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Department of Medical Assistance Services
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Board of Medical Assistance Services


chapter
Amount, Duration, and Scope of Medical and Remedial Care and Services [12 VAC 30 ‑ 50]
Guidance Documents   Periodic Reviews
Chapter Information
Description This chapter contains all of the services covered by Medicaid and the limits placed upon them.
State Authority COV 32.1-325 et seq et seq.
Federal Authority Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
Exempt from APA No, changes to this chapter are subject to the Administrative Process Act and the standard executive branch review process.
Text of Regulation Link to Virginia Administrative Code
Goals of Regulation None entered
Meetings

Contact Information
Name / Title: Brian McCormick  / Regulatory Supervisor
Address: 600 E. Broad Street
Suite 1300
Richmond, VA 23219
Email Address: Brian.McCormick@DMAS.Virginia.gov
Telephone: (804)371-8856    FAX: (804)786-1680   
Current Actions
Action Title Latest Stage Status
Discontinue Coverage of Benzodiazepines-Barbiturates for Dual Eligible Individuals Fast-Track Secretary of Health and Human Resources review in progress.
2011 Mental Health Services Program Changes for Appropriate Utilization & Provider Qualifications Final Secretary of Health and Human Resources review in progress.
EPSDT Applied Behavior Analysis Therapy Services Proposed Secretary of Health and Human Resources review in progress.
Early Intervention (Part C) Case Management Fast-Track Secretary of Health and Human Resources review in progress.
Inpatient and Outpatient Rehabilitation Update Fast-Track Secretary of Health and Human Resources review in progress.
Signature Requirement for Medical Records Emergency/NOIRA Governor's office has completed its review - Next step is Submission to the Registrar.
Physician Face to Face Encounter for Home Health Certification Final Not yet submitted to Attorney General for certification.
Prior Authorization for Dental Services - -
Abortion Services - -
Case Management for Mental Health Services - -
Coverage of Medical Nutrition Therapy - -
Medicare Prescription Drug Program (Part D) - -
Optional Family Planning Services and Group - -
Program of All Inclusive Care for the Elderly (PACE) - -
Discontinue Coverage of Erectile Dysfunction Drugs for Sex Offenders - -
Coverage of Substance Abuse Treatment Services - -

Past Actions
Action Title Latest Stage Status
Institutions for Mental Disease Reimbursement Changes Proposed Not yet submitted to Attorney General for certification.
Mental Health Skill-building Services Proposed Attorney General review in progress.
Part D Coverage of Benzodiazepines and Barbiturates Fast-Track Stage complete. This regulation became effective on 1/2/2014.
Smoking Cessation Services for Pregnant Women Final Stage complete. This regulation became effective on 2/27/2013.
2010 Durable Medical Equipment (DME) Changes Final Stage complete. This regulation became effective on 7/1/2012.
CH 0080 Pharmacy Supplemental Rebate/Unit Dose Fee/Drug Threshold Fast-Track Stage complete. This regulation became effective on 1/16/2014.
Coverage and Reimbursement of Early Intervention Services under Part C of IDEA Final Stage complete. This regulation became effective on 10/25/2012.
Children's Exemption from Hospice Election Final Stage complete. This regulation became effective on 11/10/2010.
Amount, Duration and Scope of Services - Abortion Services Final Stage complete. This regulation became effective on 7/1/2010.
Community Mental Health Services Prior Authorization Final Stage complete. This regulation became effective on 2/16/2011.
Nurse Practitioners Authorization of DME Final Stage complete. This regulation became effective on 1/1/2010.
Prior Authorization of Intensive In-Home Services Final Stage complete. This regulation became effective on 3/3/2010.
Substance Abuse Treatment Services Final Stage complete. This regulation became effective on 1/21/2010.
Attorney General Regulatory Reform Task Force Changes Final Stage complete. This regulation became effective on 4/15/2009.
Program of All Inclusive Care (PACE) as State Plan Service Fast-Track Stage complete. This regulation became effective on 2/5/2009.
Hearing Aid Services for Children Final Stage complete. This regulation became effective on 1/1/2008.
IFDDS Waiver Changes Final Stage complete. This regulation became effective on 7/11/2007.
Medicare Prescription Drug Program (Part D) Final Stage complete. This regulation became effective on 3/7/2007.
Program of All-Inclusive Care for the Elderly (PACE) Fast-Track Stage complete. This regulation became effective on 7/1/2007.
Prior Authorization for Dental Services Final Stage complete. This regulation became effective on 7/1/2006.
Medicaid and FAMIS Prior Authorization Fast-Track Stage complete. This regulation became effective on 7/3/2006.
Add Community-Based Residential Services as covered Medicaid services Final Stage complete. This regulation became effective on 1/25/2006.
Non-Emergency Transportation as a Medical Expense Final Stage complete. This regulation became effective on 7/1/2005.
Discontinue Coverage of Erectile Dysfunction Drugs for Sex Offenders Emergency/NOIRA Stage complete. Emergency regulation expired on 5/26/2006.
PDL, P&T Com, Drug Rebates, UR of High Drug Thresholds Final Stage complete. This regulation became effective on 1/3/2005.
Add Marriage and Family Therapists as Enrolled Providers Final Stage complete. This regulation became effective on 7/1/2004.
Community Mental Health Rehabilitation Services Final Stage complete. This regulation became effective on 12/3/2003.
Prior Authorization for MRI, CAT and PET Scans Emergency Stage complete. Emergency regulation expired on 6/30/2004.
Coverage of Stretcher Vans as Non-emergency Transportation Emergency Stage complete. Emergency regulation expired on 6/30/2004.
34-Day Supply of Prescription Drugs Final Stage complete. This regulation became effective on 7/1/2002.
Dental Services Final Stage complete. This regulation became effective on 7/1/2002.
Limit Coverage of Out-of-State Inpatient Hospital Services Final Stage complete. This regulation became effective on 1/2/2002.
Coverage of Ocular Prosthetics Final Stage complete. This regulation became effective on 12/5/2001.
Individual and Family Developmental Disabilities Support Waiver Final Stage complete. This regulation became effective on 7/1/2001.
Transportation Services as an Administrative Expense Final Stage complete. This regulation became effective on 7/2/2001.
Residential Psychiatric Treatment under EPSDT Final Stage complete. This regulation became effective on 1/1/2001.
Case Management for Treatment Foster Care Final Stage complete. This regulation became effective on 1/1/2001.
Expansion of School-Based Services for Special Education Children Final Stage complete. This regulation became effective on 1/1/2001.
Clinic Services: Mental Health Clinic Provider Qualifications Final Stage complete. This regulation became effective on 7/5/2000.
2000 Omnibus Amendments: HIV eligibility expansion, organ transplant coverage expansion, colorectal cancer screenings coverage. Final Stage complete. This regulation became effective on 7/1/2000.
Program of All-Inclusive Care for the Elderly (PACE) Final Stage complete. This regulation became effective on 7/1/2000.
Hospice Services and Payment Methodology Final Stage complete. This regulation became effective on 1/5/2000.
Amount, Duration, and Scope of Services Pharmacy Services: Pharmacy Infusion Services Proposed Stage complete. Comment period ended 11/10/2000.
Pharmacy Services: Coverage of Weight Loss Drugs Final Stage complete. This regulation became effective on 9/1/1999.
Preventive Services: Maternal Length of Stay Final Stage complete. This regulation became effective on 10/1/1999.
Coverage of Organ Transplant Services: Technical Amendment Final Stage complete. This regulation became effective on 9/15/1999.
Coverage of Leukemia Diagnoses under Bone Marrow/Stem Cell Transplantation Final Stage complete. This regulation became effective on 7/1/1999.

Withdrawn Actions
Action Title Latest Stage Status
Freestanding Birthing Centers Final Stage withdrawn prior to submitting for AG review.
Expand Coverage of School Health Assessments -
CH 0050 Chap 50 Freestanding Birthing Centers -
Cover Special DME in Nursing Facilities -
Mental Health Services Program Changes to Ensure Appropriate Utilization and Provider Qualifications Emergency/NOIRA Stage withdrawn on 1/13/2012 after the comment period had ended.
Pediatric Dental Program Proposed Stage withdrawn before DPB completed its review.
Restore Elderly Case Management -
2001 Technical Amendments Final Stage withdrawn before submission to the Registrar.
2000 Hospital Technical Amendments Final Stage withdrawn before submission to the Registrar.
Home Health Services Durable Medical Equipment -
2000 Technical Amendments Final Stage withdrawn before submission to the Registrar.