Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
1/25/2020

Chapter 130. Amount, Duration, and Scope of Selected ServicesRead Chapter

Section 10
[Repealed]
Section 15
[Repealed]
Section 20
[Repealed]
Section 30
[Repealed]
Section 40
[Repealed]
Section 42
[Repealed]
Section 50
[Repealed]
Section 60
[Repealed]
Section 70
[Repealed]
Section 80
Scope
Section 90
Authorization for services
Section 100
Criteria for long-stay acute care hospital stays
Section 110
Documentation requirements
Section 120
Long-stay acute care hospital services
Section 130
Long-stay acute care hospital requirements
Section 140
Definitions
Section 150
Persons subject to nursing home preadmission screening and identification of conditions of mental illness and mental retardation (Level I)
Section 160
Level II determination
Section 170
Categorical determinations
Section 180
Annual resident review
Section 190
Determinations and placement of individuals with MI or MR/RC
Section 200
PASARR evaluation criteria
Section 210
Specialized services
Section 220
Placement options
Section 230
Evaluating the need for NF services and NF level of care (PASARR/NF)
Section 240
Evaluating whether an individual with MI requires specialized services (PASARR/MI)
Section 250
Evaluating whether an individual with MR/RC requires specialized services (PASARR/MR)
Section 260
Appeals
Section 270
Definitions
Section 280
Authority
Section 290
Scope and purpose
Section 300
Retrospective DUR
Section 310
Prospective DUR
Section 320
Criteria and standards for DUR
Section 330
Educational program
Section 335
Other interventions
Section 340
DUR Board
Section 350
DUR Committee
Section 360
Exemption of organized health care settings
Section 370
[Repealed]
Section 380
Definitions
Section 390
Scope
Section 400
Utilization review process
Section 410
[Repealed]
Section 420
Medical quality assurance
Section 430
Introduction
Section 440
Definitions
Section 450
Patient assessment criteria
Section 460
Directions for applying the criteria
Section 470
[Repealed]
Section 540
[Repealed]
Section 550
[Repealed]
Section 560
[Repealed]
Section 565
[Repealed]
Section 570
[Repealed]
Section 580
[Repealed]
Section 590
[Repealed]
Section 600
Definitions
Section 610
Purpose and scope
Section 620
Limitations
Section 630
[Repealed]
Section 730
[Repealed]
Section 740
General
Section 750
Time frames for determining cost effectiveness
Section 760
Notices
Section 770
[Reserved]
Section 780
[Repealed]
Section 790
Information required of applicants and recipients
Section 800
Definitions
Section 810
Client Medical Management Program for individuals
Section 820
Client Medical Management Program for providers
Section 850
[Repealed]
Section 860
[Repealed]
Section 870
[Repealed]
Section 880
[Repealed]
Section 890
[Repealed]
Section 900
Definitions
Section 910
Targeted case management for foster care children in treatment foster care (TFC) covered services
Section 920
Provider qualifications
Section 930
Organization and administration requirements
Section 940
Discharge from care
Section 950
Entries in case records
Section 1000
Pharmacy services prior authorization
Section 2000
Marketing requirements and restrictions
Section 3000
[Repealed]
Section 3010
[Repealed]
Section 3020
[Repealed]
Section 3030
[Repealed]
Section 5000
Addiction and recovery treatment services
Section 5010
Addiction and recovery treatment services; purpose
Section 5020
Definitions
Section 5030
Eligible individuals
Section 5040
Covered services: requirements; limits; standards
Section 5050
Covered services: clinic services - opioid treatment services
Section 5060
Covered services: clinic services - office-based opioid treatment
Section 5070
Covered services: practitioner services - early intervention/screening brief intervention and referral to treatment (ASAM Level 0.5)
Section 5080
Covered services: outpatient services - physician services (ASAM Level 1.0)
Section 5090
Covered services: community based services - intensive outpatient services (ASAM Level 2.1)
Section 5100
Covered services: community based care - partial hospitalization services (ASAM Level 2.5)
Section 5110
Covered services: clinically managed low intensity residential services (ASAM Level 3.1)
Section 5120
Covered services: clinically managed population - specific high intensity residential service (ASAM Level 3.3)
Section 5130
Covered services: clinically managed high intensity residential services (adult) and clinically managed medium intensity residential services...
Section 5140
Covered services: medically monitored intensive inpatient services (adult) and medically monitored high intensity inpatient services (adolescent)...
Section 5150
Covered services: medically managed intensive inpatient services (ASAM Level 4.0)
Section 5160
Peer support services and family support partners: definitions
Section 5170
Peer support services and family support partners: service definitions
Section 5180
Peer support services and family support partners: medical necessity criteria
Section 5190
Peer support services and family support partners: provider and setting requirements
Section 5200
Peer support services and family support partners: documentation of required activities
Section 5210
Peer support services and family support partners: limitations and exclusions to service delivery
FORMS
FORMS (12VAC30-130)
DIBR
DOCUMENTS INCORPORATED BY REFERENCE (12VAC30-130)

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