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
 
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 .
Federal Authority Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
Text of Regulation Link to Virginia Administrative Code
Goals of Regulation None entered
Meetings See all meetings (45) relating to this chapter.

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
MR Removal and Updates
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. Becomes effective on 02/11/2026.
Pharmacist as Providers and Other Licensed Practitioners Fast-Track Attorney General review in progress.
Adult Dental and 2024 Updates Fast-Track Attorney General review in progress.
Private Duty Nursing Services Under EPSDT Fast-Track Submitted to the Registrar and awaiting publication (02/09/2026).
School Services Fast-Track Attorney General review is complete - Agency can submit to DPB.
Medicaid Enterprise System Updates
Action is Exempt from Article 2 of the Administrative Process Act
Final Attorney General review is complete - Agency can submit for Governor's Office review.
12 Months Postpartum Emergency/NOIRA Returned to agency requesting additional information.
Pharmacy Updates Fast-Track Returned to agency requesting additional information.
Clarifications for Durable Medical Equipment and Supplies—Revisions Emergency Returned to agency requesting additional information. (returned 2 times)
90-Day Prescriptions Fast-Track Returned to agency requesting additional information. (returned 2 times)

Past Actions
Action Title Latest Stage Status
Repeal of Case Management Services for Recipients of Auxiliary Grants Fast-Track Stage complete. This regulation became effective on 06/19/2025.
Brain Injury Services Targeted Case Management NOIRA Stage complete. Comment period ended 05/21/2025.
Complex Rehabilitation Technology Fast-Track Stage complete. This regulation became effective on 02/13/2025.
Preventive Services Fast-Track Stage complete. This regulation became effective on 09/25/2025.
Program of All-Inclusive Care for the Elderly Fast-Track Stage complete. This regulation became effective on 10/10/2024.
Clinical Trials
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 11/23/2022.
Mental Health and Substance Use Case Management Fast-Track Stage complete. This regulation became effective on 01/02/2025.
Update to Outpatient Practitioners Fast-Track Stage complete. This regulation became effective on 12/08/2022.
2020 Program of All-Inclusive Care for the Elderly (PACE) Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 08/04/2021.
Electronic Visit Verification Final Stage complete. This regulation became effective on 08/18/2021.
Home Health Changes Due to Federal Regulatory Change
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 08/19/2020.
Change from Service Specific Provider Intake to Comprehensive Needs Assessment Fast-Track Stage complete. This regulation became effective on 03/17/2022.
Federal Changes to Programs of All-Inclusive Care for the Elderly (PACE)
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 09/16/2020.
Update to State Supplemental Drug Rebate Agreement Fast-Track Stage complete. This regulation became effective on 04/04/2021.
Expansion-Related Changes - Alternative Benefit Plan Fast-Track Stage complete. This regulation became effective on 02/17/2022.
Clarifications for Durable Medical Equipment and Supplies Final Stage complete. This regulation became effective on 02/21/2020.
Removal of the 21 Out of 60 Day Limit Fast-Track Stage complete. This regulation became effective on 10/30/2020.
Three Waivers (ID, DD, DS) Redesign Final Stage complete. This regulation became effective on 03/31/2021.
2016 Psychiatric Residential Treatment Services Program Changes Final Stage complete. This regulation became effective on 08/22/2019.
CMH and Peers Updates Fast-Track Stage complete. This regulation became effective on 04/14/2021.
Peers Amendments Fast-Track Stage complete. This regulation became effective on 02/21/2019.
Limit Dental Services for NF Residents
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2018.
Supplemental Drug Rebates and MCOs Fast-Track Stage complete. This regulation became effective on 03/21/2019.
Consumer Directed Services Facilitators Final Stage complete. This regulation became effective on 10/27/2018.
EPSDT Behavioral Therapy Services Final Stage complete. This regulation became effective on 12/12/2018.
LMHP-R, RP, and S May Provide Outpatient Psychiatric Services Fast-Track Stage complete. This regulation became effective on 12/13/2018.
LDCT Lung Cancer Screening Final Stage complete. This regulation became effective on 01/10/2018.
Revision for CMS Conditions of Participation
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 01/13/2018.
Peer Support Services and Family Support Partners Fast-Track Stage complete. This regulation became effective on 11/16/2017.
Institutions for Mental Disease Reimbursement Changes Final Stage complete. This regulation became effective on 03/08/2017.
Outpatient Mental Health Service Limit Review
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/26/2017.
Plan First Family Planning Services (Optional Group) Final Stage complete. This regulation became effective on 02/22/2017.
Coverage of Mosquito Repellant to Prevent Zika Virus Fast-Track Stage complete. This regulation became effective on 06/29/2017.
PACE and Licensure of Adult Day Care Centers
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 09/01/2016.
Dental Services for Pregnant Women Final Stage complete. This regulation became effective on 07/27/2016.
Mental Health Skill-building Services Final Stage complete. This regulation became effective on 07/27/2016.
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 01/30/2015.
Early Intervention (Part C) Case Management Fast-Track Stage complete. This regulation became effective on 02/13/2015.
Part D Coverage of Benzodiazepines and Barbiturates Fast-Track Stage complete. This regulation became effective on 01/02/2014.
Smoking Cessation Services for Pregnant Women
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 02/27/2013.
2010 Durable Medical Equipment (DME) Changes Final Stage complete. This regulation became effective on 07/01/2012.
CH 0080 Pharmacy Supplemental Rebate/Unit Dose Fee/Drug Threshold Fast-Track Stage complete. This regulation became effective on 01/16/2014.
Inpatient and Outpatient Rehabilitation Update Fast-Track Stage complete. This regulation became effective on 01/01/2016.
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
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 11/10/2010.
Amount, Duration and Scope of Services - Abortion Services
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2010.
Community Mental Health Services Prior Authorization Final Stage complete. This regulation became effective on 02/16/2011.
Nurse Practitioners Authorization of DME
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 01/01/2010.
Prior Authorization of Intensive In-Home Services Final Stage complete. This regulation became effective on 03/03/2010.
Substance Abuse Treatment Services Final Stage complete. This regulation became effective on 01/21/2010.
Attorney General Regulatory Reform Task Force Changes
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 04/15/2009.
Program of All Inclusive Care (PACE) as State Plan Service Fast-Track Stage complete. This regulation became effective on 02/05/2009.
Hearing Aid Services for Children
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 01/01/2008.
IFDDS Waiver Changes Final Stage complete. This regulation became effective on 07/11/2007.
Medicare Prescription Drug Program (Part D) Final Stage complete. This regulation became effective on 03/07/2007.
Program of All-Inclusive Care for the Elderly (PACE) Fast-Track Stage complete. This regulation became effective on 07/01/2007.
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 07/01/2006.
Medicaid and FAMIS Prior Authorization Fast-Track Stage complete. This regulation became effective on 07/03/2006.
Medicare Prescription Drug Program (Part D)
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage withdrawn on 11/08/2005 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 01/25/2006.
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
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2005.
Discontinue Coverage of Erectile Dysfunction Drugs for Sex Offenders Emergency/NOIRA Stage withdrawn on 05/26/2005 prior to submitting for AG review.
Prior Authorization for Dental Services Emergency/NOIRA Stage withdrawn on 05/20/2005 prior to submitting for AG review.
PDL, P&T Com, Drug Rebates, UR of High Drug Thresholds Final Stage complete. This regulation became effective on 01/03/2005.
Add Marriage and Family Therapists as Enrolled Providers
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2004.
Community Mental Health Rehabilitation Services Final Stage complete. This regulation became effective on 12/03/2003.
Prior Authorization for MRI, CAT and PET Scans Emergency Stage complete. Emergency regulation expired on 06/30/2004.
Coverage of Stretcher Vans as Non-emergency Transportation Emergency Stage complete. Emergency regulation expired on 06/30/2004.
34-Day Supply of Prescription Drugs
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2002.
Dental Services
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2002.
Case Management for Mental Health Services NOIRA Stage withdrawn on 12/02/2002 prior to submission to DPB.
Limit Coverage of Out-of-State Inpatient Hospital Services Final Stage complete. This regulation became effective on 01/02/2002.
Coverage of Ocular Prosthetics
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 12/05/2001.
Abortion Services NOIRA Stage withdrawn on 06/13/2002 prior to submission to DPB.
Individual and Family Developmental Disabilities Support Waiver Final Stage complete. This regulation became effective on 07/01/2001.
Transportation Services as an Administrative Expense Final Stage complete. This regulation became effective on 07/02/2001.
Residential Psychiatric Treatment under EPSDT Final Stage complete. This regulation became effective on 01/01/2001.
Case Management for Treatment Foster Care Final Stage complete. This regulation became effective on 01/01/2001.
Expansion of School-Based Services for Special Education Children Final Stage complete. This regulation became effective on 01/01/2001.
Coverage of Substance Abuse Treatment Services Proposed Stage withdrawn on 11/16/2001 prior to submitting for AG review.
Coverage of Medical Nutrition Therapy NOIRA Stage withdrawn on 06/13/2002 prior to submission to DPB.
Clinic Services: Mental Health Clinic Provider Qualifications Final Stage complete. This regulation became effective on 07/05/2000.
2000 Omnibus Amendments: HIV eligibility expansion, organ transplant coverage expansion, colorectal cancer screenings coverage.
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2000.
Program of All-Inclusive Care for the Elderly (PACE) Final Stage complete. This regulation became effective on 07/01/2000.
Hospice Services and Payment Methodology Final Stage complete. This regulation became effective on 01/05/2000.
Pharmacy Services: Coverage of Weight Loss Drugs
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 09/01/1999.
Preventive Services: Maternal Length of Stay
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 10/01/1999.
Coverage of Organ Transplant Services: Technical Amendment
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 09/15/1999.
Coverage of Leukemia Diagnoses under Bone Marrow/Stem Cell Transplantation
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/1999.

Withdrawn Actions
Action Title Latest Stage Status
Over-the-Counter Drugs Fast-Track Stage withdrawn on 04/10/2024 prior to submitting for AG review.
Doula Services Fast-Track Stage withdrawn on 04/28/2022 prior to submitting for AG review.
Removal of the 21 Out of 60 Day Limit
CMHRS Changes Required by CMS NOIRA Stage withdrawn on 11/29/2018 after the comment period had ended.
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 Fast-Track Stage withdrawn on 10/13/2016 prior to submitting for AG review.
Signature Requirement for Medical Records NOIRA Stage withdrawn on 07/06/2016 prior to submission to DPB.
Amount, Duration, and Scope of Services Pharmacy Services: Pharmacy Infusion Services Proposed Stage withdrawn on 03/18/2016 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 Final Stage withdrawn on 11/12/2013 prior to submitting for AG review.
CH 0050 Chap 50 Freestanding Birthing Centers
Cover Special DME in Nursing Facilities Final Stage withdrawn on 03/01/2013 prior to submission to DPB.
Mental Health Services Program Changes to Ensure Appropriate Utilization and Provider Qualifications Emergency/NOIRA Stage withdrawn on 01/13/2012 prior to submitting for AG review.
Pediatric Dental Program Proposed Stage withdrawn on 11/03/2005 before DPB completed its review.
Restore Elderly Case Management Emergency/NOIRA Stage withdrawn on 11/26/2007 before Attorney General's office completed its review.
2001 Technical Amendments
Final Stage withdrawn on 08/09/2007 before submission to the Registrar.
2000 Hospital Technical Amendments
Final Stage withdrawn on 08/09/2007 before submission to the Registrar.
Home Health Services Durable Medical Equipment Final Stage withdrawn on 08/09/2007 prior to submission to DPB.
2000 Technical Amendments
Final Stage withdrawn on 08/09/2007 before submission to the Registrar.