reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part II - General Information › Section 12VAC5-200-20 - Authority for regulations

Current through Register Vol. 40, No. 24, July 15, 2024
Section 32.1-11 of the Code of Virginia establishes the
					 responsibility of the board as follows: "The board may formulate a program of
					 environmental health services, laboratory services and preventive, curative and
					 restorative medical care services, including home and clinic health services
					 described in Titles V, XVIII and XIX of the United States Social Security Act
					 and amendments thereto, to be provided by the department on a district or local
					 basis. The board shall define the income limitations within which a person
					 shall be deemed to be medically indigent. Persons so deemed to be medically
					 indigent shall receive the medical care services of the department without
					 charge. The board may also prescribe the charges to be paid for the medical
					 care services of the department by persons who are not deemed to be medically
					 indigent and may, in its discretion and within the limitations of available
					 funds, prescribe a scale of such charges based upon ability to pay. Funds
					 received in payment of such charges are hereby appropriated to the board for
					 the purpose of carrying out the provisions of this title. The board shall
					 review periodically the program and charges adopted pursuant to this
					 section."
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part II - General Information › Section 12VAC5-200-30 - Purpose of chapter

Current through Register Vol. 40, No. 24, July 15, 2024
The board has promulgated this chapter to:
(i) establish financial eligibility criteria
				  to determine if a person is medically indigent and therefore qualified to
				  receive medical care services from the department without charge;
(ii) establish income scales and a mechanism
				  for determining charges for medical care provided by the department to
				  individuals who are not medically indigent, based upon their ability to pay;
(iii) establish a mechanism for
				  handling appeals and waivers; and
(iv) establish continuity of eligibility
				  among state agencies. The regulations are constructed to assure that
				  eligibility criteria remain appropriate for changing economic
				  conditions.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part II - General Information › Section 12VAC5-200-40 - Administration of chapter

Current through Register Vol. 40, No. 24, July 15, 2024
This chapter is administered by the commissioner.
The commissioner shall assure uniformity and consistency
					 by interpreting and implementing the rules of the department for the provision
					 of medical care and related goods and services. The commissioner may issue a
					 guidance document that interprets these regulations and provides guidance for
					 their implementation. Such a document shall be reviewed and revised whenever
					 the regulations of this chapter are reviewed, and may also be amended or
					 revised as needed to meet changing circumstances.
Whenever possible, charges for services shall use the most
					 appropriate current Medicaid charges (and matching Medicaid codes). If there is
					 no Medicaid code for a particular service, the most appropriate current
					 Medicare charge (and matching code) shall be used. If both Medicaid and
					 Medicare charges (and codes) exist for the same service, the Medicaid charge
					 (and code) will be used. If neither a Medicaid nor a Medicare code exists for a
					 particular service, the commissioner, or a designee, shall determine an
					 appropriate charge and develop a matching code. A guidance document shall
					 include procedures for determining the costs and establishing the charges for
					 medical care and related goods and services when any of these are not otherwise
					 addressed in these regulations or the Code of Virginia.
The commissioner shall publish specific income levels
					 expressed in dollar amounts for determining eligibility for medical care
					 services of the department in accordance with the income scales defined in
					 12VAC5-200-10.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part II - General Information › Section 12VAC5-200-50 - Recipients of services

Current through Register Vol. 40, No. 24, July 15, 2024
This chapter shall apply to all persons seeking medical
					 care services provided by the department, except where other eligibility
					 criteria are required for programs administered under federal
					 statute.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part II - General Information › Section 12VAC5-200-60 - Application of the Administrative Process Act

Current through Register Vol. 40, No. 24, July 15, 2024
The provisions of the Virginia Administrative Process Act
					 govern the adoption of these regulations and any subsequent
					 amendments.
Statutory Authority
§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part III - Application and Charges › Section 12VAC5-200-80 - Application process

Current through Register Vol. 40, No. 24, July 15, 2024
Upon an applicant's request for medical care services
					 (excepting those services described in
					 12VAC5-200-150,
					 12VAC5-200-160, and
					 12VAC5-200-170 ) the department
					 will require information as to the family size, financial status and other
					 related data as described on the application for medical care. The applicant
					 must be informed during the interviewing process of the provisions as described
					 in this section of the regulations.
An application date is established when the applicant
					 completes and signs the application for medical care services.
When an applicant is in need of emergency medical services,
					 the district director, or his designee, shall waive this application process
					 for that individual until such time as the individual is able to participate in
					 the interviewing process.
It is the applicant's responsibility to furnish the
					 department with proof of the applicant's financial data in order to be
					 appropriately classified according to income level and family size so that
					 eligibility for discounts for medical care services can be determined.
Any individual who is acting on behalf of an applicant will
					 be responsible for the accuracy of all financial data provided to the
					 department.
Individuals who have failed to make any payment within the
					 past 90 days for medical care services or other goods or services they have
					 received may have their medical care services terminated. The district director
					 may terminate services only following notice to the individual that such
					 services will be terminated and only after determining that terminating
					 services would not be detrimental to the individual's health. Medical care
					 services cannot be terminated for individuals receiving ongoing care without
					 making a good faith effort to secure alternative care.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part III - Application and Charges › Section 12VAC5-200-90 - Charges for services

Current through Register Vol. 40, No. 24, July 15, 2024
Charges for services means the reasonable charges
					 established by the board for medical care services. No charge shall be
					 established outside the provisions of these regulations. The department may
					 prescribe a scale of discounts for certain medical care services. Charges will
					 be based on current published Medicaid reimbursement levels. In those instances
					 where Medicaid does not reimburse for a service provided by the department,
					 charges shall be based on the appropriate current Medicare reimbursement
					 levels. Where neither Medicaid nor Medicare reimburse for a service, the
					 commissioner shall establish charges based on the costs of providing the
					 medical care services. Charges for goods and services not directly provided by
					 the agency may be based on the agency's cost.
Directors of health districts may request permission from
					 the commissioner, or commissioner's designee, to round charges to a convenient
					 value.
On selected occasions it may be desirable to provide
					 certain medical services, e.g., influenza immunization, to large numbers of
					 people quickly and conveniently and thereby promote their use by the public. In
					 order to accomplish this, districts may charge a flat rate charge for these
					 services under these circumstances. This provision includes services that are
					 otherwise available at a discounted charge. No eligibility determination will
					 be done and all service recipients will be charged the same flat rate charge.
					 However, the district must also provide convenient alternative times and venues
					 where applicants can request an eligibility determination and obtain these
					 services at a discounted rate if eligible. The commissioner or commissioner's
					 designee must approve such flat rate charge arrangements in advance, including
					 approval of the specific flat rate charge.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part III - Application and Charges › Section 12VAC5-200-100 - Flat rate charges

Current through Register Vol. 40, No. 24, July 15, 2024
Except as otherwise set out in this chapter, charges for
					 certain goods and medical care services may be set at a flat rate charge not
					 subject to discounting. All flat rate charges must be expressly approved by the
					 commissioner or commissioner's designee prior to their
					 implementation.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part III - Application and Charges › Section 12VAC5-200-105 - Charges for services and goods provided by contract

Current through Register Vol. 40, No. 24, July 15, 2024
The department, health districts, and local health
					 departments may enter into contracts with agencies external to the department
					 whereby the department, health district, or local health department provides
					 medical services and goods. Charges for such services and goods will be
					 determined by the contract. If a patient copayment is required in the contract,
					 the patient shall pay the full copayment to the department, district, or local
					 health department regardless of the patient's income status. The patient shall
					 not be required to pay if state or federal law precludes a
					 copayment.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part III - Application and Charges › Section 12VAC5-200-110 - Income levels for charges

Current through Register Vol. 40, No. 24, July 15, 2024
The department shall annually publish specific income
					 levels expressed in dollar amounts for determining eligibility for discounts to
					 the charges for medical care services.
The charges made to the applicant shall be subject to 100%
					 discounting for those who are found to be medically indigent as defined in Part
					 I.
Applicants for medical care services, including those in
					 Northern Virginia as defined in Part I, whose family income exceeds Income
					 Level A shall be assessed a charge as follows:
1. Income Level A - 100% discount of the
				  established charge for the service.
2. Income Level B - 90% discount of the
				  established charge for the service.
3. Income Level C - 75% discount of the
				  established charge for the service.
4. Income Level D - 50% discount of the
				  established charge for the service.
5. Income Level E - 25% discount of the
				  established charge for the service.
6. Income Level F - 5.0% discount of the
				  established charge for the service.
7. Income Level G - No discount will be
				  given.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part III - Application and Charges › Section 12VAC5-200-120 - Automatic eligibility

Current through Register Vol. 40, No. 24, July 15, 2024
Applicants receiving the following public assistance
					 program will receive services as Income Level A patients without additional
					 income verification.
General Relief
Title XIX-Medicaid
National School Lunch Program for children receiving school
					 meals at no cost. Only used for child dental services.
Applicants who are eligible for services under this
					 section, and are not participating in Medicaid or any other children's medical
					 insurance program sponsored by the state, should apply for these programs.
					 Applicants who do not apply for Medicaid or a children's medical insurance
					 program within 60 days of receiving services may be assessed the undiscounted
					 charge for the medical care and related goods and services
					 provided.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part III - Application and Charges › Section 12VAC5-200-130 - Explanation of charges

Current through Register Vol. 40, No. 24, July 15, 2024
Prior to services being rendered, an explanation of the
					 estimated charges, applicable discounts, and expected payment shall be provided
					 to the applicant.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part III - Application and Charges › Section 12VAC5-200-140 - Redetermination of eligibility

Current through Register Vol. 40, No. 24, July 15, 2024
Eligibility to receive discounts from established charges
					 must be redetermined at least every 12 months, or when income or family status
					 changes, unless otherwise required by law or regulation.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part IV - Nonchargeable Services › Section 12VAC5-200-150 - Services provided at no charge to the patient

Current through Register Vol. 40, No. 24, July 15, 2024
The following services are provided at no charge:
1. Those immunizations for children as
				  required by § 32.1-46 of the Code of Virginia, and of persons up to the
				  age of 21 when the person lacks evidence of complete and appropriate
				  immunizations for the diseases covered by that section of the Code of
				  Virginia.
2. Examination and
				  testing of persons suspected of having or known to have tuberculosis as
				  required by § 32.1-50 of the Code of Virginia.
3. Examination, testing and treatment of
				  persons for sexually transmitted diseases as required by § 32.1-57 of the
				  Code of Virginia.
4. Anonymous or
				  confidential testing for human immunodeficiency virus as required by §
				  32.1-55.1 of the Code of Virginia.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part IV - Nonchargeable Services › Section 12VAC5-200-160 - Immunization services

Current through Register Vol. 40, No. 24, July 15, 2024
The department may provide immunization services free of
					 charge to appropriate individuals in the event of an epidemic or when declared
					 necessary by the commissioner or district health director to protect the public
					 health of all citizens of the Commonwealth.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part IV - Nonchargeable Services › Section 12VAC5-200-170 - Other health care services

Current through Register Vol. 40, No. 24, July 15, 2024
The department may elect to provide other medical services
					 at no charge to appropriate citizens of the Commonwealth when directed by the
					 board, the commissioner or a district health director.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part V - Exceptions › Section 12VAC5-200-180 - Exceptions

Current through Register Vol. 40, No. 24, July 15, 2024
A continuing exception to the above regulations for
					 assessing charges for medical care services will exist for patients determined
					 to be eligible for services provided under those programs of the department
					 specified in the Code of Virginia or published in separate state
					 plans.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part V - Exceptions › Section 12VAC5-200-190 - Limitations

Current through Register Vol. 40, No. 24, July 15, 2024
A. The district
				  director can limit the provision of medical care services based on an
				  assessment of public need and available department resources.
B. The district director may establish
				  policies to limit the provision of medical care services provided by the
				  department based on legal residence and visa status except where federal funds
				  are appropriated for the service.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part VI - Waiver of Charges › Section 12VAC5-200-220 - General

Current through Register Vol. 40, No. 24, July 15, 2024
In instances when patients have financial hardships and
					 there are no other avenues of care, the patient, guardian or other authorized
					 person may request a waiver of charges for up to 180 calendar days. A waiver
					 shall be requested in writing to the district director. If a waiver is granted,
					 it shall be for the duration of the financial hardship or 180 days, whichever
					 is shorter.
If the waiver request is approved, the patient will receive
					 a full discount for all charges while covered by the waiver. If the waiver
					 request is denied, the charges will continue as before.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part VI - Waiver of Charges › Section 12VAC5-200-230 - Waivers

Current through Register Vol. 40, No. 24, July 15, 2024
A. The commissioner
				  is authorized to grant or deny requested waivers and may delegate this
				  authority to the district directors. A waiver to all or a portion of a charge
				  may be granted for reasons of unusually serious health problems or
				  extraordinary financial hardship. A resulting waived or partially waived charge
				  shall be determined by the commissioner or designee, and reviewed and revised
				  as needed. The commissioner or designee shall also identify those expenses that
				  are considered to be medical bills, and shall review and revise this
				  determination as needed.
B. In the
				  event of an adverse decision, the patient, guardian or other authorized person
				  will be advised of their rights to appeal under Part VII.
C. Waivers will not be continued past 180
				  days. Additional waivers may be granted, but the applicant must reapply at
				  least every 180 days.
D. No person
				  believed to be eligible for Medicaid or any state-sponsored children's medical
				  insurance program and who has failed to complete an application for these
				  programs will be eligible for a waiver.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of
						Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part VI - Waiver of Charges › Section 12VAC5-200-240 to 12VAC5-200-260 - Reserved

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part VII - Appeal Process › Section 12VAC5-200-270 - Rights

Current through Register Vol. 40, No. 24, July 15, 2024
A. If an applicant
				  for or recipient of medical care services as defined in these regulations is
				  denied such services, has services terminated, wishes to contest the determined
				  income level, or is denied a waiver as defined in Part VI of these regulations,
				  the applicant/recipient is entitled to appeal that action as set forth under
				  this part. There are no further rights of appeal except as set forth in this
				  part.
B. The applicant/recipient
				  has the right to be informed in writing of the appeal process, including time
				  limits, and the right to receive a written statement of the reasons for denial.
				  If a person already receiving services is denied those services, a written
				  notice of termination shall be given 30 days in advance of discontinuing
				  services. The person has the right to confront any witnesses who may have
				  testified against him.
C. An
				  individual or his representative may make a written or oral appeal to the
				  district or program director within 30 days of the denial of service.
D. Upon receipt of the appeal, the district
				  director shall review and make written recommendations to the commissioner, or
				  commissioner's designee, within 15 days. Within 45 days following the date on
				  which an appeal is filed, the commissioner, or commissioner's designee, shall
				  make a final decision.
E. Services
				  to applicants/recipients shall continue during the appeal process.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part VIII - Fraud › Section 12VAC5-200-280 - Fraud

Current through Register Vol. 40, No. 24, July 15, 2024
If the district director identifies a patient willfully
					 misrepresenting himself, or withholding or falsifying information in an attempt
					 to obtain medical services free or at a reduced rate, the director may
					 discontinue services to the affected person 30 days after notifying the person
					 that services will be discontinued. Such recipient is entitled to the appeal
					 process set forth in Part VII of this chapter.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 200 - REGULATIONS GOVERNING ELIGIBILITY STANDARDS AND CHARGES FOR MEDICAL CARE SERVICES TO INDIVIDUALS › Part IX - Charges and Payment Requirements by Income Levels › Section 12VAC5-200-290 - Charges and payment requirements

Current through Register Vol. 40, No. 24, July 15, 2024
This part shall be administered by the commissioner. The
					 commissioner shall establish a procedure for the ongoing development;
					 maintenance, revision, and updating; and promulgation of these charges and
					 payments schedules. There shall be two sets of schedules, one for Northern
					 Virginia as defined in
					 12VAC5-200-10 and one for the
					 remainder of the Commonwealth.
By the provisions of the "Regulations Governing Eligibility
					 Standards and Charges for Medical Care Services to Individuals" (12VAC5-200)
					 promulgated by the Board of Health in accordance with §§ 32.1-11 and
					 32.1-12 of the Code of Virginia, the charges for medical care services, stating
					 the minimum required payments to be made by patients or other responsible
					 persons toward their charges, according to income levels are available to the
					 public for inspection and copying at the headquarters, district, and local
					 health department offices of the department.
Statutory Authority
§§ 32.1-11 and 32.1-12 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part II - General Information › Section 12VAC5-215-20 - Authority for regulations

Current through Register Vol. 40, No. 24, July 15, 2024
The board, by §§ 32.1-276.2 through 32.1-276.11
					 of the Code of Virginia, is required to collect, analyze and make public
					 certain financial data and findings relating to hospitals which operate within
					 the Commonwealth of Virginia. Sections 32.1-276.7 and 32.1-276.8 of the Code of
					 Virginia direct the board from time to time to make such rules and regulations
					 as may be necessary to carry out its responsibilities as prescribed in the Code
					 of Virginia.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part II - General Information › Section 12VAC5-215-30 - Purpose, administration, application, and effective date of rules and regulations

Current through Register Vol. 40, No. 24, July 15, 2024
A. The
				  board has promulgated these rules and regulations to set forth an orderly
				  administrative process by which the board may govern its own affairs and
				  require compliance with the provisions of §§ 32.1-276.2 through
				  32.1-276.11 of the Code of Virginia.
B. These rules and regulations are
				  administered by the board.
C. These
				  rules and regulations have general applicability throughout the Commonwealth.
				  The requirements of the Virginia Administrative Process Act, codified as §
				  9-6.14:1 et seq. of the Code of Virginia, apply to their
				  promulgation.
D. These rules and
				  regulations or any subsequent amendment, modification, or deletion in
				  connection with these rules and regulations shall become effective 30 days
				  after the final regulation is published in The Virginia Register.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part II - General Information › Section 12VAC5-215-40 - Powers and procedures of regulations not exclusive

Current through Register Vol. 40, No. 24, July 15, 2024
The board reserves the right to authorize any procedure for
					 the enforcement of these regulations that is not inconsistent with the
					 provision set forth herein and the provisions of §§ 32.1-27 and
					 32.1-276.11 of the Code of Virginia.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part III - Filing Requirements and Fee Structure › Section 12VAC5-215-60 - Schedule of charges

Current through Register Vol. 40, No. 24, July 15, 2024
Each health care institution shall file annually a
					 schedule of charges to be in effect on the first day of such fiscal year, as
					 prescribed in § 9-159A 3 (Repealed) of the Code of Virginia. The
					 institution's schedule of charges shall be received by the board within 10 days
					 after the beginning of its respective applicable fiscal year.
Any subsequent amendment or modification to the annually
					 filed schedule of charges shall be filed within 10 days of the effective date
					 of the revised annual projection. In addition to the requirement above, a new
					 schedule of charges must be submitted if any of the following conditions exist:
(i) the creation or revision of a
				  markup or pricing methodology, or
(ii) the creation or revision of charges for
				  new services or products. Amendments or modifications to a schedule of charges
				  that are due only to cost adjustments resulting from the pass through of a
				  markup or pricing methodology that had been implemented since the beginning of
				  the fiscal year are considered minimal and need not be reported.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part III - Filing Requirements and Fee Structure › Section 12VAC5-215-70 - Survey of rates

Current through Register Vol. 40, No. 24, July 15, 2024
Each health care institution shall file annually a survey
					 of rates charged. For hospitals, the survey shall consist of up to 30 select
					 charges, including semi-private and private room rates. The survey shall also
					 consist of charges of the most frequently occurring diagnoses or procedures for
					 inpatient and outpatient treatment. The charges shall be calculated by taking
					 an average for one month of all patient bills where the requested CPT or ICD-9
					 code numbers are indicated as the principal diagnosis or procedure. For
					 hospitals this information shall be received by the board no later than April
					 30 of each year.
The annual charge survey for nursing homes shall include
					 up to 30 select charges, including semi-private and private room rates. The
					 select charges shall reflect the rates in effect as of the first day of a
					 sample month to be chosen by the board. For nursing homes this information
					 shall be received by the board no later than March 31 of each
					 year.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part III - Filing Requirements and Fee Structure › Section 12VAC5-215-80 - Commercial diversification survey

Current through Register Vol. 40, No. 24, July 15, 2024
Each hospital or any corporation that controls a hospital
					 shall respond to a survey conducted by the board to determine the extent of
					 commercial diversification by such hospitals in the Commonwealth. The survey
					 shall be in a form and manner prescribed by the board and shall request the
					 information specified in subdivisions a through j below for each affiliate of
					 such hospital or corporation, if any:
a. The name and principal activity;
b. The date of the affiliation;
c. The nature of the affiliation;
d. The method by which each affiliate was
				  acquired or created;
e. The tax
				  status of each affiliate and, if tax-exempt, its Internal Revenue tax exemption
				  code number;
f. The total
				  assets;
g. The total
				  revenues;
h. The net profit after
				  taxes, or if not-for-profit, its excess revenues;
i. The net equity or, if not-for-profit, its
				  fund balance; and
j. Information
				  regarding related party transactions.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part III - Filing Requirements and Fee Structure › Section 12VAC5-215-90 - Affiliates

Current through Register Vol. 40, No. 24, July 15, 2024
The information specified in
					 12VAC5-215-80 shall relate to any
					 legal controls that exist as of the hospital's fiscal year end. The response to
					 the survey shall include the required information for all affiliates in which
					 the hospital or any corporation which controls a hospital has a 25% or greater
					 interest. Information regarding affiliates or organizations that do not have
					 corporate headquarters in Virginia and that do no business in Virginia need not
					 be provided.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part III - Filing Requirements and Fee Structure › Section 12VAC5-215-100 - Financial statement (healthcare institution)

Current through Register Vol. 40, No. 24, July 15, 2024
Each hospital that reports to the board or any corporation
					 which controls a hospital that reports to the board shall submit audited
					 consolidated financial statements and consolidating financial schedules to the
					 board which include its total assets, liabilities, revenues, expenses, and net
					 worth.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part III - Filing Requirements and Fee Structure › Section 12VAC5-215-110 - Deadline

Current through Register Vol. 40, No. 24, July 15, 2024
The information required by
					 12VAC5-215-80,
					 12VAC5-215-90, and
					 12VAC5-215-100 shall be due 120
					 days after the hospital's fiscal year end.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part III - Filing Requirements and Fee Structure › Section 12VAC5-215-120 - IRS Forms

Current through Register Vol. 40, No. 24, July 15, 2024
Each health care institution that reports to the board,
					 any corporation controlling a hospital, and each affiliate of the hospital or
					 corporation that controls a hospital shall submit, if the health care
					 institution, corporation, or affiliate is an organization exempt from taxes
					 pursuant to § 501(C)(3) of the Internal Revenue Code, a copy of the most
					 recent federal information return (Form 990) which was filed on behalf of the
					 institution, corporation, or affiliate together with all accompanying schedules
					 that are required to be made available to the public by the Internal Revenue
					 Service. Information regarding not-for-profit affiliates which do no business
					 in Virginia need not be submitted.
The information required by this section shall be due to
					 the board 120 days after the completion of the health care institution's fiscal
					 year end. If the information return (Form 990) has not been filed with the
					 Internal Revenue Service, the due date will be extended to no later than the
					 normal due date to the IRS or any extensions granted.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part III - Filing Requirements and Fee Structure › Section 12VAC5-215-130 - Filing

Current through Register Vol. 40, No. 24, July 15, 2024
All filings required by this chapter will be made to the
					 board.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part III - Filing Requirements and Fee Structure › Section 12VAC5-215-140 - Fees

Current through Register Vol. 40, No. 24, July 15, 2024
A fee based on an adjusted patient days rate shall be set
					 by the board, based on the needs to meet annual board expenses. The fee shall
					 be established at least annually and reviewed for its sufficiency at least
					 annually by the board. All fees shall be paid directly to the board. The fee
					 shall be no more than 11 cents per adjusted patient day for each health care
					 institution. Prior to the beginning of each new fiscal year, the board shall
					 determine a fee for hospitals and a fee for nursing homes based upon the
					 board's proportionate costs of operation for review of hospital and nursing
					 home filings in the current fiscal year, as well as the anticipated costs for
					 such review in the upcoming year.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part III - Filing Requirements and Fee Structure › Section 12VAC5-215-150 - Schedule

Current through Register Vol. 40, No. 24, July 15, 2024
Fifty percent of the fee shall be paid to the board no
					 later than 30 days before the beginning of the health care institution's fiscal
					 year. The fee shall be based on the health care institution's most recently
					 submitted annual historical adjusted patient days. If there have been no
					 previous annual historical filings, the health care institution's fee shall be
					 based on its projected adjusted patient days for the fiscal year. The balance
					 of the fee shall be paid to the board at the same time the health care
					 institution submits its annual historical filing under the provisions of
					 12VAC5-215-50.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part III - Filing Requirements and Fee Structure › Section 12VAC5-215-160 - Late fees

Current through Register Vol. 40, No. 24, July 15, 2024
A. A late charge
				  shall be paid to the board by a health care institution that files reports or
				  fees past the due date. The late charge may be waived if such a waiver is
				  requested prior to the due date and the health care institution can show that
				  an extenuating circumstance exists. Examples of extenuating circumstances
				  include, but are not limited to, involvement by the institution in a bankruptcy
				  proceeding, closure of the institution, change of ownership of the institution,
				  or the institution is a new facility that has recently opened.
B. A late charge of $10 per working day shall
				  be paid to the board by a health care institution that files its annual
				  historical filing, unconsolidated audited financial statements or fees past the
				  due date.
C. A late charge of $50
				  shall be paid to the board by the health care institution that files the charge
				  schedule past the due date.
D. A
				  late charge of $25 per working day shall be paid to the board by the reporting
				  entity required to complete the survey required by
				  12VAC5-215-80 including the
				  audited consolidated financial statement required by
				  12VAC5-215-100, or both.
E. A late charge of $25 per working day shall
				  be paid to the board by the reporting entity required to complete the survey
				  required by
				  12VAC5-215-70.
F. A late charge of $25 per working day shall
				  be paid to the board by the reporting entity required to submit the Form 990s
				  as provided by
				  12VAC5-215-120.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part IV - Work Flow and Analysis › Section 12VAC5-215-170 - Analysis of historical filing data and schedule of charges

Current through Register Vol. 40, No. 24, July 15, 2024
A. The annual
				  historical filing data submitted by health care institutions as prescribed in
				  12VAC5-215-50 shall be analyzed as
				  directed by the board.
B. The
				  annual schedule of charges shall be analyzed as directed by the
				  board.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part V - Publication and Dissemination of Information Related to Health Care Institutions › Section 12VAC5-215-180 - Rate publication

Current through Register Vol. 40, No. 24, July 15, 2024
Periodically, but at least annually, the board will publish
					 the rates charged by each health care institution in Virginia for up to 30 of
					 the most frequently used services in Virginia, including each institution's
					 average semi-private and private room rates. The data will be summarized by
					 geographic area in Virginia, and will be kept on file at the board office for
					 public inspection and made available to the news media. In addition, annual
					 charge schedules and subsequent amendments to these schedules filed under the
					 provisions of
					 12VAC5-215-60 will be kept on file
					 at the board office for public inspection.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part V - Publication and Dissemination of Information Related to Health Care Institutions › Section 12VAC5-215-190 - Annual report publication

Current through Register Vol. 40, No. 24, July 15, 2024
Periodically, but at least annually, the board will
					 publish an annual report which will include, but not be limited to the
					 following: cost per admission comparison, cost per patient day comparison,
					 percentage increase in cost per patient day, operating profits and losses,
					 deductions from revenue (contractuals, bad debts, and charity care) and
					 utilization.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part V - Publication and Dissemination of Information Related to Health Care Institutions › Section 12VAC5-215-200 - Comparison report

Current through Register Vol. 40, No. 24, July 15, 2024
The board will also periodically publish and disseminate
					 information which will allow consumers to compare costs and services of
					 hospitals, nursing homes and certified nursing facilities.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part V - Publication and Dissemination of Information Related to Health Care Institutions › Section 12VAC5-215-210 - Statistical data

Current through Register Vol. 40, No. 24, July 15, 2024
The board shall release historical financial and
					 statistical data reported by health care institutions pursuant to §§
					 32.1-276.2 through 32.1-276.11 of the Code of Virginia. Under no circumstances
					 will data be released which contains "personal information" as defined in
					 § 2.1-379(2) of the Code of Virginia.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 et seq. of the Code
						of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 215 - RULES AND REGULATIONS GOVERNING HEALTH DATA REPORTING › Part V - Publication and Dissemination of Information Related to Health Care Institutions › Form - FORMS (12VAC5-215)

Current through Register Vol. 40, No. 24, July 15, 2024
Hospital Annual Historical Filing Form, 03-01, revised
					 4/30/96.
Ambulatory Surgical Hospital Annual Historical Filing
					 Form, 03-02, revised 4/30/96.
Nursing Home Annual Historical Filing Form, 03-03, revised
					 4/30/96.
Income Statement Reconciliation Worksheet, 04-04, revised
					 4/30/96.
Psychiatric Hospital Annual Historical Filing Form, 03-05,
					 revised 4/30/96.
Rehabilitation Hospital Annual Historical Filing Form,
					 03-06, revised 4/30/96.
Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 216 - METHODOLOGY TO MEASURE EFFICIENCY AND PRODUCTIVITY OF HEALTH CARE INSTITUTIONS › Section 12VAC5-216-10 - Purpose; limitations; activities

Current through Register Vol. 40, No. 24, July 15, 2024
A. The methodology set forth in this chapter
				is market oriented. Consumers and buyers of health care will receive
				information from the board that will allow them to make prudent health care
				decisions.
B. Nothing in this
				chapter or the actions taken by the board pursuant to any of its provisions
				shall be construed as constituting approval by the Commonwealth or any of its
				agencies or officers of the reasonableness of any charges made or costs
				incurred by any health care institution.
C. The board will collect, analyze, and
				publish information on health care institutional provider practices relating to
				efficiency and productivity.
Statutory Authority
§§ 32.1-12 and 32.1-276.2 of the Code of
					 Virginia.