Virginia regulations · Through 2026 Regular Session (effective July 1, 2026)

12VAC30-80-170: Payment of Medicare Part A and Part B Deductible/Coinsurance

Except for a nominal recipient copayment (as specified in 12VAC30-20-150 and 12VAC30-20-160), if applicable, the Medicaid agency uses the following general method for payment:

1. Payments are limited to state plan rates and payment methodologies for the groups and payments listed below and designated with the letters "SP."

For specific Medicare services which are not otherwise covered by this state plan, the Medicaid agency uses Medicare payment rates unless a special rate or method is set out.

Not applicable. There are no special rates or methods used for specific Medicare services which are not otherwise covered by this state plan.

2. Payments are up to the full amount of the Medicare rate for the groups and payments listed below and designated with the letters "MR."

3. Payments are up to the amount of a special rate, or according to a special method, for the groups and payments listed below and designated with the letters "NR."

4. Any exceptions to the general methods used for a particular group or payment are specified.

Payment of Medicare Part A and Part B Deductible/Coinsurance

QMBs:

Part A

Deductibles

Coinsurance

Part B

Deductibles

Coinsurance

Other Medicaid Recipients

(Other Dual Eligibles)

Part A

Deductibles

Coinsurance

Part B

Deductibles

Coinsurance

Dual Eligible

(QMB Plus)

Part A

Deductibles

Coinsurance

Part B

Deductibles

Coinsurance

Where this section sits in the code

Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 80. Methods and Standards for Establishing Payment Rate; Other Types of Care