Administrative Code

Virginia Administrative Code
6/25/2022

Part II. General Information

12VAC5-200-20. Authority for regulations.

Section 32.1-11 of the Code of Virginia establishes the responsibility of the board as follows: "The board may formulate a program of environmental health services, laboratory services and preventive, curative and restorative medical care services, including home and clinic health services described in Titles V, XVIII and XIX of the United States Social Security Act and amendments thereto, to be provided by the department on a district or local basis. The board shall define the income limitations within which a person shall be deemed to be medically indigent. Persons so deemed to be medically indigent shall receive the medical care services of the department without charge. The board may also prescribe the charges to be paid for the medical care services of the department by persons who are not deemed to be medically indigent and may, in its discretion and within the limitations of available funds, prescribe a scale of such charges based upon ability to pay. Funds received in payment of such charges are hereby appropriated to the board for the purpose of carrying out the provisions of this title. The board shall review periodically the program and charges adopted pursuant to this section."

Statutory Authority

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

Historical Notes

Derived from VR355-39-100 § 2.1, eff. December 1, 1993; amended, Virginia Register Volume 20, Issue 22, eff. August 11, 2004.

12VAC5-200-30. Purpose of chapter.

The board has promulgated this chapter to: (i) establish financial eligibility criteria to determine if a person is medically indigent and therefore qualified to receive medical care services from the department without charge; (ii) establish income scales and a mechanism for determining charges for medical care provided by the department to individuals who are not medically indigent, based upon their ability to pay; (iii) establish a mechanism for handling appeals and waivers; and (iv) establish continuity of eligibility among state agencies. The regulations are constructed to assure that eligibility criteria remain appropriate for changing economic conditions.

Statutory Authority

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

Historical Notes

Derived from VR355-39-100 § 2.2, eff. December 1, 1993; amended, Virginia Register Volume 20, Issue 22, eff. August 11, 2004.

12VAC5-200-40. Administration of chapter.

This chapter is administered by the commissioner.

The commissioner shall assure uniformity and consistency by interpreting and implementing the rules of the department for the provision of medical care and related goods and services. The commissioner may issue a guidance document that interprets these regulations and provides guidance for their implementation. Such a document shall be reviewed and revised whenever the regulations of this chapter are reviewed, and may also be amended or revised as needed to meet changing circumstances.

Whenever possible, charges for services shall use the most appropriate current Medicaid charges (and matching Medicaid codes). If there is no Medicaid code for a particular service, the most appropriate current Medicare charge (and matching code) shall be used. If both Medicaid and Medicare charges (and codes) exist for the same service, the Medicaid charge (and code) will be used. If neither a Medicaid nor a Medicare code exists for a particular service, the commissioner, or a designee, shall determine an appropriate charge and develop a matching code. A guidance document shall include procedures for determining the costs and establishing the charges for medical care and related goods and services when any of these are not otherwise addressed in these regulations or the Code of Virginia.

The commissioner shall publish specific income levels expressed in dollar amounts for determining eligibility for medical care services of the department in accordance with the income scales defined in 12VAC5-200-10.

Statutory Authority

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

Historical Notes

Derived from VR355-39-100 § 2.3, eff. December 1, 1993; amended, Virginia Register Volume 20, Issue 22, eff. August 11, 2004.

12VAC5-200-50. Recipients of services.

This chapter shall apply to all persons seeking medical care services provided by the department, except where other eligibility criteria are required for programs administered under federal statute.

Statutory Authority

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

Historical Notes

Derived from VR355-39-100 § 2.4, eff. December 1, 1993; amended, Virginia Register Volume 20, Issue 22, eff. August 11, 2004.

12VAC5-200-60. Application of the Administrative Process Act.

The provisions of the Virginia Administrative Process Act govern the adoption of these regulations and any subsequent amendments.

Statutory Authority

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

Historical Notes

Derived from VR355-39-100 § 2.5, eff. December 1, 1993.

12VAC5-200-70. (Repealed.)

Historical Notes

Derived from VR355-39-100 § 2.6, eff. December 1, 1993; repealed, Virginia Register Volume 20, Issue 22, eff. August 11, 2004.

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.