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Virginia Administrative Code
Title 12. Health
Title 12. Health
Agency 30. Department of Medical Assistance Services
11/23/2024

Chapter 10.
State Plan under Title XIX of the Social Security Act Medical Assistance Program; General Provisions
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  • Part III.
    Services; General Provisions
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    • Section 140
    Amount, duration, and scope of services: Categorically needy
    Section 150
    Amount, duration, and scope of services: Medically needy
    Section 160
    Amount, duration, and scope of services: Other required special groups
    Section 170
    Amount, duration, and scope of services: Limited coverage for certain aliens
    Section 180
    Amount, duration, and scope of services: Homeless individuals
    Section 190
    Amount, duration, and scope of services: Presumptively eligible pregnant women
    Section 200
    Amount, duration, and scope of services: EPSDT services
    Section 210
    Amount, duration, and scope of services: Comparability of services
    Section 220
    Amount, duration, and scope of services: home health services
    Section 230
    Amount, duration, and scope of services: Assurance of transportation
    Section 240
    Amount, duration, and scope of services: payment for nursing facility services
    Section 250
    Amount, duration, and scope of services: Methods and standards to assure quality of services
    Section 260
    Amount, duration, and scope of services: Family planning services
    Section 270
    Amount, duration, and scope of services: Optometric services
    Section 280
    Amount, duration, and scope of services: Organ transplant procedures
    Section 290
    Amount, duration, and scope of services: Participation by Indian Health Service facilities
    Section 300
    Amount, duration, and scope of services: Respiratory care services for ventilator-dependent individuals
    Section 310
    Coordination of Medicaid with Medicare and other insurance: Premiums
    Section 320
    Coordination of Medicaid with Medicare and other insurance: Deductibles/coinsurance
    Section 325
    Premiums, deductibles, coinsurance and other cost sharing obligations
    Section 330
    Medicaid for individuals age 65 or over in institutions for mental diseases
    Section 340
    Special requirements applicable to sterilization procedures
    Section 350
    Families receiving extended Medicaid benefits
    Section 360
    [Reserved]
  • Part IV.
    General Program Administration
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    • Section 400
    Methods of administration
    Section 410
    Hearings for applicants and recipients
    Section 420
    Safeguarding information on applicants and recipients
    Section 430
    Medicaid quality control
    Section 435
    Medicaid prohibition on payments to institutions or entities located outside of the United States
    Section 440
    Medicaid Agency Fraud Detection and Investigation Program
    Section 441
    Medicaid agency fraud detection and investigation program
    Section 445
    Recovery audit contractors
    Section 450
    Reports
    Section 460
    Maintenance of records
    Section 470
    Availability of agency program manuals
    Section 480
    Reporting provider payments to Internal Revenue Service
    Section 490
    Free choice of providers
    Section 500
    Relations with standard-setting and survey agencies
    Section 510
    Consultation to medical facilities
    Section 520
    Required provider agreement
    Section 530
    Utilization and quality control
    Section 540
    Inspection of care in intermediate care facilities for persons with intellectual and developmental disabilities, facilities providing inpatient...
    Section 550
    Relations with state health and vocational rehabilitation agencies and Title V grantees
    Section 560
    Liens and recoveries
    Section 570
    Recipient cost sharing and similar charges
    Section 580
    Payment for services
    Section 590
    Direct payments to certain recipients for physicians' or dentists' services
    Section 600
    Prohibition against reassignment of provider claims
    Section 610
    Third party liability
    Section 620
    Use of contracts
    Section 630
    [Repealed]
    Section 631
    Standards for payment for nursing facility and intermediate care facility for the mentally retarded services
    Section 640
    Program for licensing administrators of nursing homes
    Section 650
    Drug Utilization Review Program
    Section 660
    Disclosure of survey information and provider or contractor evaluation
    Section 670
    Appeals process
    Section 680
    Conflict of interest provisions
    Section 690
    Exclusion of providers and suspension of practitioners and other individuals
    Section 700
    Disclosure of information by providers and fiscal agents
    Section 710
    Income and eligibility verification system
    Section 720
    Medicaid eligibility cards for homeless individuals
    Section 730
    Systematic alien verification for entitlements
    Section 740
    [Repealed]
    Section 750
    [Repealed]
    Section 751
    Enforcement of compliance for nursing facilities
    Section 760
    Pharmacy services rebate agreement terms
    Section 770
    Required coordination between the Medicaid and WIC Programs
    Section 780
    Nurse aide training and competency evaluation for nursing facilities
    Section 790
    Preadmission screening and annual resident review in nursing facilities
    Section 800
    Survey and certification process
    Section 810
    Resident assessment for nursing facilities
    Section 815
    Cooperation with Medicaid Integrity Program efforts
    Section 820
    Employee education about false claims recoveries

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