reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 130 - AMOUNT, DURATION AND SCOPE OF SELECTED SERVICES › Part XX - Addiction and Recovery Treatment Services › Section 12VAC30-130-5180 - Peer support services and family support partners: medical necessity criteria

Current through Register Vol. 40, No. 24, July 15, 2024
A. In order
				  to receive ARTS peer support services, individuals 21 years of age or older
				  shall meet the following requirements:
1. The
				  individual shall have a substance use disorder or co-occurring mental health
				  and substance use disorders diagnosis.
2. The individual shall require
				  recovery-oriented assistance and support services for:
a. The acquisition of skills needed to engage
				  in and maintain recovery;
b. The
				  development of self-advocacy skills to achieve a decreasing dependency on
				  formalized treatment systems; and
c. Increasing responsibilities, wellness
				  potential, and shared accountability for the individual's own
				  recovery.
3. The
				  individual shall demonstrate moderate to severe functional impairment as a
				  result of the diagnosis, and the functional impairment shall be of a degree
				  that it interferes with or limits performance in at least one of the following
				  domains: educational (e.g., obtaining a high school or college degree); social
				  (e.g., developing a social support system); vocational (e.g., obtaining
				  part-time or full-time employment); or self-maintenance (e.g., managing
				  symptoms, understanding his illness, living more independently).
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 130 - AMOUNT, DURATION AND SCOPE OF SELECTED SERVICES › Part XX - Addiction and Recovery Treatment Services › Section 12VAC30-130-5190 - Peer support services and family support partners: provider and setting requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Effective July 1, 2017, a peer recovery specialist shall have the
				  qualifications, education, experience, and certification required by DBHDS in
				  accordance with 12VAC35-250. Effective December 18, 2017, peer recovery
				  specialists shall also be registered with the Board of Counseling.
B. Prior to service initiation, a documented
				  assessment by a practitioner who meets the definition of "credentialed
				  addiction treatment professional" found in
				  12VAC30-130-5020 and
				  who is acting within his scope of practice under state law shall be required. A
				  certified substance abuse counselor, as defined in §
										54.1-3507.1
				  of the Code of Virginia, may also provide a documented assessment if he is
				  acting under the supervision or direction of a licensed substance use treatment
				  practitioner or licensed mental health professional. The PRS shall perform ARTS
				  peer services under the oversight of the practitioner described in this
				  subsection conducting the assessment and providing the clinical oversight of
				  the recovery, resiliency, and wellness plan. The assessment shall verify that
				  the individual meets the medical necessity criteria set forth in
				  12VAC30-130-5180
				  A or B, as applicable.
C. The PRS
				  shall be employed by or have a contractual relationship with the enrolled
				  provider licensed for one of the following:
1. Acute care general hospital (ASAM Level
				  4.0) licensed by the Department of Health as defined in
				  12VAC30-130-5150.
2. Freestanding psychiatric hospital or
				  inpatient psychiatric unit (ASAM Levels 3.5 and 3.7) licensed by the Department
				  of Behavioral Health and Developmental Services as defined in
				  12VAC30-130-5130
				  and
				  12VAC30-130-5140.
3. Residential placements (ASAM Levels 3.1,
				  3.3, 3.5, and 3.7) licensed by the Department of Behavioral Health and
				  Developmental Services as defined in
				  12VAC30-130-5110
				  through
				  12VAC30-130-5140.
4. ASAM Levels 2.1 and 2.5, licensed by the
				  Department of Behavioral Health and Developmental Services as defined in
				  12VAC30-130-5090
				  and
				  12VAC30-130-5100.
5. ASAM Level 1.0 as defined in
				  12VAC30-30-5080.
6. Opioid
				  treatment services as defined in
				  12VAC30-130-5050.
7. Office-based opioid treatment as defined
				  in
				  12VAC30-130-5060.
8. Hospital emergency department services
				  licensed by the Department of Health.
9. Pharmacy services licensed by the
				  Department of Health.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 130 - AMOUNT, DURATION AND SCOPE OF SELECTED SERVICES › Part XX - Addiction and Recovery Treatment Services › Form - FORMS (12VAC30-130)

Current through Register Vol. 40, No. 24, July 15, 2024
Forms accompanying Part II of this chapter:
Virginia
					 Uniform Assessment Instrument (eff. 1994)
Forms accompanying Part III of this chapter:
MI/IDD
					 Supplement, DMAS-95, Level I PASRR Form and Instructions (rev
					 4/2019)
MI/IDD/Related
					 Conditions Supplement Level II, DMAS-95 MI/IDD/RC Supplement (rev.
					 12/2015)
Forms accompanying Part VII of this chapter:
Request
					 for Hospice Benefits, DMAS-420 (rev. 9/2019)
Forms accompanying Part IX of this chapter:
Patient
					 Information Form Medicaid LTC Communication Form, DMAS-122, 225 (eff.
					 10/2011)
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 130 - AMOUNT, DURATION AND SCOPE OF SELECTED SERVICES › Part XX - Addiction and Recovery Treatment Services › DOCUMENTS INCORPORATED BY REFERENCE (12VAC30-130)

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Medicaid Nursing Home Manual, Department of
					 Medical Assistance Services.
Virginia Medicaid Rehabilitation Manual, Department of
					 Medical Assistance Services.
Virginia Medicaid Hospice Manual, Department of Medical
					 Assistance Services.
Virginia Medicaid School Division Manual, Department of
					 Medical Assistance Services.
Policy Manual: Definitions of Priority Mental Health
					 Populations, POLICY 1029(SYS)90 - 2
The ASAM Criteria: Treatment Criteria for Addictive,
					 Substance-Related, and Co-Occurring Conditions, Third Edition, American Society
					 of Addiction Medicine, Inc., 4601 North Park Avenue, Upper Arcade, Suite 101
					 Chevy Chase, Maryland 20815, www.asam.org
Diagnostic and Statistical Manual of Mental Disorders:
					 DSM-5, Fifth Edition, 2013, American Psychiatric Association, 1000 Wilson
					 Boulevard, Arlington, Virginia 22209, www.psych.org
Medicaid Memo: Updates to Telemedicine Coverage, May 13,
					 2014, Department of Medical Assistance Services
Department of Behavioral Health and Developmental Services
					 Opioid Medication Assisted Treatment License and Oversight (eff.
					 3/2017)
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 135 - DEMONSTRATION WAIVER SERVICES › Part I - Family Planning Waiver (Repealed) › Section 12VAC30-135-10

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part I - Family Planning Waiver (Repealed) › Section 12VAC30-135-20

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part I - Family Planning Waiver (Repealed) › Section 12VAC30-135-30

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part I - Family Planning Waiver (Repealed) › Section 12VAC30-135-40

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part I - Family Planning Waiver (Repealed) › Section 12VAC30-135-50

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part I - Family Planning Waiver (Repealed) › Section 12VAC30-135-60

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part I - Family Planning Waiver (Repealed) › Section 12VAC30-135-70

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part I - Family Planning Waiver (Repealed) › Section 12VAC30-135-80

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part I - Family Planning Waiver (Repealed) › Section 12VAC30-135-90

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-100

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-110

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-120

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-130

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-140

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-150

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-160

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-170

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-180

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-190

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-200

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-210

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-220

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-230

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-240

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-250

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-260

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-270

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-280

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-290

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-300

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-310

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-320

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-340

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section 12VAC30-135-360

Current through Register Vol. 40, No. 24, July 15, 2024
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 135 - DEMONSTRATION WAIVER SERVICES › Part II - Children's Mental Health Waiver › Section - DOCUMENTS INCORPORATED BY REFERENCE (12VAC30-135)

Current through Register Vol. 40, No. 24, July 15, 2024
Child Adolescent Functional Assessment Scale (Uniform
					 Assessment Instrument), Functional Assessment Systems, 2000.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-400

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-410

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-420

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-430

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-440

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-450

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-460

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-470

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-475

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-480

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-485

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-487

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-489

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-491

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-494

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-495

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-496

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section 12VAC30-135-498

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 135 - DEMONSTRATION WAIVER SERVICES › Part III - Governor's Access Plan Demonstration Waiver for Individuals with Serious Mental Illness › Section

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325
						of the Code of Virginia;
						42 USC §
													1315 and 42 USC § 1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part I - General Provisions › Section 12VAC30-141-20 - Administration and general background

Current through Register Vol. 40, No. 24, July 15, 2024
A. The state shall use funds provided under
				  Title XXI for obtaining coverage that meets the requirements for a State Child
				  Health Insurance Plan (also known as Title XXI).
B. The DMAS director will have the authority
				  to contract with entities for the purpose of establishing a centralized
				  processing site, determining eligibility, enrolling eligible children into
				  health plans, performing outreach, data collection, reporting, and other
				  services necessary for the administration of the Family Access to Medical
				  Insurance Security Plan.
C. Health
				  care services under FAMIS shall be provided through MCHIPs and through
				  fee-for-service or through any other health care delivery system deemed
				  appropriate by the Department of Medical Assistance Services.
Statutory Authority: §
												32.1-351
						of the Code of Virginia;
						42 USC §
													1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part I - General Provisions › Section 12VAC30-141-30 - Outreach and public participation

Current through Register Vol. 40, No. 24, July 15, 2024
A. DMAS will work cooperatively with other
				  state agencies and contractors to ensure that federal law and any applicable
				  federal regulations are met.
B.
				  DMAS shall develop a comprehensive marketing and outreach effort. The marketing
				  and outreach efforts will be aimed at promoting the FAMIS and Medicaid programs
				  and increasing enrollment and may include contracting with a public relations
				  firm, nonprofit agencies, and foundations; coordination with other state
				  agencies; coordination with the business community; and coordination with
				  health care associations and providers.
C. DMAS shall ensure consultation by Native
				  American tribes on the development and implementation of enrollment processes
				  and procedures to exempt cost-sharing for American Indian and Alaskan Native
				  children in compliance with
				  42 CFR
				  457.120 and 42 CFR 457.125.
Statutory Authority: §
												32.1-351
						of the Code of Virginia;
						42 USC §
													1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part II - Appeal of Adverse Actions › Section 12VAC30-141-50 - Notice of adverse action or adverse benefit determination

Current through Register Vol. 40, No. 24, July 15, 2024
A. The local
				  department of social services, CPU, or DMAS shall send written notification to
				  enrollees at least 10 calendar days prior to suspension or termination of
				  enrollment.
B. DMAS or the MCO
				  shall send written notification to enrollees at least 10 calendar days prior to
				  reduction, suspension, or termination of a previously authorized health
				  service.
C. The local department of
				  social services, CPU, DMAS, or the MCO shall send written notification to
				  applicants and enrollees of all other adverse actions within 10 calendar days
				  of the adverse action.
D. Notice
				  shall include:
1. The determination the LDSS,
				  CPU, DMAS, or MCO has made or intends to make;
2. The reasons for the determination,
				  including the right of the enrollee to be provided, upon request and free of
				  charge, reasonable access to and copies of all documents, records, and other
				  information relevant to the determination;
3. An explanation of applicable rights to
				  request an appeal of that determination. For adverse benefit determinations by
				  an MCO, this shall include information on the MCO's internal appeal process
				  and, after the internal appeal process is exhausted, a state fair hearing
				  pursuant to 42 CFR 402(b) and 42 CFR 402(c);
4. The procedure for exercising these appeal
				  rights;
5. The circumstances under
				  which an appeal process can be expedited and how to request it; and
6. The circumstances under which enrollment
				  or services may continue pending appeal, how to request benefits be continued,
				  and the circumstances, consistent with state policy, under which the enrollee
				  may be required to pay the costs of these services.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part II - Appeal of Adverse Actions › Section 12VAC30-141-60 - Request for review

Current through Register Vol. 40, No. 24, July 15, 2024
A. Requests
				  for review of MCHIP adverse actions shall be submitted in writing to the
				  MCHIP.
B. Requests for review of
				  adverse actions made by the local department of social services, the CPU, or
				  DMAS shall be submitted in writing to DMAS.
C. Any written communication clearly
				  expressing a desire to have an adverse action reviewed shall be treated as a
				  request for review.
D. To be
				  timely, requests for review of a MCHIP determination shall be received by the
				  MCHIP no later than 30 calendar days from the date of the MCHIP's notice of
				  adverse action.
E. To be timely,
				  requests for review of a local department of social services, DMAS, or CPU
				  determination shall be filed with DMAS no later than 30 calendar days from the
				  date of the CPU's, LDSS' or DMAS' notice of adverse action. Requests for review
				  of a local department of social services, DMAS, or CPU determination shall be
				  considered filed with DMAS on the date the request is postmarked, if mailed, or
				  on the date the request is received, if delivered other than by mail, by
				  DMAS.
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 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part III - Eligibility Determination and Application Requirements › Section 12VAC30-141-100 - General conditions of eligibility

Current through Register Vol. 40, No. 24, July 15, 2024
A. An LDSS, DMAS, or the CPU determines
				  eligibility for Title XXI services.
B. FAMIS shall be in effect
				  statewide.
C. FAMIS serves targeted
				  low-income children consistent with requirements at
				  42 CFR
				  457.310, 42 CFR 457.315, and
				  42 CFR
				  457.320.
D. Each individual covered under the plan
				  shall be:
1. Financially eligible to receive
				  services as established using the methods and standards described in subsection
				  F of this section; and
2. Meet the
				  applicable nonfinancial eligibility conditions.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part III - Eligibility Determination and Application Requirements › Section 12VAC30-141-110 - Duration of eligibility and renewal

Current through Register Vol. 40, No. 24, July 15, 2024
A. The effective date of FAMIS eligibility
				  shall be the date of birth for a newborn deemed eligible under
				  12VAC30-141-100
				  G. For all other children, the effective date of FAMIS eligibility shall be the
				  first day of the month in which a signed completed application was received by
				  either the LDSS or CPU if the applicant met all eligibility requirements in
				  that month. In no case shall a child's eligibility be effective earlier than
				  the date of the child's birth.
B.
				  Eligibility for FAMIS will continue for 12 months so long as the child remains
				  a resident of Virginia and the child's countable income does not exceed 200% of
				  the federal poverty level. A child born to a mother who was enrolled in FAMIS,
				  under either the Title XXI Plan or a related waiver (such as FAMIS MOMS), on
				  the date of the child's birth shall remain eligible for one year regardless of
				  income unless otherwise found to be eligible for Medicaid. A change in
				  eligibility will be effective the first of the month following expiration of a
				  10-calendar-day advance notice. Eligibility based on all eligibility criteria
				  listed in
				  12VAC30-141-100
				  D will be redetermined no less often than annually.
C. Renewal of coverage.
1. Renewal of coverage for individuals whose
				  financial eligibility is based on the applicable modified adjusted gross income
				  (MAGI) standard are performed as follows, consistent with
				  42 CFR
				  457.343:
a.
				  Renewal of coverage is completed once every 12 months, and
b. Without requiring information from the
				  individual if able to do so based on an ex parte review of reliable information
				  contained in the individual's account or other more current information
				  available to the agency.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part III - Eligibility Determination and Application Requirements › Section 12VAC30-141-120

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-351
						of the Code of Virginia;
						42 USC §
													1396 et
						seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part III - Eligibility Determination and Application Requirements › Section 12VAC30-141-130 - Nondiscriminatory provisions

Current through Register Vol. 40, No. 24, July 15, 2024
FAMIS shall be conducted in compliance with all civil
					 rights requirements. FAMIS shall not:
1. Discriminate during the eligibility
				  determination process on the basis of diagnosis;
2. Cover children of higher income without
				  first covering children with a lower family income within a defined group of
				  covered targeted low-income children; and
3. Deny eligibility based on a child having a
				  preexisting medical condition.
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 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part III - Eligibility Determination and Application Requirements › Section 12VAC30-141-140 - No entitlement

Current through Register Vol. 40, No. 24, July 15, 2024
In accordance with § 2102(b)(4) of the Social
					 Security Act and § 32.1-353 of the Code of Virginia, FAMIS shall not
					 create any entitlement for, right to, or interest in payment of medical
					 services on the part of any medically indigent child or any right or
					 entitlement to participation.
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 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part III - Eligibility Determination and Application Requirements › Section 12VAC30-141-150 - Application requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Availability of program information. DMAS or its designee shall furnish the
				  following information in written form and orally as appropriate to all
				  applicants and to other individuals who request it:
1. The eligibility requirements;
2. Summary of covered benefits;
3. Copayment amounts required; and
4. The rights and responsibilities of
				  applicants and enrollees.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part IV - Cost Sharing › Section 12VAC30-141-160 - Copayments for families not participating in FAMIS Select

Current through Register Vol. 40, No. 24, July 15, 2024
A. Copayments shall
				  apply to all enrollees in an MCHIP.
B. These cost-sharing provisions shall be
				  implemented with the following restrictions:
1. Total cost sharing for each 12-month
				  eligibility period shall be limited to (i) for families with incomes equal to
				  or less than 150% of federal poverty level (FPL), the lesser of (a) $180 and
				  (b) 2.5% of the family's income for the year (or 12-month eligibility period);
				  and (ii) for families with incomes greater than 150% of FPL, the lesser of $350
				  and 5.0% of the family's income for the year (or 12-month eligibility
				  period).
2. DMAS or its designee
				  shall ensure that the annual aggregate cost sharing for all FAMIS enrollees in
				  a family does not exceed the aforementioned caps.
3. Families will be required to submit
				  documentation to DMAS or its designee showing that their maximum copayment
				  amounts are met for the year.
4.
				  Once the cap is met, DMAS or its designee will issue a new eligibility card
				  excluding such families from paying additional copays for the 12-month
				  enrollment period.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part IV - Cost Sharing › Section 12VAC30-141-175 - FAMIS Select

Current through Register Vol. 40, No. 24, July 15, 2024
A. Enrollees in
				  FAMIS may, but shall not be required to, enroll in a private or
				  employer-sponsored health plan if DMAS or its designee determines that such
				  enrollment is cost effective, as defined in this section.
B. Eligibility determination. FAMIS children
				  may elect to receive coverage under a health plan purchased privately or
				  through an employer and DMAS may elect to provide coverage by paying all or a
				  portion of the premium if all of the following conditions are met:
1. The children are determined to be eligible
				  for FAMIS;
2. The cost of coverage
				  for the child under FAMIS Select is equal to or less than the Commonwealth's
				  cost of obtaining coverage under FAMIS only for the eligible targeted
				  low-income children involved. The cost-effectiveness determination methodology
				  is described in subsection E of this section;
3. The policyholder agrees to assign rights
				  to benefits under the private or employer-sponsored health plan to DMAS to
				  assist the Commonwealth in pursuing these third-party payments for childhood
				  immunizations. When a child is provided coverage under a private or
				  employer-sponsored health plan, that plan becomes the payer for all other
				  services covered under that plan; and
4. The policyholder is not under a court
				  order to provide medical support for the applicant child.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part IV - Cost Sharing › Section 12VAC30-141-180 - Liability for excess benefits; liability for excess benefits or payments obtained without intent; recovery of FAMIS payments

Current through Register Vol. 40, No. 24, July 15, 2024
A. Any person who, without the intent to
				  violate this section, obtains benefits or payments under FAMIS to which he is
				  not entitled shall be liable for any excess benefits or payments received. If
				  the enrollee knew or reasonably should have known that he was not entitled to
				  the excess benefits, he may also be liable for interest on the amount of the
				  excess benefits or payments at the judgment rate as defined in §
				  6.1-330.54 of the Code of Virginia from the date upon which excess benefits or
				  payments to the date on which repayment is made to the Commonwealth. No person
				  shall be liable for payment of interest, however, when excess benefits or
				  payments were obtained as a result of errors made solely by DMAS or its
				  designee.
B. Any payment
				  erroneously made on behalf of a FAMIS enrollee or former enrollee may be
				  recovered by DMAS from the enrollee or the enrollee's income, assets, or estate
				  unless state or federal law or regulation otherwise exempts such
				  property.
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 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part V - Benefits and Reimbursement › Section 12VAC30-141-200 - Benefit packages

Current through Register Vol. 40, No. 24, July 15, 2024
The Commonwealth's Title XXI State Plan utilizes two
					 benefit packages within FAMIS as set forth in the FAMIS State Plan, as may be
					 amended from time to time. One package is a modified Medicaid look-alike
					 component offered through a fee-for-service program ; the other package is
					 modeled after the state employee health plan and delivered by contracted
					 MCHIPs.
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 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part V - Benefits and Reimbursement › Section 12VAC30-141-210 to 12VAC30-141-490 - Reserved

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part V - Benefits and Reimbursement › Section 12VAC30-141-510 to 12VAC30-141-550 - Reserved

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 141 - FAMILY ACCESS TO MEDICAL INSURANCE SECURITY PLAN › Part VI - Quality Assurance and Utilization Control › Section 12VAC30-141-560 - Quality assurance

Current through Register Vol. 40, No. 24, July 15, 2024
A. Each
				  provider entity shall meet requirements for the following either as
				  administered by DMAS or as determined by contract with DMAS: access to
				  well-child health services, immunizations, provider network adequacy, a system
				  to provide enrollees urgent care and emergency services, systems for
				  complaints, grievances and reviews, a data management system and quality
				  improvement programs and activities.
B. Each MCHIP shall meet requirements
				  determined by the contract for the internal and external quality monitoring and
				  reporting of access to services, timeliness of services, and appropriateness of
				  services, as determined by DMAS.
Statutory Authority
§§ 32.1-324 and 32.1-325 of the Code of
						Virginia.