Action:
Removal of the 21 Out of 60 Day Limit
Action 5331
General Information
| Action Summary |
This action is necessary to comply with the Centers for Medicare & Medicaid Services (CMS) Medicaid Mental Health Parity Rule, issued on March 30, 2016. The overall objective of the Medicaid Mental Health Parity Rule is to ensure that accessing mental health and substance use disorder services is no more difficult than accessing medical/surgical services.To comply with the Medicaid Mental Health Parity Rule, the Department of Medical Assistance Services (DMAS) must remove the limit of 21 days per admission in a 60 day period for the same or similar diagnosis or treatment plan for psychiatric inpatient hospitalization, as this limit for coverage of non-psychiatric admissions was removed on July 1, 1998. (Medicaid managed care plans do not apply the limit of 21 out of 60 days, and both the limit and the change only apply to fee for service.) Psychiatric inpatient hospitalizations must be service authorized based on medical necessity and not be limited to 21 days per admission in a 60 day period. The citation for the federal regulation to remove the "21 out of 60 day limit" can be found in 42 CFR 438.910(b)(1).
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| Chapters Affected |
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VAC |
Chapter Name |
Action Type |
| Primary |
12 VAC 30-50 |
Amount, Duration, and Scope of Medical and Remedial Care and Services |
Amend Existing Regulation
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| Other chapters |
| |
12 VAC 30 - 60 |
Standards Established and Methods Used to Assure High Quality Care |
Amend Existing Regulation
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| Executive Branch Review |
This action will go through the normal Executive Branch Review process.
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| RIS Project |
Yes [006072] |
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Is Federal action a driving factor in this regulatory change? If so, please provide a specific reference to the law, regulation
or court case.
42 CFR 438.910(b)(1)
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| New Periodic Review |
This action will not be used to conduct a new periodic review.
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Stages
Stages associated with this regulatory action.
| Stage ID |
Stage Type |
Status |
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8680
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Fast-Track
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Stage complete. This regulation became effective on 10/30/2020. |
Contact Information
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Name / Title:
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Emily McClellan
/
Regulatory Supervisor
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Address:
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Policy Division, DMAS
600 E. Broad Street, Suite 1300
Richmond, VA 23219
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Email Address:
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Emily.McClellan@DMAS.Virginia.gov
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Phone:
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(804)371-4300
FAX: (804)786-1680
TDD: ()-
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This person is the primary contact for this chapter.
