GroundRules
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- 12VAC30-60-20 · Utilization control: general acute care hospitals; enrolled providers
- 12VAC30-60-21 · Utilization control of nonparticipating out-of-state inpatient hospitals
- 12VAC30-60-25 · Utilization control: freestanding psychiatric hospitals
- 12VAC30-60-30 · Utilization control: Long-stay acute care hospitals (nonmental hospitals)
- 12VAC30-60-40 · Utilization control: Nursing facilities
- 12VAC30-60-50 · Utilization control: Intermediate care facilities for persons with intellectual and developmental disabilities and institutions for mental disease
- 12VAC30-60-61 · Services related to the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT); community mental health and behavioral therapy services for youth
- 12VAC30-60-65 · Electronic visit verification
- 12VAC30-60-70 · Utilization control: home health services
- 12VAC30-60-75 · Durable medical equipment (DME) and supplies
- 12VAC30-60-80 · Utilization control: Optometrists' services
- 12VAC30-60-100 · Utilization control: Incorporation of specialized quality standards
- 12VAC30-60-110 · Utilization control: Effect of geographic boundaries on provision of care
- 12VAC30-60-120 · Quality management: Intensive physical rehabilitative services and comprehensive outpatient rehabilitation facility services
- 12VAC30-60-130 · Hospice services
- 12VAC30-60-140 · Community mental health services
- 12VAC30-60-143 · Mental health services utilization criteria; definitions
- 12VAC30-60-145 · Developmental disability utilization criteria
- 12VAC30-60-150 · Quality management review of outpatient rehabilitation therapy services
- 12VAC30-60-170 · Utilization review of treatment foster care case management services
- 12VAC30-60-181 · Utilization review of addiction and recovery treatment services
- 12VAC30-60-185 · Utilization review of substance use case management
- 12VAC30-60-200 · Ticket to Work and Work Incentives Improvement Act (TWWIIA) basic coverage group: alternative benefits for Medicaid Buy-In program
- 12VAC30-60-301 · Definitions
- 12VAC30-60-302 · Access to Medicaid-funded long-term services and supports
- 12VAC30-60-303 · Screening criteria for Medicaid-funded long-term services and supports
- 12VAC30-60-304 · Requests and referrals for LTSS screening for adults and children living in the community; adults and children in hospitals; and adults and children in nursing facilities
- 12VAC30-60-305 · Screenings in the community and hospitals and nursing facilities for Medicaid-funded long-term services and supports
- 12VAC30-60-306 · Submission of LTSS screenings
- 12VAC30-60-308 · Nursing facility admission for LTSS and level of care determination requirements
- 12VAC30-60-310 · Competency training and testing requirements
- 12VAC30-60-313 · Individuals determined to not meet criteria for Medicaid-funded long-term services and supports
- 12VAC30-60-315 · Periodic evaluations for individuals receiving Medicaid-funded long-term services and supports
- 12VAC30-60-316 · Criteria for continued nursing facility care using the Minimum Data Set (MDS)
- 12VAC30-60-318 · Definitions to be applied when completing the MDS
- 12VAC30-60-320 · Adult ventilation/tracheostomy specialized care criteria
- 12VAC30-60-330 · [Reserved]
- 12VAC30-60-340 · Pediatric and adolescent specialized care criteria
- 12VAC30-60-350 · Criteria for coverage of specialized treatment beds
- 12VAC30-60-361 · Criteria for supports and services in intermediate care facilities for individuals with intellectual disabilities
- 12VAC30-70-10 · Effect of participation in Health Insurance for the Aged program
- 12VAC30-70-20 · Standards applied to non-participants in Title XVIII programs
- 12VAC30-70-30 · Limitations of Medical Assistance Program payment; Medicare reimbursement principles
- 12VAC30-70-40 · Payment of reasonable costs based on other methods
- 12VAC30-70-50 · Hospital reimbursement system
- 12VAC30-70-60 · Establishment of reasonable and adequate payment rates; cost reporting
- 12VAC30-70-70 · Revaluation of assets
- 12VAC30-70-80 · Refund of overpayments
- 12VAC30-70-90 · Reimbursement of certified hospitals exempt from Medicare Prospective Payment system
- 12VAC30-70-100 · Reimbursement of return on equity capital to proprietary providers
- 12VAC30-70-110 · Group ceiling for state-owned university teaching hospitals
- 12VAC30-70-130 · Payment adjustment fund
- 12VAC30-70-150 · Methods and standards for establishing payment rates - inpatient hospital care: Dispute resolution for state-operated providers
- 12VAC30-70-160 · [Reserved]
- 12VAC30-70-201 · Application of payment methodologies
- 12VAC30-70-221 · General
- 12VAC30-70-231 · Operating payment for DRG cases
- 12VAC30-70-241 · Operating payment for per diem cases
- 12VAC30-70-251 · Operating payment for transfer cases
- 12VAC30-70-261 · Outlier operating payment
- 12VAC30-70-271 · Payment for capital costs
- 12VAC30-70-281 · Payment for direct medical education costs of nursing schools, paramedical programs, and graduate medical education for interns and residents
- 12VAC30-70-291 · Payment for indirect medical education costs
- 12VAC30-70-301 · Payment to disproportionate share hospitals
- 12VAC30-70-311 · Hospital specific operating rate per case
- 12VAC30-70-321 · Hospital specific operating rate per day
- 12VAC30-70-331 · Statewide operating rate per case
- 12VAC30-70-341 · Statewide operating rate per day
- 12VAC30-70-351 · Updating rates for inflation
- 12VAC30-70-361 · Base year standardized operating costs per case
- 12VAC30-70-371 · Base year standardized operating costs per day
- 12VAC30-70-381 · DRG relative weights and hospital case-mix indices
- 12VAC30-70-391 · Recalibration and rebasing policy
- 12VAC30-70-400 · Determination of per diem rates
- 12VAC30-70-410 · State university teaching hospitals
- 12VAC30-70-411 · Supplemental payments for certain teaching hospitals
- 12VAC30-70-415 · Reimbursement for freestanding psychiatric hospital services under EPSDT
- 12VAC30-70-417 · Reimbursement for inpatient psychiatric services in residential treatment facilities (Level C) under EPSDT
- 12VAC30-70-418 · Reimbursement for residential and inpatient substance use treatment services
- 12VAC30-70-420 · Reimbursement of noncost-reporting general acute care hospital providers
- 12VAC30-70-425 · Supplemental payments for non-state-government-owned hospitals for inpatient services
- 12VAC30-70-428 · Supplemental payments for private hosptial partners of Type One hospitals
- 12VAC30-70-429 · Supplemental payments for private acute care hospitals
- 12VAC30-70-430 · Medicare upper limit
- 12VAC30-70-435 · Lump sum payment
- 12VAC30-70-441 · Public comment process
- 12VAC30-70-450 · Cost reporting requirements
- 12VAC30-70-460 · Hospital settlement
- 12VAC30-70-470 · Underpayments
- 12VAC30-70-480 · Refund of overpayments
- 12VAC30-70-490 · Medicaid Hospital Payment Policy Advisory Council
- 12VAC30-80-10 · General
- 12VAC30-80-20 · Services that are reimbursed on a cost basis
- 12VAC30-80-21 · Reimbursement for services furnished individuals residing in a freestanding psychiatric hospital or residential treatment center (Level C)
- 12VAC30-80-25 · Reimbursement for federally qualified health centers (FQHCs) and rural health clinics (RHCs)
- 12VAC30-80-26 · Reimbursement for Indian Health Service tribal 638 facilities
- 12VAC30-80-30 · Fee-for-service providers
- 12VAC30-80-32 · Reimbursement for substance use disorder services
- 12VAC30-80-35 · Fee for service: ambulatory surgery centers
- 12VAC30-80-36 · Fee-for-service providers: outpatient hospitals