Administrative Code

Creating a Report: Check the sections you'd like to appear in the report, then use the "Create Report" button at the bottom of the page to generate your report. Once the report is generated you'll then have the option to download it as a pdf, print or email the report.

Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 80. Methods and Standards for Establishing Payment Rate; Other Types of Care
5/20/2022

12VAC30-80-170. Payment of Medicare Part A and Part B Deductible/Coinsurance.

Except for a nominal recipient copayment (as specified in 12VAC30-20-150 and 12VAC30-20-160), if applicable, the Medicaid agency uses the following general method for payment:

1. Payments are limited to state plan rates and payment methodologies for the groups and payments listed below and designated with the letters "SP."

For specific Medicare services which are not otherwise covered by this state plan, the Medicaid agency uses Medicare payment rates unless a special rate or method is set out.

Not applicable. There are no special rates or methods used for specific Medicare services which are not otherwise covered by this state plan.

2. Payments are up to the full amount of the Medicare rate for the groups and payments listed below and designated with the letters "MR."

3. Payments are up to the amount of a special rate, or according to a special method, for the groups and payments listed below and designated with the letters "NR."

4. Any exceptions to the general methods used for a particular group or payment are specified.

Payment of Medicare Part A and Part B Deductible/Coinsurance

QMBs:

Part A

SP

Deductibles

SP

Coinsurance

Part B

SP

Deductibles

SP

Coinsurance

Other Medicaid Recipients
(Other Dual Eligibles)

Part A

SP

Deductibles

SP

Coinsurance

Part B

SP

Deductibles

SP

Coinsurance

Dual Eligible
(QMB Plus)

Part A

SP

Deductibles

SP

Coinsurance

Part B

SP

Deductibles

SP

Coinsurance

Statutory Authority

§ 32.1-325 of the Code of Virginia.

Historical Notes

Derived from VR460-03-4.1922, eff. June 16, 1993; amended, Virginia Register Volume 12, Issue 5, eff. December 5, 1995; Volume 12, Issue 18, eff. July 1, 1996; Volume 15, Issue 18, eff. July 1, 1999.

Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.

As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.