Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 5. Department of Health
Chapter 200. Regulations Governing Eligibility Standards and Charges for Medical Care Services to Individuals
6/25/2022

12VAC5-200-90. Charges for services.

Charges for services means the reasonable charges established by the board for medical care services. No charge shall be established outside the provisions of these regulations. The department may prescribe a scale of discounts for certain medical care services. Charges will be based on current published Medicaid reimbursement levels. In those instances where Medicaid does not reimburse for a service provided by the department, charges shall be based on the appropriate current Medicare reimbursement levels. Where neither Medicaid nor Medicare reimburse for a service, the commissioner shall establish charges based on the costs of providing the medical care services. Charges for goods and services not directly provided by the agency may be based on the agency's cost.

Directors of health districts may request permission from the commissioner, or commissioner's designee, to round charges to a convenient value.

On selected occasions it may be desirable to provide certain medical services, e.g., influenza immunization, to large numbers of people quickly and conveniently and thereby promote their use by the public. In order to accomplish this, districts may charge a flat rate charge for these services under these circumstances. This provision includes services that are otherwise available at a discounted charge. No eligibility determination will be done and all service recipients will be charged the same flat rate charge. However, the district must also provide convenient alternative times and venues where applicants can request an eligibility determination and obtain these services at a discounted rate if eligible. The commissioner or commissioner's designee must approve such flat rate charge arrangements in advance, including approval of the specific flat rate charge.

Statutory Authority

§§ 32.1-11 and 32.1-12 of the Code of Virginia.

Historical Notes

Derived from VR355-39-100 § 3.2, eff. December 1, 1993; amended, Virginia Register Volume 20, Issue 22, eff. August 11, 2004.

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