Part I. Single State Agency Organization
12VAC30-10-10. Designation and authority.
A. The Department of Medical Assistance Services (DMAS) is the single state agency designated to administer or supervise the administration of the Medicaid program under Title XIX of the Social Security Act. (All references in this plan to "the Medicaid agency" mean the agency named in this subsection.)
12VAC30-20-10 is a certification signed by the State Attorney General identifying the single state agency and citing the legal authority under which it administers or supervises administration of the program.
B. The entire plan under Title XIX is administered or supervised by the state agency named in subsection A of this section.
C. No waivers of the single state agency requirements have ever been granted.
D. Eligibility determinations (including any delegations).
1. The entities that conduct determinations of eligibility for families, adults, and individuals younger than 21 years of age are DMAS, the single state agency under Title IV-A (TANF), and the Exchange, which is a government agency established under § 1311(b)(1) or 1321(c)(1) of the Patient Protection and Affordable Care Act (42 USC § 18001).
2. The entities that conduct determinations of eligibility based on age, blindness, and disability are DMAS and the single state agency under Title IV-A (TANF).
3. DMAS makes the following assurances with regard to eligibility determinations:
a. DMAS is responsible for all Medicaid eligibility determinations.
b. There is a written agreement between DMAS, the Exchange, and the single state agency under Title IV-A. The Exchange and the single state agency under Title IV-A have been delegated authority to determine eligibility for Medicaid eligibility in compliance with 42 CFR 431.10(d).
c. DMAS does not delegate authority to make eligibility determinations to entities other than government entities that maintain personnel standards on a merit basis.
d. The delegated entity is capable of performing the delegated functions.
E. All other provisions of this plan are administered by the Medicaid agency except for those functions for which final authority has been granted to a Professional Standards Review Organization under Title XI of the Act.
F. All other requirements of 42 CFR 431.10 are met.
Statutory Authority
§ 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.
Historical Notes
Subsection (a) derived from VR460-01-2, eff. March 1, 1985; subsection (b) derived from VR460-01-3, eff. October 1, 1976; subsection (c) derived from VR460-01-4, eff. October 1, 1976; subsection (d) derived from VR460-01-5, eff. October 1, 1976; subsections (e) and (f) derived from VR460-01-6, eff. October 1, 1976; Volume 38, Issue 12, eff. March 17, 2022.
12VAC30-10-20. (Repealed.)
Historical Notes
Derived from VR460-01-7, eff. March 1, 1985; amended, Virginia Register Volume 17, Issue 19, eff. August eff. August 1, 2001; Errata, 17:24 VA.R. August 13, 2001; repealed, Virginia Register Volume 38, Issue 12, eff. March 17, 2022.
12VAC30-10-30. Statewide operation.
The plan is in operation on a Statewide basis in accordance with all requirements of 42 CFR 431.50.
The plan is State administered.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all other applicable statutory and regulatory sections.
Historical Notes
Derived from VR460-01-8, eff. October 18, 1974.
12VAC30-10-40. State Medical Care Advisory Committee.
A. There is an advisory committee to the Medicaid agency director on health and medical care services established in accordance with and meeting all the requirements of 42 CFR 431.12.
B. Tribal consultation. Section 1902(a)(73) of the Social Security Act requires a state in which one or more Indian health programs or Urban Indian organizations furnish health care services to establish a process for the state Medicaid agency to seek advice on a regular, ongoing basis from designees of Indian health programs, whether operated by the Indian Health Service, a Tribe, or Tribal organizations under the Indian Self-Determination and Education Assistance Act (P.L. 93-638) or Urban Indian Organizations under the Indian Health Care Improvement Act (25 USC § 1601 et seq.), concerning Medicaid matters having a direct impact on Indian health programs.
C. The Department of Medical Assistance Services (DMAS) seeks advice on an ongoing basis from federally recognized tribes, Indian health programs, and Urban Indian organizations on matters related to Medicaid and Children's Health Insurance Program programs. DMAS has identified a program designee as an advisory contact, through which the dissemination of information will occur. Designees from each Tribe, Indian health program, and Urban Indian organization receive written communication from DMAS about State Plan amendments, waiver proposals, waiver extensions, waiver amendments, and waiver renewals before any of these documents are submitted to the Centers for Medicare and Medicaid Services. Tribes, Indian health programs, and Urban Indian organizations may request additional information and may request meetings to discuss the proposed changes. DMAS invites these groups to request additional information or offer comments on proposed changes within 30 days of the notification of State Plan amendments, waiver proposals, waiver extensions, waiver amendments, or waiver renewals. For emergency-related submissions, such as a natural disaster or a legislative mandate, DMAS seeks information requests, comments, or proposed changes within 15 days of notification. The coordination of this consultation process was established through an email communication with designees from each Tribe and Indian health program on January 29, 2021. To maintain a cooperative channel of communication and informative dialogue between DMAS and the Tribal organizations, the agency sought out and will continue to seek advice on a regular, ongoing basis via email, teleconference, or meetings.
Statutory Authority
§ 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.
Historical Notes
Derived from VR460-01-9, eff. October 18, 1974; amended, Virginia Register Volume 38, Issue 4, eff. November 11, 2021.
12VAC30-10-50. Pediatric immunization program.
A. The state has implemented a program for the distribution of pediatric vaccines to program-registered providers for the immunization of federally vaccine-eligible children in accordance with § 1928 as indicated below.
1. The state program will provide each vaccine-eligible child with medically appropriate vaccines according to the schedule developed by the Advisory Committee on Immunization Practices and without charge for the vaccines.
2. The state will outreach and encourage a variety of providers to participate in the program and to administer vaccines in multiple settings, e.g., private health care providers, providers that receive funds under Title V of the Indian Health Care Improvement Act, health programs or facilities operated by Indian tribes, and maintain a list of program-registered providers.
3. With respect to any population of vaccine-eligible children a substantial portion of whose parents have limited ability to speak the English language, the state will identify program-registered providers who are able to communicate with this vaccine-eligible population in the language and cultural context which is most appropriate.
4. The state will instruct program-registered providers to determine eligibility in accordance with § 1928(b) and (h) of the Social Security Act.
5. The state will assure that no program-registered provider will charge more for the administration of the vaccine than the regional maximum established by the Secretary. The state will inform program-registered providers of the maximum fee for the administration of vaccines.
6. The state will assure that no vaccine-eligible child is denied vaccines because of an inability to pay an administration fee.
7. Except as authorized under § 1915(b) of the Social Security Act or as permitted by the Secretary to prevent fraud or abuse, the state will not impose any additional qualifications or conditions, in addition to those indicated above, in order for a provider to qualify as a program-registered provider.
B. The state has not modified or repealed any immunization law in effect as of May 1, 1993, to reduce the amount of health insurance coverage of pediatric vaccines.
C. The state Medicaid agency has coordinated with the state public health agency in the completion of this preprint page.
D. The state agency with overall responsibility for the implementation and enforcement of the provisions of § 1928 is the State Public Health Agency.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all other applicable statutory and regulatory sections.
Historical Notes
Derived from VR460-01-9.1, eff. October 1, 1994.