Agencies | Governor
Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
Board
Board of Medical Assistance Services


chapter
Amount, Duration, and Scope of Medical and Remedial Care and Services [12 VAC 30 ‑ 50]
Guidance Documents   Periodic Reviews
Chapter Information
Description This chapter contains all of the services covered by Medicaid and the limits placed upon them.
State Authority COV 32.1-325 et seq et seq.
Federal Authority Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
Exempt from APA No, changes to this chapter are subject to the Administrative Process Act and the standard executive branch review process.
Text of Regulation Link to Virginia Administrative Code
Goals of Regulation None entered
Meetings

Contact Information
Name / Title: Emily McClellan  / Regulatory Supervisor
Address: Policy Division, DMAS
600 E. Broad Street, Suite 1300
Richmond, VA 23219
Email Address: Emily.McClellan@DMAS.Virginia.gov
Telephone: (804)371-4300    FAX: (804)786-1680    TDD: ()-
Current Actions
Action Title Latest Stage Status
Revision for CMS Conditions of Participation Final Exempt action can be submitted directly to the Registrar.
LDCT Lung Cancer Screening Proposed Governor's office review in progress.
Clarifications for Durable Medical Equipment and Supplies NOIRA Stage complete. Comment period ended 6/14/2017.
Peer Support Services and Family Support Partners Fast-Track DPB review in progress.
Outpatient Mental Health Service Limit Review Final Stage complete. Becomes effective on 7/26/2017.
Coverage of Mosquito Repellant to Prevent Zika Virus Fast-Track Stage complete. Becomes effective on 6/29/2017.
EPSDT Behavioral Therapy Services Proposed Governor's office review in progress.
Consumer Directed Services Facilitators Proposed Comment period is underway and will end on 7/14/2017.
CH 0060 2016 Psychiatric Residential Treatment Services Program Changes Emergency/NOIRA Stage complete. Becomes effective on 7/1/2017.

Past Actions
Action Title Latest Stage Status
Institutions for Mental Disease Reimbursement Changes Final Stage complete. This regulation became effective on 3/8/2017.
Plan First Family Planning Services (Optional Group) Final Stage complete. This regulation became effective on 2/22/2017.
PACE and Licensure of Adult Day Care Centers Final Stage complete. This regulation became effective on 9/1/2016.
Dental Services for Pregnant Women Final Stage complete. This regulation became effective on 7/27/2016.
Mental Health Skill-building Services Final Stage complete. This regulation became effective on 7/27/2016.
Discontinue Coverage of Benzodiazepines-Barbiturates for Dual Eligible Individuals Fast-Track Stage complete. This regulation became effective on 10/22/2015.
2011 Mental Health Services Program Changes for Appropriate Utilization & Provider Qualifications Final Stage complete. This regulation became effective on 1/30/2015.
Early Intervention (Part C) Case Management Fast-Track Stage complete. This regulation became effective on 2/13/2015.
Part D Coverage of Benzodiazepines and Barbiturates Fast-Track Stage complete. This regulation became effective on 1/2/2014.
Smoking Cessation Services for Pregnant Women Final Stage complete. This regulation became effective on 2/27/2013.
2010 Durable Medical Equipment (DME) Changes Final Stage complete. This regulation became effective on 7/1/2012.
CH 0080 Pharmacy Supplemental Rebate/Unit Dose Fee/Drug Threshold Fast-Track Stage complete. This regulation became effective on 1/16/2014.
Inpatient and Outpatient Rehabilitation Update Fast-Track Stage complete. This regulation became effective on 1/1/2016.
Coverage and Reimbursement of Early Intervention Services under Part C of IDEA Final Stage complete. This regulation became effective on 10/25/2012.
Children's Exemption from Hospice Election Final Stage complete. This regulation became effective on 11/10/2010.
Amount, Duration and Scope of Services - Abortion Services Final Stage complete. This regulation became effective on 7/1/2010.
Community Mental Health Services Prior Authorization Final Stage complete. This regulation became effective on 2/16/2011.
Nurse Practitioners Authorization of DME Final Stage complete. This regulation became effective on 1/1/2010.
Prior Authorization of Intensive In-Home Services Final Stage complete. This regulation became effective on 3/3/2010.
Substance Abuse Treatment Services Final Stage complete. This regulation became effective on 1/21/2010.
Attorney General Regulatory Reform Task Force Changes Final Stage complete. This regulation became effective on 4/15/2009.
Program of All Inclusive Care (PACE) as State Plan Service Fast-Track Stage complete. This regulation became effective on 2/5/2009.
Hearing Aid Services for Children Final Stage complete. This regulation became effective on 1/1/2008.
IFDDS Waiver Changes Final Stage complete. This regulation became effective on 7/11/2007.
Medicare Prescription Drug Program (Part D) Final Stage complete. This regulation became effective on 3/7/2007.
Program of All-Inclusive Care for the Elderly (PACE) Fast-Track Stage complete. This regulation became effective on 7/1/2007.
Program of All Inclusive Care for the Elderly (PACE) Fast-Track Stage withdrawn on 10/10/2006 before DPB completed its review.
Prior Authorization for Dental Services Final Stage complete. This regulation became effective on 7/1/2006.
Medicaid and FAMIS Prior Authorization Fast-Track Stage complete. This regulation became effective on 7/3/2006.
Medicare Prescription Drug Program (Part D) Final Stage withdrawn on 11/8/2005 before Attorney General's office completed its review.
Add Community-Based Residential Services as covered Medicaid services Final Stage complete. This regulation became effective on 1/25/2006.
Discontinue Coverage of Erectile Dysfunction Drugs for Sex Offenders Proposed Stage withdrawn on 10/28/2005 before DPB completed its review.
Non-Emergency Transportation as a Medical Expense Final Stage complete. This regulation became effective on 7/1/2005.
PDL, P&T Com, Drug Rebates, UR of High Drug Thresholds Final Stage complete. This regulation became effective on 1/3/2005.
Add Marriage and Family Therapists as Enrolled Providers Final Stage complete. This regulation became effective on 7/1/2004.
Community Mental Health Rehabilitation Services Final Stage complete. This regulation became effective on 12/3/2003.
Prior Authorization for MRI, CAT and PET Scans Emergency Stage complete. Emergency regulation expired on 6/30/2004.
Coverage of Stretcher Vans as Non-emergency Transportation Emergency Stage complete. Emergency regulation expired on 6/30/2004.
34-Day Supply of Prescription Drugs Final Stage complete. This regulation became effective on 7/1/2002.
Dental Services Final Stage complete. This regulation became effective on 7/1/2002.
Limit Coverage of Out-of-State Inpatient Hospital Services Final Stage complete. This regulation became effective on 1/2/2002.
Coverage of Ocular Prosthetics Final Stage complete. This regulation became effective on 12/5/2001.
Individual and Family Developmental Disabilities Support Waiver Final Stage complete. This regulation became effective on 7/1/2001.
Transportation Services as an Administrative Expense Final Stage complete. This regulation became effective on 7/2/2001.
Residential Psychiatric Treatment under EPSDT Final Stage complete. This regulation became effective on 1/1/2001.
Case Management for Treatment Foster Care Final Stage complete. This regulation became effective on 1/1/2001.
Expansion of School-Based Services for Special Education Children Final Stage complete. This regulation became effective on 1/1/2001.
Coverage of Substance Abuse Treatment Services NOIRA Stage withdrawn on 11/16/2001 after the comment period had ended.
Clinic Services: Mental Health Clinic Provider Qualifications Final Stage complete. This regulation became effective on 7/5/2000.
2000 Omnibus Amendments: HIV eligibility expansion, organ transplant coverage expansion, colorectal cancer screenings coverage. Final Stage complete. This regulation became effective on 7/1/2000.
Program of All-Inclusive Care for the Elderly (PACE) Final Stage complete. This regulation became effective on 7/1/2000.
Hospice Services and Payment Methodology Final Stage complete. This regulation became effective on 1/5/2000.
Pharmacy Services: Coverage of Weight Loss Drugs Final Stage complete. This regulation became effective on 9/1/1999.
Preventive Services: Maternal Length of Stay Final Stage complete. This regulation became effective on 10/1/1999.
Coverage of Organ Transplant Services: Technical Amendment Final Stage complete. This regulation became effective on 9/15/1999.
Coverage of Leukemia Diagnoses under Bone Marrow/Stem Cell Transplantation Final Stage complete. This regulation became effective on 7/1/1999.
Case Management for Mental Health Services -
Coverage of Medical Nutrition Therapy -
Discontinue Coverage of Erectile Dysfunction Drugs for Sex Offenders -
Prior Authorization for Dental Services -
Abortion Services -

Withdrawn Actions
Action Title Latest Stage Status
Physician Face to Face Encounter for Home Health/DME Certification Final Stage withdrawn on 10/13/2016 prior to submitting for AG review.
Smoking Cessation Coverage -
Signature Requirement for Medical Records Emergency/NOIRA Stage withdrawn on 7/6/2016 after the Governor's office completed its review.
Amount, Duration, and Scope of Services Pharmacy Services: Pharmacy Infusion Services Proposed Stage withdrawn on 3/18/2016 after the comment period had ended.
Freestanding Birthing Centers Final Stage withdrawn on 11/12/2013 prior to submitting for AG review.
Expand Coverage of School Health Assessments -
CH 0050 Chap 50 Freestanding Birthing Centers -
Cover Special DME in Nursing Facilities -
Mental Health Services Program Changes to Ensure Appropriate Utilization and Provider Qualifications Emergency/NOIRA Stage withdrawn on 1/13/2012 after the comment period had ended.
Pediatric Dental Program Proposed Stage withdrawn on 11/3/2005 before DPB completed its review.
Restore Elderly Case Management -
2001 Technical Amendments Final Stage withdrawn on 8/9/2007 before submission to the Registrar.
2000 Hospital Technical Amendments Final Stage withdrawn on 8/9/2007 before submission to the Registrar.
Home Health Services Durable Medical Equipment -
2000 Technical Amendments Final Stage withdrawn on 8/9/2007 before submission to the Registrar.