Part IV. Case Management Services
12VAC30-50-410. Case management services for high risk pregnant women and children.
A. Target Group: To reimburse case management services for high-risk Medicaid eligible pregnant women and children up to age 2.
B. Services will be provided to the entire state.
C. Comparability of Services: Services are not comparable in amount, duration, and scope. Authority of section 1915(g)(1) of the Act is invoked to provide services without regard to the requirements of section 1902(a)(10)(B) of the Act.
D. Definition of Services: The case management services will provide maternal and child health coordination to minimize fragmentation of care, reduce barriers, and link clients with appropriate services to ensure comprehensive, continuous health care. The Maternity Care Coordinator will provide:
1. Assessment-Determining clients' service needs, which include psychosocial, nutrition, medical, and educational factors.
2. Service Planning-Developing an individualized description of what services and resources are needed to meet the service needs of the client and help access those resources.
3. Coordination & Referral-Assisting the client in arranging for appropriate services and ensuring continuity of care.
4. Follow-up & Monitoring-Assessing ongoing progress and ensuring services are delivered.
5. Education & Counseling-Guiding the client and developing a supportive relationship that promotes the service plan.
E. Qualifications of Providers: Any duly enrolled provider which the Department determines is qualified who has signed an agreement with Department of Medical Assistance Services to deliver Maternity Care Coordination services. Qualified service providers will provide case management regardless of their capacity to provide any other services under the Plan. A Maternity Care Coordinator is the Registered Nurse or Social Worker employed by a qualified service provider who provides care coordination services to eligible clients. The RN must be licensed in Virginia and should have a minimum of one year of experience in community health nursing and experience in working with pregnant women. The Social Worker (MSW, BSW) must have a minimum of one year of experience in health and human services, and have experience in working with pregnant women and their families. The Maternity Care Coordinator assists clients in accessing the health care and social service system in order that outcomes which contribute to physical and emotional health and wellness can be obtained.
F. The State assures that the provision of case management services will not restrict an individual's free choice of providers in violation of § 1902(a)(23) of the Act.
1. Eligible recipients will have free choice of the providers of case management services.
2. Eligible recipients will have free choice of the providers of other medical care under the plan.
G. Payment for case management services under the plan does not duplicate payments made to public agencies or private entities under other program authorities for this same purpose.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all other applicable statutory and regulatory sections.
Historical Notes
Derived from VR460-03-3.1102 § 1, eff. May 1, 1994.
12VAC30-50-415. Case management for individuals receiving early intervention (Part C) services.
A. Target group for early intervention case management. Medicaid eligible children from birth up to three years of age who have (i) a 25% developmental delay in one or more areas of development, (ii) atypical development, or (iii) a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay who participate in the early intervention services system described in Chapter 53 (§ 2.2-5300 et seq.) of Title 2.2 of the Code of Virginia are the target group.
B. Services are provided throughout the Commonwealth.
C. Services are not comparable in amount, duration, and scope. The authority of § 1915(g)(1) of the Social Security Act (the Act) is invoked to provide services without regard to the requirements of § 1902(a)(10)(B) of the Act.
D. Definition of services. Early intervention case management services are services furnished to assist individuals eligible under the State Plan who reside in a community setting in gaining access to medical, social, educational, and other services. Early intervention case management includes the following assistance:
1. Comprehensive assessment and at least annual reassessment of individual needs to determine the need for any medical, educational, social, or other services, including EPSDT services.
2. Development and at least annual revision of an individualized family service plan (IFSP) as defined in coverage of early intervention services under Part C of Individuals with Disabilities Education Act (IDEA) (12VAC30-50-131) based on the information collected through the assessment. A face-to-face contact with the child's family is required for the initial development and revision of the IFSP. The case manager shall be responsible for determining if the family's particular situation warrants additional face-to-face visits.
3. Referral and related activities to help the eligible individual obtain needed services, including activities that help link the individual with medical, social, and educational providers or other programs and services that are capable of providing needed services to address identified needs and achieve goals specified in the IFSP.
4. Monitoring and follow-up activities, including activities and contacts that are necessary to ensure that the IFSP is effectively implemented and adequately addresses the needs of the eligible individual. At a minimum one telephone, email, or face-to-face contact shall be made with the child's family every three calendar months, or attempts of such contacts. This contact or attempted contact shall be documented. The case manager shall be responsible for determining if the family's particular situation warrants additional family contacts.
5. Early intervention case management includes contacts with family members, service providers, and other noneligible individuals and entities who have direct knowledge of the eligible individual's needs and care.
E. Qualifications of providers. Individual providers of early intervention case management must be certified as early intervention case managers by the Department of Behavioral Health and Developmental Services.
F. Freedom of choice. The Commonwealth assures that the provision of case management services will not restrict an eligible individual's freedom of choice of providers.
1. Eligible recipients shall have free choice of the providers of early intervention case management services within the specified geographic area identified in this plan.
2. Eligible recipients shall have free choice of the providers of other medical care under the plan.
3. Providers of early intervention case management shall be limited to entities designated by the local lead agencies under contract with the Department of Behavioral Health and Developmental Services pursuant to § 2.2-5304.1 of the Code of Virginia.
G. Access to services. The Commonwealth assures the following:
1. Case management services shall be provided in a manner consistent with the best interest of recipients and shall not be used to restrict an individual's access to other Medicaid services.
2. Individuals shall not be compelled to receive case management services. The receipt of other Medicaid services shall not be a condition for the receipt of case management services, and the receipt of case management services shall not be a condition for receipt of other Medicaid services.
3. Providers of case management services do not exercise DMAS authority to authorize or deny the provision of other Medicaid services.
H. Payment for early intervention case management services shall not duplicate payments made to public agencies or private entities under other program authorities for this same purpose.
I. Case records. Case management services shall be documented and maintained in individual case records in accordance with 42 CFR 441.18(a)(7). Case records shall include:
1. The name of the individual;
2. The dates of the case management services;
3. The name of the provider agency and the person providing the case management services;
4. The nature, content, and units of the case management services received and whether the goals specified in the care plan have been achieved;
5. Whether the individual has declined services in the care plan;
6. The need for, and occurrences of, coordination with other case managers;
7. A timeline for obtaining needed services; and
8. A timeline for reevaluation of the plan.
J. Limitations.
1. Early intervention case management shall not include the following:
a. Activities not consistent with the definition of case management services in 42 CFR 440.169.
b. The direct delivery of an underlying medical, educational, social, or other service to which an eligible individual has been referred.
c. Activities integral to the administration of foster care programs.
d. Activities for which third parties are liable to pay, except for case management that is included in an IFSP consistent with § 1903(c) of the Social Security Act.
2. Providers shall not be reimbursed for case management services provided for these groups when these children also fall within the target group for early intervention case management as set out in this subdivision:
a. Seriously mentally ill adults and emotionally disturbed children (12VAC30-50-420);
b. Youth at risk of serious emotional disturbance (12VAC30-50-430);
c. Individuals with intellectual disability (12VAC30-50-440); or
d. Individuals with intellectual disability and related conditions who are participants in the home and community-based care waivers for persons with intellectual disability and related conditions (12VAC30-50-450).
3. Case management shall be reimbursed only when all of the following conditions are met:
a. A least one documented case management service is furnished during the month; and
b. The provider is certified by the Department of Behavioral Health and Developmental Services and enrolled with DMAS as an early intervention case management provider.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 31, Issue 9, eff. February 13, 2015.
12VAC30-50-420. Case management services for seriously mentally ill adults and emotionally disturbed children.
A. Target group for case management services for seriously mentally ill adults and emotionally disturbed children. The Medicaid-eligible individual shall meet the definition for "serious mental illness" pursuant to 42 CFR 483.102(b)(1) or "serious emotional disturbance in children and adolescents" pursuant to Appendix A of the Department of Behavioral Health and Developmental Services (DBHDS) Core Services Taxonomy 7.3.
1. An active client for case management shall mean an individual for whom there is a plan of care in effect that requires regular direct or client-related contacts or communication or activity with the client, family, service providers, significant others, and others, including at least one face-to-face contact every 90 days. Billing can be submitted for an active client only for months in which direct or client-related contacts, activity, or communications occur. Authorization is required for Medicaid reimbursement.
2. There shall be no maximum service limits for case management services. In accordance with 42 CFR 441.18(a)(8)(vii), reimbursement is allowed for case management services for Medicaid-eligible individuals who are in institutions, with the exception of individuals who are 22 years of age to 64 years of age and are served in institutions of mental diseases (IMDs) and individuals of any age who are inmates of public institutions. An IMD is a facility that is primarily engaged in the treatment of mental illness and has more than 16 beds in accordance with § 1905(i) of the Social Security Act.
3. For individuals who are 22 years of age to 64 years of age, services rendered during the same month as the admission to the IMD are reimbursable as long as the service was rendered prior to the date of the admission.
4. Case management services for individuals who are younger than 22 years of age or older than 64 years of age in an IMD may be billed 30 calendar days prior to discharge as long as the case management services do not duplicate other services provided by the institution.
B. Services for seriously mentally ill adults and emotionally disturbed children will be provided to the entire state.
C. Comparability of case management services for seriously mentally ill adults and emotionally disturbed children. Services are not comparable in amount, duration, or scope. Authority of § 1915(g)(1) of the Social Security Act is invoked to provide services without regard to the requirements of § 1902(a)(10)(B) of the Social Security Act.
D. Definition of case management services for seriously mentally ill adults and emotionally disturbed children. Case management services assist individual children and adults in accessing needed medical, psychiatric, social, educational, vocational, and other supports essential to meeting basic needs. Services to be provided include:
1. Assessment and planning services, to include developing an individual service plan (ISP) (does not include performing medical and psychiatric assessment but does include referral for such assessment);
2. Linking the individual to services and supports specified in the ISP;
3. Assisting the individual directly for the purpose of locating, developing, or obtaining needed services and resources;
4. Coordinating services and service planning with other agencies and providers involved with the individual;
5. Enhancing community integration by contacting other entities to arrange community access and involvement, including opportunities to learn community living skills and use vocational, civic, and recreational services;
6. Making collateral contacts with the individual's significant others to promote implementation of the service plan and community adjustment;
7. Follow-up and monitoring to assess ongoing progress and to ensure services are delivered; and
8. Education and counseling that guides the client and develops a supportive relationship that promotes the service plan.
E. Qualifications of providers of case management services for seriously mentally ill adults and emotionally disturbed children.
1. Services are not comparable in amount, duration, or scope. Authority of § 1915(g)(1) of the Social Security Act is invoked to limit case management providers for individuals with a developmental disability and individuals with serious or chronic mental illness to the Community Services Boards only to enable them to provide services to individuals with a developmental disability or serious or chronic mental illness without regard to the requirements of § 1902(a)(10)(B) of the Social Security Act.
2. To qualify as a provider of services through DMAS for rehabilitative mental health case management, the provider of the services must meet the following criteria:
a. The provider must have the administrative and financial management capacity to meet state and federal requirements;
b. The provider must have the ability to document and maintain individual case records in accordance with state and federal requirements;
c. The services shall be in accordance with the Virginia Comprehensive State Plan;
d. The provider must be licensed as a provider of case management services by DBHDS;
e. Persons providing case management services must have knowledge of:
(1) Services, systems, and programs available in the community, including primary health care, support services, eligibility criteria and intake processes, generic community resources, and mental health, developmental disability, and substance abuse treatment programs;
(2) The nature of serious mental illness, developmental disability, and substance abuse depending on the population served, including clinical and developmental issues;
(3) Different types of assessments, including functional assessments, and their uses in service planning;
(4) Treatment modalities and intervention techniques, such as behavior management, independent living skills training, supportive counseling, family education, crisis intervention, discharge planning, and service coordination;
(5) The service planning process and major components of a service plan;
(6) The use of medications in the care or treatment of the population served; and
(7) All applicable federal and state laws, state regulations, and local ordinances;
f. Persons providing case management services must have skills in:
(1) Identifying and documenting an individual's needs for resources, services, and other supports;
(2) Using information from assessments, evaluations, observation, and interviews to develop ISPs;
(3) Identifying services and resources within the community and established service system to meet the individual's needs and documenting how resources, services, and natural supports, such as family, can be utilized to achieve an individual's personal habilitative or rehabilitative and life goals; and
(4) Coordinating the provision of services by public and private providers; and
g. Persons providing case management services must have abilities to:
(1) Work as team members, maintaining effective inter-agency and intra-agency working relationships;
(2) Work independently, performing position duties under general supervision; and
(3) Engage in and sustain ongoing relationships with individuals receiving services.
3. Providers may bill Medicaid for mental health case management only when the services are provided by qualified mental health case managers.
F. The state ensures that the provision of case management services will not restrict an individual's free choice of providers in violation of § 1902(a)(23) of the Social Security Act.
1. Eligible recipients will have free choice of the providers of case management services.
2. Eligible recipients will have free choice of the providers of other medical care under the plan.
G. Payment for case management services under the plan shall not duplicate payments made to public agencies or private entities under other program authorities for this same purpose.
H. Case management services may not be billed concurrently with intensive community treatment services, treatment foster care case management services, or intensive in-home services for children and adolescents.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Historical Notes
Derived from VR460-03-3.1102 § 2, eff. May 1, 1994; amended, Virginia Register Volume 20, Issue 7, eff. February 1, 2004; Volume 27, Issue 10, eff. February 16, 2011; Volume 41, Issue 7, eff. January 2, 2025.
12VAC30-50-430. Case management services for youth at risk of serious emotional disturbance.
A. Target group for case management services for youth at risk of serious emotional disturbance. Medicaid-eligible individuals who meet the definition of youth at risk of serious emotional disturbance pursuant to Appendix A of the Department of Behavioral Health and Developmental Services (DBHDS) Core Services Taxonomy 7.3.
1. An active client shall mean an individual for whom there is a plan of care in effect that requires regular direct or client-related contacts or communication or activity with the client, family, service providers, significant others, and others, including at least one face-to-face contact every 90 days. Billing can be submitted for an active client only for months in which direct or client-related contacts, activity, or communications occur. Authorization is required for Medicaid reimbursement.
2. There shall be no maximum service limits for case management services. Case management services must not be billed for individuals who are in institutions for mental diseases, except for the 30 calendar days prior to discharge as long as the case management services do not duplicate other services provided by the institution. Case management services must not be billed for individuals who are inmates of public institutions.
B. Services for youth at risk of serious emotional disturbance will be provided in the entire state.
C. Comparability of case management services for youth at risk of serious emotional disturbance. Services are not comparable in amount, duration, or scope. Authority of § 1915(g)(1) of the Social Security Act is invoked to provide services without regard to the requirements of § 1902(a)(10)(B) of the Social Security Act.
D. Definition of case management services for youth at risk of serious emotional disturbance. Case management services assist youth at risk of serious emotional disturbance in accessing needed medical, psychiatric, social, educational, vocational, and other supports essential to meeting basic needs. Services to be provided include:
1. Assessment and planning services, to include developing an individual service plan (ISP);
2. Linking the individual directly to services and supports specified in the treatment or services plan;
3. Assisting the individual directly for the purpose of locating, developing, or obtaining needed service and resources;
4. Coordinating services and service planning with other agencies and providers involved with the individual;
5. Enhancing community integration by contacting other entities to arrange community access and involvement, including opportunities to learn community living skills and use vocational, civic, and recreational services;
6. Making collateral contacts, which are nontherapy contacts, with an individual's significant others to promote treatment or community adjustment;
7. Following up and monitoring to assess ongoing progress and ensuring services are delivered; and
8. Providing education and counseling that guides the client and develops a supportive relationship that promotes the service plan.
E. Qualifications of providers of case management services for youth at risk of serious emotional disturbance.
1. Services are not comparable in amount, duration, or scope. Authority of § 1915(g)(1) of the Social Security Act is invoked to limit case management providers to the community services boards only to enable them to provide services to individuals with a developmental disability or serious or chronic mental illness without regard to the requirements of § 1902(a)(10)(B) of the Social Security Act. To qualify as a provider of case management services to youth at risk of serious emotional disturbance, the provider of the services must meet the following criteria:
a. The provider must meet state and federal requirements regarding capacity for administrative and financial management;
b. The provider must document and maintain individual case records in accordance with state and federal requirements;
c. The provider must provide services in accordance with the Virginia Comprehensive State Plan;
d. The provider must be licensed as a provider of case management services by DBHDS;
e. Persons providing case management services must have knowledge of:
(1) Services, systems, and programs available in the community, including primary health care, support services, eligibility criteria, and intake processes, generic community resources, and mental health, developmental disability, and substance abuse treatment programs;
(2) The nature of serious mental illness, developmental disability, or substance abuse depending on the population served, including clinical and developmental issues;
(3) Different types of assessments, including functional assessments, and their uses in service planning;
(4) Treatment modalities and intervention techniques, such as behavior management, independent living skills training, supportive counseling, family education, crisis intervention, discharge planning, and service coordination;
(5) The service planning process and major components of a service plan;
(6) The use of medications in the care or treatment of the population served; and
(7) All applicable federal and state laws, state regulations, and local ordinances;
f. Persons providing case management services must have skills in:
(1) Identifying and documenting an individual's need for resources, services, and other supports;
(2) Using information from assessments, evaluations, observation, and interviews to develop ISPs;
(3) Identifying services and resources within the community and established service system to meet the individual's needs and documenting how resources, services, and natural supports, such as family, can be utilized to achieve an individual's personal habilitative or rehabilitative and life goals; and
(4) Coordinating the provision of services by diverse public and private providers; and
g. Persons providing case management services must have abilities to:
(1) Work as team members, maintaining effective inter-agency and intra-agency working relationships;
(2) Work independently performing position duties under general supervision; and
(3) Engage in and sustain ongoing relationships with individuals receiving services.
F. Providers may bill Medicaid for mental health case management to youth at risk of serious emotional disturbance only when the services are provided by qualified mental health case managers.
G. The state ensures that the provision of case management services will not restrict an individual's free choice of providers in violation of § 1902(a)(23) of the Social Security Act.
1. Eligible recipients will have free choice of the providers of case management services.
2. Eligible recipients will have free choice of the providers of other medical care under the plan.
H. Payment for case management services under the plan must not duplicate payments made to public agencies or private entities under other program authorities for this same purpose.
I. Case management may not be billed concurrently with intensive community treatment services, treatment foster care case management services, or intensive in-home services for children and adolescents.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Historical Notes
Derived from VR460-03-3.1102 § 3, eff. May 1, 1994; amended, Virginia Register Volume 20, Issue 7, eff. February 1, 2004; Volume 27, Issue 10, eff. February 16, 2011; Volume 41, Issue 7, eff. January 2, 2025.
12VAC30-50-440. Support coordination/case management services for individuals with intellectual disability.
A. Target Group. Medicaid eligible individuals who have an intellectual disability as defined in § 37.2-100 of the Code of Virginia.
1. An active individual for intellectual disability support coordination/case management shall mean a person for whom there is an individual support plan (ISP) (as defined in 12VAC30-122-20) in effect that requires direct or -related individual-related contacts or communication or activity with the individual, the individual's family or caregiver, service providers, significant others, and others including at least one face-to-face contact with the individual every 90 days. Billing can be submitted for an active individual only for months in which direct or -related individual-related contacts, activity, or communications occur, consistent with the ISP.
2. The unit of service is one month. There shall be no maximum service limits for support coordination/case management services except services for as related to individuals residing in institutions or medical facilities. For these individuals, reimbursement for support coordination/case management shall be limited to 30 days immediately preceding discharge. Support coordination/case management for individuals who reside in an institution may be billed for no more than two predischarge periods within 12 months.
B. Services will be provided in the entire state.
C. Comparability of services: Services are not comparable in amount, duration, and scope. Authority of § 1915(g)(1) of the Social Security Act (the Act) is invoked to provide services without regard to the requirements of § 1902(a)(10)(B) of the Act.
D. Definition of services. Intellectual disability support coordination/case management services to be provided include:
1. Assessment and planning services, to include developing an individual support plan (ISP) as defined on 12VAC30-122-20 and in accordance with the requirements of the Final Rule found at 42 CFR 441.725, which does not include performing medical and psychiatric assessment but does include referral for assessment;
2. Linking the individual to services and supports specified in the ISP;
3. Assisting the individual directly for the purpose of locating, identifying, or obtaining needed services and resources;
4. Coordinating services and service planning with other agencies and providers involved with the individual;
5. Enhancing community integration by contacting other entities to arrange community access and involvement, including opportunities to learn community living skills and to use vocational, civic, and recreational services;
6. Making collateral contacts with the individual's significant others to promote implementation of the ISP and community integration;
7. Following up and monitoring to assess ongoing progress and ensuring services are delivered; and
8. Education and counseling that guides the individual and develops a supportive relationship that promotes the ISP.
E. Qualifications of providers:
1. are not comparable in amount, duration, and scope. Authority of § 1915(g)(1) of the Act is invoked to limit Support coordination/case management providers for individuals with intellectual disability shall be limited to the community services boardsally. References to providers in this section shall refer to enrolled community services boards.
2. To qualify as a provider of services enrolled with DMAS for intellectual disability support coordination/case management, the provider of the services shall meet certain criteria. These criteria shall be:
a. The provider shall guarantee that s individuals have access to emergency services on a 24-hour basis;
b. The provider shall demonstrate the ability to serve individuals in need of comprehensive services regardless of the individual's ability to pay or eligibility for Medicaid reimbursement;
c. The provider shall have the administrative and financial management capacity to meet state and federal requirements;
d. The provider have the ability to shall document and maintain individual case records in accordance with state and federal requirements;
e. The provider shall submit the individual support plan in an electronic format in the state DD home and community-based services (HCBS) waiver management system for service authorization and data management for individuals enrolled in any DD HCBS waiver. The provider shall submit evidence to Department of Medical Assistance Services (DMAS) or the Department of Behavioral Health and Developmental Services (DBHDS) in specified format of follow-up and monitoring to assess ongoing progress of the ISP, ensuring services are delivered and health and safety is maintained;
f. The provider shall participate in activities designed to safeguard participants' health and safety in accordance with approved DD HCBS waiver requirements or DBHDS licensing standards; and
g. The provider shall participate in activities designed to assure ongoing compliance by DD HCBS waiver participants' providers of service subject to the Final Rule Settings Requirements found at 42 CFR 441.301(4) and as described in the approved Statewide Transition Plan;
h. The services shall be in accordance with the Virginia State Plan for Medical Assistance; and
i. The provider must be licensed as a developmental disability support coordination/case management agency by the Department of Behavioral Health and Developmental Services.
3. Providers may bill for Medicaid intellectual disability support coordination/case management only when the services are provided by qualified managers support coordinators/case managers. The manager must support coordinator/case manager shall possess a combination of intellectual disability work experience and relevant education that indicates that the incumbent, at entry level, possesses the knowledge, skills, and abilities listed in this subdivision. These must be documented observable in the application form or supporting documentation or observable and documented during the interview (with appropriate supporting documentation).
a. Knowledge of:
(1) The definition and causes of intellectual disability and best practices in supporting individuals who have intellectual disability;
(2) Treatment modalities and intervention techniques, such as positive behavior supports, person-centered practices, independent living skills training, community inclusion/employment skills, supportive guidance, family education, crisis intervention, discharge planning, and support coordination;
(3) Different types of assessments and their uses in service planning;
(4) Individuals' civil and human rights;
(5) Local community resources and service delivery systems, including support services, eligibility criteria and intake process, termination criteria and procedures, and generic community resources;
(6) Types of intellectual disability programs and services;
(7) Effective oral, written, and interpersonal communication principles and techniques;
(8) General principles of documentation; and
(9) The service planning process and the major components of an ISP.
b. Skills in:
(1) Interviewing;
(2) Negotiating with individuals and service providers;
(3) Observing recording and reporting and documenting an individual's behaviors;
(4) Identifying and documenting an individual's needs for resources, services, and other assistance;
(5) Identifying services within the established service system to meet the individual's needs and preferences;
(6) Coordinating the provision of services for the individual by diverse public and private providers, generic and natural supports;
(7) Using information from assessments, evaluations, observations, and interviews to develop and revise as needed support plans;
(8) Formulating, writing, and implementing ized consumer individual support plans to promote goal attainment and community integration for individuals with intellectual disability;
(9) Using information from assessment tools, evaluations, observations, and interviews to develop and revise as needed individual support plans (for example to ensure the ISP is implemented appropriately, identify change in status or to determine risk of crisis/hospitalization); and
(10) Identifying community resources and organizations and coordinating resources and activities.
c. Abilities to:
(1) Demonstrate a positive regard for individuals and their families (e.g., treating people as individuals, allowing risk taking, avoiding stereotypes of people with intellectual disability, respecting individual and family privacy, and believing individuals can grow and contribute to their communities);
(2) Be persistent and remain objective;
(3) Work as team member, maintaining effective ter- interagency and intra-agency working relationships;
(4) Work independently, performing position duties under general supervision;
(5) Communicate effectively, verbally and in writing; and
(6) Establish and maintain ongoing supportive relationships.
F. The state assures that the provision of support coordination/case management services will not restrict an individual's free choice of providers in violation of § 1902(a)(23) of the Act and the Final Rule at 42 CFR 441.301(c)(1)(vi).
1. Enrolled individuals will have free choice of the available providers of support coordination/case management services.
2. Enrolled individuals will have free choice of the providers of other medical care under the State Plan for Medical Assistance.
G. Payments for support coordination/case management services under the does State Plan for Medical Assistance shall not duplicate payments made to public agencies or private entities under other program authorities for this same purpose.
Statutory Authority
§ 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.
Historical Notes
Derived from VR460-03-3.1102 § 4, eff. May 1, 1994; amended, Virginia Register Volume 37, Issue 14, eff. March 31, 2021.
12VAC30-50-450. (Repealed.)
Historical Notes
Derived from VR460-03-3.1102 § 5, eff. May 1, 1994; repealed, Virginia Register Volume 37, Issue 14, eff. March 31, 2021.
12VAC30-50-460. (Repealed.)
Historical Notes
Derived from VR460-03-3.1102 § 6, eff. May 1, 1994; repealed, Virginia Register Volume 19, Issue 18, eff. July 1, 2003.
12VAC30-50-470. (Repealed.)
Historical Notes
Derived from VR460-03-3.1102 § 7, eff. June 1, 1994; amended, Virginia Register Volume 12, Issue 12, eff. April 4, 1996; repealed, Virginia Register Volume 41, Issue 19, eff. June 19, 2025.
12VAC30-50-480. Case management for foster care children.
A. Target group. Children or youth with behavioral disorders or emotional disturbances who are referred to treatment foster care by the Family Assessment and Planning Team of the Comprehensive Services Act for Youth and Families (CSA). "Child" or "youth" means any Medicaid eligible individual to 21 years of age who is otherwise eligible for CSA services. Family Assessment and Planning Teams (FAPT) are multidisciplinary teams of professionals established by each locality in accordance with §§ 2.1-753, 2.1-754, and 2.1-755 of the Code of Virginia to assess the needs of referred children. The FAPT shall develop individual services plans for youths and families who are reviewed by the team. The FAPT shall refer those children needing treatment foster care case management to a qualified participating case manager.
B. Services will be provided in the entire state.
C. Services are not comparable in amount, duration, and scope. Authority of § 1915(g)(1) of the Act is invoked to provide services without regard to the requirements of § 1902(a)(10)(B) of the Act.
D. Definition of services. Case management shall assist individuals eligible for Medicaid in gaining and coordinating access to necessary care and services appropriate to the needs of a child. Case management services will coordinate services to minimize fragmentation of care, reduce barriers, and link children with appropriate services to ensure comprehensive, continuous access to needed medical, social, educational, and other services appropriate to the needs of the child. The foster care case manager will provide:
1. Periodic assessments to determine clients' needs for psychosocial, nutritional, medical, and educational services.
2. Service planning by developing individualized treatment and service plans to describe what services and resources are needed to meet the service needs of the client and help access those resources. Such service planning shall not include performing medical and psychiatric assessment but shall include referrals for such assessments. The case manager shall collaborate closely with the FAPT and other involved parties in preparation of all case plans.
3. Coordination and referral by assisting the client in arranging for appropriate services and ensuring continuity of care for a child in treatment foster care. The case manager shall link the child to services and supports specified in the individualized treatment and service plan. The case manager shall directly assist the child to locate or obtain needed services and resources. The case manager shall coordinate services and service planning with other agencies and providers involved with the child by arranging, as needed, medical, remedial, and dental services.
4. Followup and monitoring by assessing ongoing progress in each case and ensuring services are delivered. The case manager shall continually evaluate and review each child's plan of care. The case manager shall collaborate with the FAPT and other involved parties on reviews and coordination of services to youth and families.
5. Education and counseling by guiding the client and developing a supportive relationship that promotes the service plan.
E. Provider participation. Any public or private child-placing agency licensed or certified by the Department of Social Services for treatment foster care may be a provider of treatment foster care case management.
Providers may bill Medicaid for case management for children in treatment foster care only when the services are provided by qualified treatment foster care case managers. The case manager must meet, at a minimum, the case worker qualifications found in the Minimum Standards for Licensed Child-Placing Agencies (22VAC40-130-10 et seq.).
F. Freedom of choice. Section 1915(g)(1) of the Act specifies that there shall be no restriction on free choice of qualified providers, in violation of § 1902(a)(23) of the Act. The state assures that there will be no restriction on a recipient's free choice of qualified providers of case management services. In addition, the state assures that case management services will not restrict an individual's free choice of providers of other Medicaid services.
1. Eligible recipients will have free choice of the providers of case management services.
2. Eligible recipients will have free choice of the providers of other medical care under the plan.
3. Eligible recipients will be free to refuse case management services.
G. Payment for case management services under the plan does not duplicate payments made to public agencies or private entities under other program authorities for this same purpose. The case management services will be funded from Medicaid service funds, not administrative. This case management service shall not be construed as case management under EPSDT.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 17, Issue 5, eff. January 1, 2001.
12VAC30-50-490. Support coordination/case management for individuals with developmental disabilities.
A. Target group. Medicaid-eligible individuals with developmental disability (other than intellectual disability) or related conditions as defined in § 37.2-100 of the Code of Virginia who are on the waiting list or are receiving services under one of the Developmental Disabilities (DD) Waivers.
1. When an individual applies for the DD Waivers and is found to meet the criteria as defined in 12VAC30-122-50, but there is no available slot, the individual will be placed on a waitlist until a slot is available. Individuals on the waitlist shall not receive developmental disability support coordination/case management services unless a special service need (as defined in subdivision 4 of this subsection) is identified, in which case an ISP shall be developed to address the special service need. Support coordinators/case managers shall make face-to-face contact with the individual at least every 90 calendar days to monitor the special service need, and documentation is required to support such contact. The support coordinator/case manager shall assure the ISP addresses the current special service needs of the individual and shall coordinate with the Department of Medical Assistance Services designee to assure actual enrollment into the waiver upon slot availability.
2. An active individual for developmental disability support coordination/case management shall mean a person for whom there is an individual support plan (ISP), as defined in 12VAC30-122-20, that requires direct or -related individual-related contacts or communication or activity with the individual, the individual's family/caregiver, service providers, and significant others . Billing can be submitted for an active individual only for months in which direct or -related individual-related contacts, activity, or communications occur, consistent with the goals or outcomes in the individual's ISP. Face-to-face contact between the support coordinator/case manager and the individual shall occur at least every 90 calendar days in which there is an activity submitted for billing.
manager will
3. The unit of service is one month. There shall be no maximum service limits for support coordination/case management services except management services for as related to individuals residing in medical institutions or medical facilities. For these individuals, reimbursement for support coordination/case management services shall be limited to 90 days immediately preceding discharge from those settings. Support coordination/case management for individuals in a medical institution or facility may be billed for no more than two 90-day periods in a 12-month period.
4. A special service need is one that requires linkage to and temporary monitoring of those supports and services identified in the ISP to address an individual's mental health, behavioral, and medical needs or provide assistance related to an acute need that coincides with the allowable activities noted in subsection D of this section. If an activity related to the special service need is provided in a given month, then the support coordinator/case manager would be eligible for reimbursement. Once the special service need is addressed related to the specific activity identified, billing for the service shall not continue until a special service need presents again.
B. Services will be provided in the entire state.
C. Comparability of services. Services are not comparable in amount, duration, and scope. Authority of § 1915(g)(1) of the Social Security Act (Act) is invoked to provide services without regard to the requirements of § 1902(a)(10)(B) of the Act and to limit support coordination/case management providers to the community services boards or behavioral health authorities (CSBs or BHAs). CSBs or BHAs shall contract with private support coordinators/case managers for this service in accordance with subdivision F 1 of this section.
D. Definition of services. Support coordination/case management services will be provided for Medicaid-eligible individuals with developmental disability or related conditions who are on the DD Waivers waiting list for or enrolled in one of the home and community-based services DD Waivers. Support coordination/case management services that may be provided include:
1. Assessment and planning services, to include developing an ISP as defined on 12VAC30-122-20 and in accordance with the requirements of the Final Rule found at 42 CFR 441.725, which does not include performing medical and psychiatric assessment but does include referral for such assessment;
2. Linking the individual to services and supports specified in the ISP;
3. Assisting the individual directly for the purpose of locating, developing, or obtaining needed services and resources;
4. Coordinating services and service planning with other agencies and providers involved with the individual;
5. Enhancing community integration by contacting other entities to arrange community access and involvement, including opportunities to learn community living skills and to use vocational, civic, and recreational services;
6. Making collateral contacts with the individual's significant others to promote implementation of the ISP and community integration;
7. Following up and monitoring to assess ongoing progress and ensure services are delivered as outlined in the ISP and addressing any change of status; and;
8. Education and guidance that supports the individual and develops a supportive relationship that promotes the ISP.
E. Qualifications of providers.
1. CSBs or BHAs shall have current, signed provider agreements with the Department of Medical Assistance Services (DMAS) and shall directly bill DMAS for reimbursement. CSBs or BHAs shall contract with other entities to provide support coordination/case management in accordance with subdivision F 1 of this section.
2. Support coordinators/case managers shall not be (i) the direct care staff person, as defined in 12VAC30-122-20, (ii) the immediate supervisor of the direct care staff person, (iii) otherwise related by business or organization to the direct care staff person, or (iv) an immediate family member of the direct care staff person.
3. Support coordination/case management services shall not be provided to the individual by (i) parents, guardians, spouses, or any family living with the individual or (ii) parents, guardians, spouses, or any family employed by an organization that provides support coordination/case management for the individual except in cases where the family member was employed by the case management entity prior to implementation of this chapter.
4. Providers of developmental disability support coordination/case management services shall meet the following criteria:
a. The provider shall guarantee that individuals have access to emergency services on a 24-hour basis pursuant to § 37.2-500 of the Code of Virginia;
b. The provider shall demonstrate the ability to serve individuals in need of comprehensive services regardless of the individual's ability to pay or eligibility for Medicaid;
c. The provider shall have the administrative and financial management capacity to meet state and federal requirements;
d. The provider shall document and maintain individual case records in accordance with state and federal requirements; and
e. The provider shall submit the individual support plan in an electronic format in the state DD home and community-based services (HCBS) waiver management system for service authorization and data management for individuals enrolled in any DD HCBS waiver. The provider shall submit evidence of follow-up and monitoring to assess ongoing progress of the ISP, ensuring services are delivered and health and safety is maintained;
f. The provider shall participate in activities designed to safeguard participants' health and safety in accordance with approved DD HCBS waiver requirements or DBHDS licensing standards;
g. The provider shall participate in activities designed to assure ongoing compliance by DD HCBS waiver participants' providers of service subject to the Final Rule Settings Requirements found at 42 CFS 441.301(4) and as described in the approved Statewide Transition Plan; and
h. The provider shall be licensed as a support coordination/case management entity.
5. The provider shall ensure that support coordinators/case managers who provide developmental disability support coordination/case management services and were hired after September 1, 2016, shall possess a minimum of a bachelor's degree in a human services field or be a registered nurse. Support coordinators/case managers hired before September 1, 2016, who do not possess a minimum of a bachelor's degree in a human services field or are not a registered nurse may continue to provide support coordination/case management if they are employed by or contracting with an entity that has a Medicaid provider participation agreement to provide developmental disability support coordination/case management prior to February 1, 2005, and the support coordinator/case manager has maintained employment with the provider without interruption and that is documented in the personnel record.
6. In addition to the requirements in subdivision 5 of this subsection, the support coordinator/case manager shall possess developmental disability work experience or relevant education that indicates that at entry level he possesses the following knowledge, skills, and abilities that shall be documented in the employment application form or supporting documentation or during the job interview:
a. Knowledge of:
(1) The definition and causes of developmental disability and best practices in supporting individuals who have developmental disabilities;
(2) Treatment modalities and intervention techniques, such as positive behavioral supports, person-centered practices, independent living skills, training, community inclusion/employment training, supportive guidance, family education, crisis intervention, discharge planning, and service coordination;
(3) Different types of assessments and their uses in determining the specific needs of the individual with respect to his ISP;
(4) Individuals' human and civil rights;
(5) Local service delivery systems, including support services;
(6) Types of programs and services that support individuals with developmental disabilities;
(7) Effective oral, written, and interpersonal communication principles and techniques;
(8) General principles of documentation; and
(9) The service planning process and the major components of the ISP.
b. Skills in:
(1) Interviewing;
(2) Negotiating with individuals and service providers;
(3) Observing recording, and reporting and documenting an individual's behaviors;
(4) Identifying and documenting an individual's needs for resources, services, and other assistance;
(5) Identifying services within the established service system to meet the individual's needs and preferences;
(6) Coordinating the provision of services by diverse public and private providers and generic and natural supports;
(7) Analyzing and planning for the service needs of individuals with developmental disability;
(8) Formulating, writing, and implementing individual-specific support plans promote goal attainment for recipients with developmental disabilities designed to facilitate attainment of the individual's unique goals for a meaningful, quality life; and
(9) Using information from assessments, evaluations, observations, and interviews to develop and revise as needed individual support plans tools (e.g., to ensure the ISP is implemented appropriately, identify change in status, or to determine risk of crisis/hospitalization).
c. Abilities to:
(1) Demonstrate a positive regard for individuals and their families (e.g., allowing risk taking, avoiding stereotypes of people with developmental disabilities, respecting individual and family privacy, believing individuals can grow and contribute to their community);
(2) Be persistent and remain objective;
(3) Work as a team member, maintaining effective interagency and intra-agency working relationships;
(4) Work independently, performing position duties under general supervision;
(5) Communicate effectively, orally and in writing; and
(6) Establish and maintain ongoing supportive relationships.
A case manager may provide services facilitation services. In these cases, the case manager must meet all the case management provider requirements as well as the service facilitation provider requirements. Individuals and their family/caregivers, as appropriate, have the right to choose whether the case manager may provide services facilitation or to have a separate services facilitator and this choice must be clearly documented in the individual's record. If case managers are not services facilitation providers, the case manager must assist the individual and his family/caregiver, as appropriate, to locate an available services facilitator.
7. Support coordinators/case managers shall receive supervision within the employing organization. The supervisor of the support coordinator/case manager shall have either:
a. A master's degree in a human services field and one year of required documented experience working with individuals who have developmental disabilities as defined in § 37.2-100 of the Code of Virginia;
b. A registered nurse license in the Commonwealth, or hold a multistate licensure privilege and one year of documented experience working with individuals who have developmental disabilities as defined in § 37.2-100 of the Code of Virginia;
c. A bachelor's degree and two years of experience working with individuals who have developmental disabilities as defined in § 37.2-100 of the Code of Virginia;
d. A high school diploma or GED and five years of paid experience in developing, conducting, and approving assessments and ISPs as well as working with individuals who have developmental disabilities as defined in § 37.2-100 of the Code of Virginia;
e. A license to practice medicine or osteopathic medicine in the Commonwealth and one year of required documented experience working with individuals who have developmental disabilities as defined in § 37.2-100 of the Code of Virginia; or
f. Requirements as set out in the Department of Behavioral Health and Developmental Disabilities licensing regulations (12VAC35-105-1250).
8. Support coordinators/case managers shall obtain at least one hour of documented supervision at least every 90 calendar days.
9. A support coordinator/case manager shall complete a minimum of eight hours of training annually in one or more of a combination of areas described in the knowledge, skills, and abilities in subdivision 6 of this subsection and shall provide documentation to his supervisor that demonstrates that training is completed. The documentation shall be maintained by the supervisor of the support coordinator/case manager in the employee's personnel file for the purposes of utilization review. This documentation shall be provided to the Department of Medical Assistance Services and the Department of Behavioral Health and Developmental Services upon request.
F. The state assures that the provision of management support coordination/case management services will not restrict an individual's free choice of providers in violation of § 1902(a)(23) of the Act and the Final Rule at 42 CFR 441.301(c)(1)(vi).
1. To provide choice to individuals who are enrolled in the Developmental Disabilities (DD) Waivers (Building Independence (BI), Community Living (CL), and Family and Individual Supports (FIS)), CSBs or BHAs shall contract with private support coordination/case management entities to provide developmental disabilities support coordination/case management services. If there are no qualified providers in that CSB's or BHA's catchment area, then the CSB or BHA shall provide the support coordination/case management services. The CSBs or BHAs shall be the only licensed entities permitted to be reimbursed for developmental disabilities or intellectual disability support coordination/case management services. For those individuals who receive developmental disabilities support coordination/case management services:
a. The CSB or BHA that serves the individual shall be the responsible provider of support coordination/case management. This CSB or BHA shall be the provider responsible for submitting claims to the Department of Medical Assistance Services (DMAS) for reimbursement.
b. The CSB shall inform the individual that the individual has a choice with respect to the support coordination/case management services that he receives. The individual shall be informed that he can choose from among these options:
(1) The individual may have his choice of support coordinator/case manager employed by the CSB or BHA.
(2) The individual may have his choice of another CSB or BHA with which the responsible CSB or BHA provider has a memorandum of agreement if the individual or family decides not to choose is desired in the responsible CSB or BHA provider.
(3) The individual may have a choice of a designated private provider with whom the responsible CSB or BHA provider has a contract for support coordination/case management if the individual or family decides not to choose the responsible CSB or BHA provider or another CSB or BHA when there is a memorandum of agreement.
c. At any time, the individual or family may request to change their support coordinator/case manager.
2. Eligible individuals will have free choice of the providers of other medical care under the State Plan for Medical Assistance.
G. Payment for management support coordination/case management services under the does State Plan shall not duplicate payments made to public agencies or private entities under other program authorities for this same purpose.
Statutory Authority
§ 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.
Historical Notes
Derived from Virginia Register Volume 17, Issue 18, eff. July 1, 2001; amended, Virginia Register Volume 23, Issue 20, eff. July 11, 2007; Volume 37, Issue 14, eff. March 31, 2021.
12VAC30-50-491. Substance use case management services for individuals who have a primary diagnosis of substance use disorder.
A. Target group for substance use case management services for individuals who have a primary diagnosis of substance use disorder.
1. The Medicaid-eligible individual shall meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria for a substance use disorder. Tobacco-related disorders or caffeine-related disorders and nonsubstance-related disorders shall not be covered. Substance use case management shall include an active individual service plan (ISP) that requires a minimum of two substance use case management service activities each month and at least one face-to-face contact with the individual at least every 90 calendar days.
2. There shall be no maximum service limits for case management services.
3. In accordance with 42 CFR 441.18(a)(8)(vii), reimbursement is allowed for case management services for Medicaid-eligible individuals who are in institutions, with the exception of individuals who are 22 years of age to 64 years of age and served in institutions of mental diseases (IMDs) and individuals of any age who are inmates of public institutions. An IMD is a facility that is primarily engaged in the treatment of mental illness and has more than 16 beds.
4. For individuals who are 22 years of age to 64 years of age, services rendered during the same month as the admission to the IMD are reimbursable as long as the service was rendered prior to the date of the admission.
5. Case management services for individuals who are younger than 22 years of age or older than 64 years of age in an IMD may be billed 30 calendar days prior to discharge as long as the case management services do not duplicate other services provided by the institution.
B. Services for substance use case management for individuals who have a primary diagnosis of substance use disorder will be provided to the entire state.
C. Comparability of services for substance use case management services for individuals who have a primary diagnosis of substance use disorder. Services are not comparable in amount, duration, or scope. Authority of § 1915(g)(1) of the Social Security Act is invoked to provide services without regard to the requirements of § 1902(a)(10)(B) of the Social Security Act.
D. Definition of substance use case management services for individuals who have a primary diagnosis of substance use disorder. Substance use case management services assist individuals and family members in accessing needed medical, psychiatric, psychological, social, educational, vocational, recovery, and other supports essential to meeting the individual's basic needs. Substance use case management is reimbursable on a monthly basis only when the minimum substance use case management service activities are met. Substance use case management does not include maintaining service waiting lists or periodically contacting or tracking individuals to determine potential service needs. Substance use case management services are to be person centered, individualized, and culturally and linguistically appropriate to meet the individual's and family member's needs.
Substance use case management service activities to be provided shall include:
1. Assessing needs and planning services to include developing a substance use case management individual service plan (ISP). The ISP shall utilize accepted placement criteria and shall be fully completed within 30 calendar days of initiation of service;
2. Enhancing community integration through increased opportunities for community access and involvement and enhancing community living skills to promote community adjustment, including, to the maximum extent possible, the use of local community resources available to the general public;
3. Making collateral contacts with the individual's significant others with properly authorized releases to promote implementation of the individual's ISP and the individual's community adjustment;
4. Linking the individual to those community supports that are most likely to promote the personal habilitative or rehabilitative, recovery, and life goals of the individual as developed in the ISP;
5. Assisting the individual directly to locate, develop, or obtain needed services, resources, and appropriate public benefits;
6. Ensuring the coordination of services and service planning within a provider agency, with other providers, and with other human service agencies and systems, such as local health and social services departments;
7. Monitoring service delivery through contacts with individuals receiving services and service providers and site and home visits to assess the quality of care and satisfaction of the individual;
8. Providing follow-up instruction, education, and counseling to guide the individual and develop a supportive relationship that promotes the ISP;
9. Advocating for the individual in response to the individual's changing needs based on changes in the ISP;
10. Planning for transitions in the individual's life;
11. Knowing and monitoring the individual's health status, any medical condition, and medications and potential side effects and assisting the individual in accessing primary care and other medical services, as needed; and
12. Understanding the capabilities of services to meet the individual's identified needs and preferences and to serve the individual without placing the individual, other participants, or staff at risk of serious harm.
E. Qualifications of providers of substance use case management services for individuals who have a primary diagnosis of substance use disorder.
1. The provider of substance use case management services must meet the following criteria:
a. The enrolled provider must have the administrative and financial management capacity to meet state and federal requirements;
b. The enrolled provider must have the ability to document and maintain individual case records in accordance with state and federal requirements; and
c. The enrolled provider must be licensed by the Department of Behavioral Health and Developmental Services (DBHDS) as a provider of substance abuse case management services.
2. Providers may bill Medicaid for substance use case management only when the services are provided by a professional who meets at least one of the following criteria:
a. At least a bachelor's degree in social work, psychology, psychiatric rehabilitation, sociology, counseling, vocational rehabilitation, or human services counseling and at least either (i) one year of substance use-related direct experience providing services to individuals with a diagnosis of substance use disorder or (ii) a minimum of one year of clinical experience working with individuals with co-occurring diagnoses of substance use disorder and mental illness;
b. Licensure by the Commonwealth as a registered nurse with (i) at least one year of substance use-related direct experience providing services to individuals with a diagnosis of substance use disorder or (ii) a minimum of one year of clinical experience working with individuals with co-occurring diagnoses of substance use disorder and mental illness; or
c. Certification as a Board of Counseling Certified Substance Abuse Counselor (CSAC), CSAC-Supervisee, or CSAC-Assistant under clinical supervision as defined in 18VAC115-30-10.
F. The state ensures that the provision of substance use case management services will not restrict an individual's free choice of providers in violation of § 1902(a)(23) of the Social Security Act.
1. Eligible individuals shall have free choice of the providers of substance use case management services.
2. Eligible individuals shall have free choice of the providers of other services under the plan.
G. Payment for substance use case management or substance use care coordination services under the plan does not duplicate payments for other case management made to public agencies or private entities under other Title XIX program authorities for this same purpose.
H. The state ensures that the individual will not be compelled to receive substance use case management services, condition receipt of case management services on the receipt of other Medicaid services, or condition receipt of other Medicaid services on receipt of case management services.
I. The state ensures that providers of substance use case management services do not exercise the agency's authority to authorize or deny the provision of other services under the plan.
J. The state ensures that substance use case management is only provided by and reimbursed to community case management providers.
K. The state ensures that substance use case management does not include the following:
1. The direct delivery of an underlying medical, educational, social, or other service to which an eligible individual has been referred.
2. Activities for which an individual may be eligible that are integral to the administration of another nonmedical program, except for case management that is included in an individualized education program or individualized family service plan consistent with § 1903(c) of the Social Security Act.
Statutory Authority
§ 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.
Historical Notes
Derived from Virginia Register Volume 26, Issue 8, eff. January 21, 2010; amended, Virginia Register Volume 33, Issue 12, eff. April 1, 2017; Volume 41, Issue 7, eff. January 2, 2025.