Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 70. Methods and Standards for Establishing Payment Rates; In-Patient Hospital Care
8/19/2022

FORMS (12VAC30-70).

Computation of Inpatient Operating Cost, HCFA-2552‑92 D-1 (12/92).

Apportionment of Cost of Services Rendered by Interns and Residents, HCFA-2552‑92 D-2 (12/92).

Cost Reporting Forms for Hospitals (Map 783 Series), eff. 10/15/93

Certification by Officer or Administrator of Provider

Analysis of Interim Payments for Title XIX Services

Computation of Title XIX Ratio of Cost to Charges

Computation of Inpatient and Outpatient Ancillary Service Costs

Computation of Outpatient Capital Reduction

Computation of Title XIX Outpatient Costs

Computation of Charges for Lower of Cost or Charge Comparison

Computation of Title XIX Reimbursement Settlement

Computation of Net Medicaid Inpatient Operating Cost Adjustment

Calculation of Medicaid Inpatient Profit Incentive for Hospitals

Plant Costs

Education Costs

Obstetrical Care Requirements Certification

Computation for Separating the Allowable Plant and Education Cost (pass-throughs) from the Inpatient Medicaid Hospital Costs

Cost Reporting Form Residential Treatment Facilities, RTF-608 (undated, filed 9/2016)

Graduate Medical Education Application (eff. 8/2019)

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