{"data":{"id":"us-va/12vac30-80-170","jurisdiction":"us-va","citation":"12VAC30-80-170","heading":"Payment of Medicare Part A and Part B Deductible/Coinsurance","body":"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:\n\n1. Payments are limited to state plan rates and payment methodologies for the groups and payments listed below and designated with the letters \"SP.\"\n\nFor 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.\n\nNot applicable. There are no special rates or methods used for specific Medicare services which are not otherwise covered by this state plan.\n\n2. Payments are up to the full amount of the Medicare rate for the groups and payments listed below and designated with the letters \"MR.\"\n\n3. 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.\"\n\n4. Any exceptions to the general methods used for a particular group or payment are specified.\n\nPayment of Medicare Part A and Part B Deductible/Coinsurance\n\nQMBs:\n\nPart A\n\nSP\n\nDeductibles\n\nSP\n\nCoinsurance\n\nPart B\n\nSP\n\nDeductibles\n\nSP\n\nCoinsurance\n\nOther Medicaid Recipients\n\n(Other Dual Eligibles)\n\nPart A\n\nSP\n\nDeductibles\n\nSP\n\nCoinsurance\n\nPart B\n\nSP\n\nDeductibles\n\nSP\n\nCoinsurance\n\nDual Eligible\n\n(QMB Plus)\n\nPart A\n\nSP\n\nDeductibles\n\nSP\n\nCoinsurance\n\nPart B\n\nSP\n\nDeductibles\n\nSP\n\nCoinsurance","path":["Title 12. Health","Agency 30. Department of Medical Assistance Services","Chapter 80. Methods and Standards for Establishing Payment Rate; Other Types of Care"],"source_url":"https://law.lis.virginia.gov/admincode/title12/agency30/chapter80/section170/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:51:00Z","sha256":"dc5bfe0588570f492ba2244b2c97fbdb9b3c3b4d9cd9871ab13d47ac2430d87b","source_id":"us-va-vac","stale":false,"prev":"us-va/12vac30-80-150","next":"us-va/12vac30-80-180"},"notice":"GroundRules: Original legal text. Not legal advice."}