GroundRules
12VAC30-70-418: Reimbursement for residential and inpatient substance use treatment services
Where this section sits in the code
- Title 12. Health
- Agency 30. Department of Medical Assistance Services
- Chapter 70. Methods and Standards for Establishing Payment Rates; In-Patient Hospital Care
- Part V. Inpatient Hospital Payment System
- Article 3. Other Provisions for Payment of Inpatient Hospital Services
A. The following substance use disorder treatment services for adults and adolescents are provided in a residential or inpatient setting: (i) clinically managed population-specific high intensity residential service (ASAM Level 3.3); (ii) clinically managed high intensity residential services (adult) and clinically managed medium intensity residential services (adolescent) (ASAM Level 3.5); (iii) medically monitored intensive inpatient services (adult) and medically monitored high intensity inpatient services (adolescent) (ASAM Level 3.7); and (iv) medically managed intensive inpatient services (ASAM Level 4.0).
B. If one of the services in subsection A of this section is furnished to an individual in a freestanding psychiatric hospital or inpatient psychiatric unit of an acute care hospital, reimbursement shall be based on the hospital reimbursement described in 12VAC30-70-241 and the reimbursement of services provided under the arrangement described in 12VAC30-80.
C. If one of the services in subsection A of this section is furnished to an individual in an appropriately licensed residential setting, reimbursement shall be based on the psychiatric residential treatment facility (Level C) reimbursement described in 12VAC30-70-417.
Collected 2026-09-14T04:50:59Z. Source file · JSON