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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 50. Amount, Duration, and Scope of Medical and Remedial Care Services
11/21/2024

12VAC30-50-180. Clinic services.

A. Reimbursement for induced abortions is provided in only those cases in which there would be a substantial endangerment of life to the mother if the fetus were carried to term.

B. Clinic services means preventive, diagnostic, therapeutic, rehabilitative, or palliative items or services that:

1. Are provided to outpatients;

2. Are provided by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients; and

3. Except in the case of nurse-midwife services, as specified in 42 CFR 440.165, are furnished by or under the direction of a physician or dentist.

C. Reimbursement to community mental health clinics for psychotherapy services is provided only when performed by a qualified therapist. For purposes of this section, a qualified therapist is:

1. A licensed physician who has completed three years of post-graduate residency training in psychiatry; or

2. An individual licensed by one of the boards administered by the Department of Health Professions to provide psychotherapy services including: (i) a licensed clinical psychologist; (ii) a LMHP-RP, as defined in 12VAC30-50-130; (iii) a licensed psychiatric nurse practitioner; (iv) a licensed clinical social worker; (v) a LMHP-S, as defined in 12VAC30-50-130; (vi) a licensed professional counselor; (vii) a LMHP-R, as defined in 12VAC30-50-130; (viii) a clinical nurse specialist-psychiatric; (ix) a licensed marriage and family therapists.

D. Addiction and recovery treatment services shall be covered in clinics consistent with 12VAC30-130-5000 et seq.

Statutory Authority

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

Historical Notes

Derived from VR460-03-3.1100 § 9, eff. July 1, 1989; amended, eff. September 1, 1993; Virginia Register Volume 10, Issue 22, eff. September 1, 1994; Volume 16, Issue 19, eff. July 5, 2000; Volume 20, Issue 19, eff. July 1, 2004; Volume 26, Issue 8, eff. January 21, 2010; Volume 26, Issue 19, eff. July 1, 2010; Volume 33, Issue 12, eff. April 1, 2017; Volume 35, Issue 5, eff. December 13, 2018.

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