Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
 
Board
Board of Medical Assistance Services
 
chapter
Administration of Medical Assistance Services [12 VAC 30 ‑ 20]
 
Guidance Documents
 
Chapter Information
Description This chapter contains numerous topics: AG certification, state agency organization/function, definition of Medicaid HMO, requirements for advance directives, coordination of Medicare Parts A/B with Medicaid, applicant/ recipient information confidentiality, NF residents' drug utilization review, reserve bed payments for recipients' absence from facility, third party liability, NF sanctions/alternative remedies, definition of specialized services, categorical determinations, etc.
State Authority COV 32.1-325
Federal Authority Title XIX, 42 U.S.C. 1396 et seq.
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
MR Removal and Updates
Action is Exempt from Article 2 of the Administrative Process Act
Final Submitted to the Registrar and awaiting publication (01/12/2026).
Provider Appeals AIMS Filing Emergency/NOIRA Returned to agency requesting additional information.
Medicaid Enterprise System Updates
Action is Exempt from Article 2 of the Administrative Process Act
Final Attorney General review in progress.

Past Actions
Action Title Latest Stage Status
Provider Appeals Update Fast-Track Stage complete. This regulation became effective on 08/01/2024.
Third Party Liability Update Fast-Track Stage complete. This regulation became effective on 05/08/2025.
Settlement Agreement Discussion Process Fast-Track Stage complete. This regulation became effective on 09/02/2021.
Expansion-Related Changes - Expansion Group, FMAP, HIPP, Determination State Fast-Track Stage complete. This regulation became effective on 03/17/2022.
Reconsideration of Final Agency Decision Final Stage complete. This regulation became effective on 12/13/2017.
Reduction in Inpatient Cost Sharing to Comply with Federal Regulation
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 07/01/2017.
Appeal Regulation Updates Final Stage complete. This regulation became effective on 08/10/2016.
Electronic Claims Submission Requirement Final Stage complete. This regulation became effective on 11/06/2014.
Estate Recovery Update under MIPPA
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 01/02/2013.
Informal Provider Appeals Update
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage complete. This regulation became effective on 08/17/2011.
Health Insurance Premium Payment (HIPP) Cost Effectiveness Methodology Final Stage complete. This regulation became effective on 10/25/2012.
Health Insurance Premium Payment (HIPP) for Kids Program Fast-Track Stage complete. This regulation became effective on 11/08/2012.
Estate Recovery Update Final Stage complete. This regulation became effective on 07/23/2009.
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.
HIPP Program Modifications Fast-Track Stage complete. This regulation became effective on 07/23/2009.
2007 Omnibus: False Claims Recoveries;Third Party Liability
Action is Exempt from Article 2 of the Administrative Process Act
Final Stage withdrawn on 08/27/2007 prior to submitting for AG review.
Long Term Care Partnership Insurance Fast-Track Stage complete. This regulation became effective on 09/01/2007.
Estate Recovery Update Proposed Stage withdrawn on 03/07/2007 prior to submitting for AG review.
Periodic Review of Estate Recoveries NOIRA Stage withdrawn on 02/05/2007 after the comment period had ended.
Increased Cost-Sharing Measures Emergency/NOIRA Stage withdrawn on 03/15/2005 before Attorney General's office completed its review.
Provider Appeals Final Stage complete. This regulation became effective on 07/04/2001.

Withdrawn Actions
Action Title Latest Stage Status
Removal of Cost-Sharing Fast-Track Stage withdrawn on 04/25/2024 prior to submitting for AG review.
Third Party Liability - Payment of Claims Final Stage withdrawn on 08/08/2022 prior to submitting for AG review.
Reduction in Inpatient Cost Sharing to Comply With Federal Regulation Final Stage withdrawn on 07/06/2018 before DPB completed its review.
2015 HIPP Updates Fast-Track Stage withdrawn on 03/10/2017 prior to submitting for AG review.
Increase Cost-Sharing Measures Emergency Stage withdrawn on 03/12/2007 prior to submitting for AG review.
Recipient Cost Sharing and Similar Charges Proposed Stage withdrawn on 07/24/2003 after the comment period had ended.

Periodic Reviews
Last Activity Status
8/25/2014 Filed Pending