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Table of Contents » Title 12. Health » Agency 30. Department of Medical Assistance Services » Chapter 120. Waivered Services » Part VI. Medallion Mandatory Managed Care » 12VAC30-120-395. Preauthorized, emergency, and post-stabilization services and payment rate for care provided by out-of-network providers.

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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 120. Waivered Services

11/21/2024

12VAC30-120-395. Preauthorized, emergency, and post-stabilization services and payment rate for care provided by out-of-network providers.

The MCOs shall pay for preauthorized, emergency, and post-stabilization services to members in compliance with the contract and 42 CFR 438.114. Preauthorized, emergency, and post-stabilization services provided to a managed care member by a provider or facility not participating in the MCO's network will be reimbursed according to the current Medicaid fee schedule. This reimbursement shall be considered payment in full to the provider or facility of emergency services.

Statutory Authority

§ 32.1-325 of the Code of Virginia; 42 USC § 1396.

Historical Notes

Derived from Virginia Register Volume 13, Issue 5, eff. January 1, 1997; amended, Virginia Register Volume 19, Issue 3, eff. December 1, 2002; Volume 19, Issue 23, eff. August 27, 2003; Volume 32, Issue 22, eff. July 27, 2016; Volume 35, Issue 14, eff. April 18, 2019.

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