{"data":{"id":"us-va/12vac30-60-140","jurisdiction":"us-va","citation":"12VAC30-60-140","heading":"Community mental health services","body":"A. Utilization review general requirements.  Utilization reviews shall be conducted, at a minimum annually  for each enrolled provider, by the  Department of  Medical Assistance Services (DMAS) or its contractor. During each  review, an appropriate sample of the provider's total Medicaid population will be selected for review. An expanded review shall be conducted if an appropriate number of exceptions or problems are identified.\n\nB. The  review by DMAS or its contractor shall include the following items:\n\n1. Medical or clinical necessity of the delivered service;\n\n2. The admission to service and level of care was appropriate;\n\n3. The services were provided by appropriately qualified individuals as defined in the Amount, Duration, and Scope of Services found in  12VAC30-50; and\n\n4. Delivered services as documented are consistent with recipients' Individual Service Plans, invoices submitted, and specified service limitations.","path":["Title 12. Health","Agency 30. Department of Medical Assistance Services","Chapter 60. Standards Established and Methods Used to Assure High Quality Care"],"source_url":"https://law.lis.virginia.gov/admincode/title12/agency30/chapter60/section140/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:50:57Z","sha256":"807ca330ccb89c5cf38f91f82f46fea4a946ad3618c2683a2de7c416e2b4811d","source_id":"us-va-vac","stale":false,"prev":"us-va/12vac30-60-130","next":"us-va/12vac30-60-143"},"notice":"GroundRules: Original legal text. Not legal advice."}