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Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
 
Board
Board of Medical Assistance Services
 
chapter
Standards Established and Methods Used to Assure High Quality Care [12 VAC 30 ‑ 60]
 
Guidance Documents
Chapter Information
Description This chapter contains the Medicaid requirements applicable to specific services which must be met in order to assure appropriate quality of care.
State Authority COV 32.1-325 et seq .
Federal Authority Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
Text of Regulation Link to Virginia Administrative Code
Goals of Regulation None entered
Meetings

Contact Information
Name / Title: Emily McClellan  / Regulatory Supervisor
Address: Policy Division, DMAS
600 E. Broad Street, Suite 1300
Richmond, VA 23219
Email Address: Emily.McClellan@DMAS.Virginia.gov
Telephone: (804)371-4300    FAX: (804)786-1680    TDD: ()-
Current Actions
Action Title Latest Stage Status
Repeal of Case Management Services for Recipients of Auxiliary Grants Fast-Track Comment period is underway and will end on 06/04/2025.
Electronic Visit Verification (EVV) for Home Health and Waiver Services Fast-Track Attorney General review in progress.
Service Authorization Fast-Track Attorney General review in progress.

Past Actions
Action Title Latest Stage Status
Repeal of the Documents Incorporated by Reference – Chapter 60 Fast-Track Stage complete. This regulation became effective on 09/26/2024.
2020 Long Term Services and Supports (LTSS) Screening Changes Fast-Track Stage complete. This regulation became effective on 10/10/2024.
Mental Health and Substance Use Case Management Fast-Track Stage complete. This regulation became effective on 01/02/2025.
Addiction and Recovery Treatment and Substance Use Disorder Services Updates Fast-Track Stage complete. This regulation became effective on 12/08/2022.
Electronic Visit Verification Final Stage complete. This regulation became effective on 08/18/2021.
Home Health Changes Due to Federal Regulatory Change
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 08/19/2020.
Change from Service Specific Provider Intake to Comprehensive Needs Assessment Fast-Track Stage complete. This regulation became effective on 03/17/2022.
LTSS Screening - Remove Three-Day Allowance After Hospital Discharge
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 12/25/2019.
Removal of the 21 Out of 60 Day Limit Fast-Track Stage complete. This regulation became effective on 10/30/2020.
CMH and Peers Updates Fast-Track Stage complete. This regulation became effective on 04/14/2021.
ARTS Updates Fast-Track Stage complete. This regulation became effective on 03/05/2020.
CMHRS Documentation of Qualifications Fast-Track Stage complete. This regulation became effective on 12/26/2019.
EPSDT Behavioral Therapy Services Final Stage complete. This regulation became effective on 12/12/2018.
2015 Long Term Services and Supports Screening Changes Final Stage complete. This regulation became effective on 08/22/2018.
Home Health Accrediting Organizations Fast-Track Stage complete. This regulation became effective on 10/19/2017.
VIDES Criteria for care in Intermediate Care Facilities for Individuals with Intellectual Disability Fast-Track Stage complete. This regulation became effective on 02/07/2019.
Revision for CMS Conditions of Participation
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 01/13/2018.
Face-to-Face Encounter Requirement for Home Health
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/13/2017.
Institutions for Mental Disease Reimbursement Changes Final Stage complete. This regulation became effective on 03/08/2017.
Mental Health Skill-building Services Final Stage complete. This regulation became effective on 07/27/2016.
Repeal MEDALLION Primary Care Case Management Program Fast-Track Stage complete. This regulation became effective on 03/28/2014.
2011 Mental Health Services Program Changes for Appropriate Utilization & Provider Qualifications Final Stage complete. This regulation became effective on 01/30/2015.
Uniform Assessment Instrument Pediatric Guidance Fast-Track Stage complete. This regulation became effective on 02/01/2014.
Technical Corrections for Utilization Review of Community Mental Health Rehabilitation Services Fast-Track Stage complete. This regulation became effective on 09/12/2013.
Inpatient and Outpatient Rehabilitation Update Fast-Track Stage complete. This regulation became effective on 01/01/2016.
Children's Exemption from Hospice Election
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 11/10/2010.
Elimination of Disease Management Program
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 11/26/2009.
Substance Abuse Treatment Services Final Stage complete. This regulation became effective on 01/21/2010.
Disease Management Program Final Stage complete. This regulation became effective on 07/09/2009.
Additional NF Reimbursement for Stage IV Pressure Ulcers Final Stage complete. This regulation became effective on 08/09/2006.
Revision of Physician Certification Standards Fast-Track Stage complete. This regulation became effective on 08/15/2005.
Discontinue Adult Specialized Care Services Reimbursement Final Stage complete. This regulation became effective on 07/01/2004.
Home Health Services -- Technical Correction
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 11/28/2003.
Community Mental Health Rehabilitation Services Final Stage complete. This regulation became effective on 12/03/2003.
NF Administrative Criteria
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 06/20/2002.
Limit Coverage of Out-of-State Inpatient Hospital Services Final Stage complete. This regulation became effective on 01/02/2002.
Home Health Services Homebound Criterion
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 02/27/2002.
Case Management for Treatment Foster Care Final Stage complete. This regulation became effective on 01/01/2001.
Coverage of Medical Nutrition Therapy NOIRA Stage withdrawn on 06/13/2002 prior to submission to DPB.
Hospice Services and Payment Methodology Final Stage complete. This regulation became effective on 01/05/2000.

Withdrawn Actions
Action Title Latest Stage Status
2020 Long Term Services and Supports (LTSS) Screening Changes Fast-Track Stage withdrawn on 08/09/2022 before Attorney General's office completed its review.
Utilization Review Changes Final Stage withdrawn on 04/15/2021 after the Governor's office completed its review.
CMHRS Changes Required by CMS NOIRA Stage withdrawn on 11/29/2018 after the comment period had ended.
Utilization Control: Nursing Facilities - Contract Termination Fast-Track Stage withdrawn on 08/07/2018 prior to submitting for AG review.
Physician Face to Face Encounter for Home Health/DME Certification
Final Stage withdrawn on 10/13/2016 prior to submitting for AG review.
Nursing Facility Criteria and Recipient Eligibility
Final Stage withdrawn on 11/12/2013 before submission to the Registrar.
CH 0060 UAI for Children
Medicaid Works, a Medicaid Buy-In Program Emergency/NOIRA Stage withdrawn on 01/16/2007 after Attorney General's review.
Mental Health Services Program Changes to Ensure Appropriate Utilization and Provider Qualifications Emergency/NOIRA Stage withdrawn on 01/13/2012 prior to submitting for AG review.

Periodic Reviews
Last Activity Status
3/7/2012 Agency Completed Amend