Administrative Code

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Virginia Administrative Code
Title 12. Health
Title 12. Health
Agency 30. Department Of Medical Assistance Services
10/28/2021

Chapter 50. Amount, Duration, and Scope of Medical and Remedial Care ServicesRead Chapter

  • Part I. Categorically NeedyRead all
  • Section 10
    Services provided to the categorically needy with limitations
    Section 20
    Services provided to the categorically needy without limitation
    Section 30
    Services not provided to the categorically needy
    Section 35
    Requirements relating to payment for covered outpatient drugs for the categorically needy
  • Part II. Ambulatory Services; Medically NeedyRead all
  • Section 40
    Ambulatory services
    Section 50
    Services provided to the medically needy with limitations
    Section 60
    Services provided to all medically needy groups without limitations
    Section 70
    Services or devices not provided to the medically needy
    Section 75
    Requirements relating to payment for covered outpatient drugs for the medically needy
    Section 80
    [Reserved]
    Section 95
    Reimbursement of services; in general
  • Part III. Amount, Duration, and Scope of ServicesRead all
  • Section 100
    Inpatient hospital services provided at general acute care hospitals and freestanding psychiatric hospitals; enrolled providers
    Section 105
    Inpatient hospital services provided at general acute care hospitals and freestanding psychiatric hospitals; nonenrolled providers (nonparticipating/out of state)
    Section 110
    Outpatient hospital and rural health clinic services
    Section 120
    Other laboratory and x-ray services
    Section 130
    Nursing facility services, EPSDT, including school health services and family planning
    Section 131
    Services provided by certified Early Intervention practitioners under EPSDT
    Section 140
    Physician's services whether furnished in the office, the patient's home, a hospital, a skilled nursing facility, or elsewhere
    Section 150
    Medical care by other licensed practitioners within the scope of their practice as defined by state law
    Section 160
    Home health services
    Section 165
    Durable medical equipment suitable for use in the home
    Section 170
    Private duty nursing services
    Section 180
    Clinic services
    Section 190
    Dental services
    Section 200
    Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders
    Section 210
    Prescribed drugs, dentures, and prosthetic devices, and eyeglasses prescribed by a physician skilled in diseases of the eye or by an optometrist
    Section 220
    Diagnostic, screening, preventive, and rehabilitative services other than those provided elsewhere in this plan
    Section 225
    Rehabilitative services; intensive physical rehabilitation, and CORF services
    Section 226
    Community mental health services
    Section 227
    Lead contamination
    Section 228
    [Repealed]
    Section 229
    [Reserved]
    Section 229.1
    [Repealed]
    Section 230
    Services for individuals age 65 or older in institutions for mental diseases
    Section 240
    Intermediate care services and intermediate care services for institutions for mental disease and mental retardation
    Section 250
    Inpatient psychiatric facility services for individuals under 21 years of age
    Section 260
    Nurse-midwife services
    Section 270
    Hospice services (in accordance with § 1905 (o) of the Act)
    Section 280
    Case management services for high-risk pregnant women and children up to age 1, as defined in 12VAC30-50-410, in accordance with § 1915 (g)(1) of ...
    Section 290
    Extended services to pregnant women
    Section 300
    Any other medical care and any other type of remedial care recognized under state law, specified by the Secretary of Health and Human Services
    Section 310
    Emergency services for aliens
    Section 320
    Program of All-Inclusive Care for the Elderly (PACE)
    Section 321
    Eligibility for PACE enrollees
    Section 325
    Rates and payments
    Section 328
    PACE enrollment and disenrollment
    Section 330
    PACE definitions
    Section 335
    General PACE plan requirements
    Section 340
    Criteria for PACE enrollment
    Section 345
    PACE enrollee rights
    Section 350
    PACE enrollee responsibilities
    Section 355
    PACE plan contract requirements and standards
    Section 360
    PACE sanctions
  • Part IV. Case Management ServicesRead all
  • Section 410
    Case management services for high risk pregnant women and children
    Section 415
    Case management for individuals receiving early intervention (Part C) services
    Section 420
    Case management services for seriously mentally ill adults and emotionally disturbed children
    Section 430
    Case management services for youth at risk of serious emotional disturbance
    Section 440
    Support coordination/case management services for individuals with intellectual disability
    Section 450
    [Repealed]
    Section 460
    [Repealed]
    Section 470
    Case management for recipients of auxiliary grants
    Section 480
    Case management for foster care children
    Section 490
    Support coordination/case management for individuals with developmental disabilities
    Section 491
    Substance use case management services for individuals who have a primary diagnosis of substance use disorder
  • Part V. Expanded Prenatal Care ServicesRead all
  • Section 510
    Requirements and limits applicable to specific services: expanded prenatal care services
  • Part VI. Drugs or Drug CategoriesRead all
  • Section 520
    Drugs or drug categories which are not covered
  • Part VIII. Organ Transplant ServicesRead all
  • Section 540
    Kidney transplantation (KT)
    Section 550
    Corneal transplantation
    Section 560
    Liver, heart, lung, allogeneic and autologous bone marrow transplantation
    Section 570
    High dose chemotherapy and bone marrow/stem cell transplantation (coverage for persons over 21 years of age)
    Section 580
    Other medically necessary transplantation procedures that are determined to not be experimental or investigational (coverage for persons younger ...
FORMS
FORMS (12VAC30-50)
DIBR
DOCUMENTS INCORPORATED BY REFERENCE (12VAC30-50)

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