
					 which render hospital or skilled nursing home services, are licensed by the
					 State Department of Mental Health and Mental Retardation and are certified for
					 the Title XVIII Program by the Department of Health's Bureau of Medical and
					 Nursing Facilities.
Descriptions of standards utilized for licensing and
					 certifying these institutions, published in official, bound form are available
					 for review upon request.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.