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Virginia Administrative Code
Title 12. Health
Title 12. Health
Agency 30. Department of Medical Assistance Services
12/22/2024

Chapter 60.
Standards Established and Methods Used to Assure High Quality Care
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Section 5
Applicability of utilization review requirements.
Section 10
Institutional care
Section 20
Utilization control: general acute care hospitals; enrolled providers
Section 21
Utilization control of nonparticipating out-of-state inpatient hospitals
Section 25
Utilization control: freestanding psychiatric hospitals
Section 30
Utilization control: Long-stay acute care hospitals (nonmental hospitals)
Section 40
Utilization control: Nursing facilities
Section 50
Utilization control: Intermediate care facilities for persons with intellectual and developmental disabilities and institutions for mental disease
Section 60
[Repealed]
Section 61
Services related to the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT); community mental health and behavioral therapy services for youth
Section 65
Electronic visit verification
Section 70
Utilization control: home health services
Section 75
Durable medical equipment (DME) and supplies
Section 80
Utilization control: Optometrists' services
Section 90
[Repealed]
Section 100
Utilization control: Incorporation of specialized quality standards
Section 110
Utilization control: Effect of geographic boundaries on provision of care
Section 120
Quality management: Intensive physical rehabilitative services and  comprehensive outpatient rehabilitation facility services
Section 130
Hospice services
Section 140
Community mental health services
Section 143
Mental health services utilization criteria; definitions
Section 145
Mental retardation utilization criteria
Section 147
[Repealed]
Section 150
Quality management review of outpatient rehabilitation therapy services
Section 160
Utilization review of case management for recipients of auxiliary grants
Section 170
Utilization review of treatment foster care case management services
Section 180
[Repealed]
Section 181
Utilization review of addiction and recovery treatment services
Section 185
Utilization review of substance use case management
Section 200
Ticket to Work and Work Incentives Improvement Act (TWWIIA) basic coverage group: alternative benefits for Medicaid Buy-In program
Section 300
[Repealed]
Section 301
Definitions
Section 302
Access to Medicaid-funded long-term services and supports
Section 303
Screening criteria for Medicaid-funded long-term services and supports
Section 304
Requests and referrals for LTSS screening for adults and children living in the community; adults and children in hospitals; and adults and children in nursing facilities
Section 305
Screenings in the community and hospitals and nursing facilities for Medicaid-funded long-term services and supports
Section 306
Submission of LTSS screenings
Section 307
[Repealed]
Section 308
Nursing facility admission for LTSS and level of care determination requirements
Section 310
Competency training and testing requirements
Section 312
[Repealed]
Section 313
Individuals determined to not meet criteria for Medicaid-funded long-term services and supports
Section 315
Periodic evaluations for individuals receiving Medicaid-funded long-term services and supports
Section 316
Criteria for continued nursing facility care using the Minimum Data Set (MDS)
Section 318
Definitions to be applied when completing the MDS
Section 320
Adult ventilation/tracheostomy specialized care criteria
Section 330
[Reserved]
Section 340
Pediatric and adolescent specialized care criteria
Section 350
Criteria for coverage of specialized treatment beds
Section 360
[Repealed]
Section 361
Criteria for supports and services in intermediate care facilities for individuals with intellectual disabilities
Section 500
[Repealed]
FORMS
FORMS (12VAC30-60)
DIBR
[Repealed]

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