Virginia Regulatory Town Hall View Chapter

Department of Medical Assistance Services

Board of Medical Assistance Services

Amount, Duration, and Scope of Medical and Remedial Care and Services [12 VAC 30 ‑ 50]

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.)
Exempt from APA	No, changes to this chapter are subject to the Administrative Process Act.
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: ()-

Action Title	Latest Stage	Status
Current Actions
Program of All-Inclusive Care for the Elderly	Fast-Track	Secretary of Health and Human Resources review in progress.
Mental Health and Substance Use Case Management	Fast-Track	Secretary of Health and Human Resources review in progress.
Case Management for Mental Health Services	-
Pharmacy Updates	-
Clarifications for Durable Medical Equipment and Supplies—Revisions	-
Preventive Services	-
90-Day Prescriptions	-
Discontinue Coverage of Erectile Dysfunction Drugs for Sex Offenders	-
Medicaid Enterprise System Updates	-
Abortion Services	-
Complex Rehabilitation Technology	-
Coverage of Medical Nutrition Therapy	-
Over-the-Counter Drugs	-
Adult Dental	-
12 Months Postpartum	-
Prior Authorization for Dental Services	-

Action Title	Latest Stage	Status
Past Actions
Clinical Trials	Final	Stage complete. This regulation became effective on 11/23/2022.
Private Duty Nursing Services Under EPSDT	Emergency/NOIRA	Stage complete. This regulation became effective on 10/06/2023 and expires on 04/05/2025.
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	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	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)	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	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	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	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	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	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	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 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	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	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	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)	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	Final	Stage complete. This regulation became effective on 07/01/2005.
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	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	Final	Stage complete. This regulation became effective on 07/01/2002.
Dental Services	Final	Stage complete. This regulation became effective on 07/01/2002.
Limit Coverage of Out-of-State Inpatient Hospital Services	Final	Stage complete. This regulation became effective on 01/02/2002.
Coverage of Ocular Prosthetics	Final	Stage complete. This regulation became effective on 12/05/2001.
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	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 07/05/2000.
2000 Omnibus Amendments: HIV eligibility expansion, organ transplant coverage expansion, colorectal cancer screenings coverage.	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	Final	Stage complete. This regulation became effective on 09/01/1999.
Preventive Services: Maternal Length of Stay	Final	Stage complete. This regulation became effective on 10/01/1999.
Coverage of Organ Transplant Services: Technical Amendment	Final	Stage complete. This regulation became effective on 09/15/1999.
Coverage of Leukemia Diagnoses under Bone Marrow/Stem Cell Transplantation	Final	Stage complete. This regulation became effective on 07/01/1999.

Action Title	Latest Stage	Status
Withdrawn Actions
Doula Services
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
Signature Requirement for Medical Records	Emergency/NOIRA	Stage withdrawn on 07/06/2016 after the Governor's office completed its review.
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
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 01/13/2012 after the comment period had ended.
Pediatric Dental Program	Proposed	Stage withdrawn on 11/03/2005 before DPB completed its review.
Restore Elderly Case Management
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
2000 Technical Amendments	Final	Stage withdrawn on 08/09/2007 before submission to the Registrar.