Chapter 60 - STANDARDS ESTABLISHED AND METHODS USED TO ASSURE HIGH QUALITY CARE
- Section 12VAC30-60-5 - Applicability of utilization review requirements
- Section 12VAC30-60-10 - Institutional care
- Section 12VAC30-60-20 - Utilization control: general acute care hospitals; enrolled providers
- Section 12VAC30-60-21 - Utilization control of nonparticipating out-of-state inpatient hospitals
- Section 12VAC30-60-25 - [Effective until 9/26/2024] Utilization control: freestanding psychiatric hospitals
- Section 12VAC30-60-25 - [Effective 9/26/2024] Utilization control: freestanding psychiatric hospitals
- Section 12VAC30-60-30 - Utilization control: Long-stay acute care hospitals (nonmental hospitals)
- Section 12VAC30-60-40 - [Effective until 9/26/2024] Utilization control: Nursing facilities
- Section 12VAC30-60-40 - [Effective 9/26/2024] Utilization control: Nursing facilities
- Section 12VAC30-60-50 - [Effective until 9/26/2024] Utilization control: Intermediate care facilities for persons with intellectual and developmental disabilities and institutions for mental disease
- Section 12VAC30-60-50 - [Effective 9/26/2024] Utilization control: Intermediate care facilities for persons with intellectual and developmental disabilities and institutions for mental disease
- Section 12VAC30-60-60 - [Repealed]
- Section 12VAC30-60-61 - Services related to the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT); community mental health and behavioral therapy services for youth
- Section 12VAC30-60-65 - Electronic visit verification
- Section 12VAC30-60-70 - Utilization control: home health services
- Section 12VAC30-60-75 - Durable medical equipment (DME) and supplies
- Section 12VAC30-60-80 - Utilization control: Optometrists' services
- Section 12VAC30-60-90 - [Repealed]
- Section 12VAC30-60-100 - Utilization control: Incorporation of specialized quality standards
- Section 12VAC30-60-110 - Utilization control: Effect of geographic boundaries on provision of care
- Section 12VAC30-60-120 - [Effective until 9/26/2024] Quality management: Intensive physical rehabilitative rehabilitation or CORF services
- Section 12VAC30-60-120 - [Effective 9/26/2024] Quality management: Intensive physical rehabilitative services and comprehensive outpatient rehabilitation facility services
- Section 12VAC30-60-130 - [Effective until 9/26/2024] Hospice services
- Section 12VAC30-60-130 - [Effective 9/26/2024] Hospice services
- Section 12VAC30-60-140 - Community mental health services
- Section 12VAC30-60-143 - Mental health services utilization criteria; definitions
- Section 12VAC30-60-145 - Mental retardation utilization criteria
- Section 12VAC30-60-147 - [Repealed]
- Section 12VAC30-60-150 - [Effective until 9/26/2024] Quality management review of outpatient rehabilitation therapy services
- Section 12VAC30-60-150 - [Effective 9/26/2024] Quality management review of outpatient rehabilitation therapy services
- Section 12VAC30-60-160 - Utilization review of case management for recipients of auxiliary grants
- Section 12VAC30-60-170 - [Effective until 9/26/2024] Utilization review of treatment foster care (TFC) case management services
- Section 12VAC30-60-170 - [Effective 9/26/2024] Utilization review of treatment foster care case management services
- Section 12VAC30-60-180 - [Repealed]
- Section 12VAC30-60-181 - Utilization review of addiction and recovery treatment services
- Section 12VAC30-60-185 - [Effective until 9/26/2024] Utilization review of substance use case management
- Section 12VAC30-60-185 - [Effective 9/26/2024] Utilization review of substance use case management
- Section 12VAC30-60-200 - Ticket to Work and Work Incentives Improvement Act (TWWIIA) basic coverage group: alternative benefits for Medicaid Buy-In program
- Section 12VAC30-60-300 - [Repealed]
- Section 12VAC30-60-301 - Definitions
- Section 12VAC30-60-302 - Access to Medicaid-funded long-term services and supports
- Section 12VAC30-60-303 - [Effective until 9/26/2024] Screening criteria for Medicaid-funded long-term services and supports
- Section 12VAC30-60-303 - [Effective 9/26/2024] Screening criteria for Medicaid-funded long-term services and supports
- Section 12VAC30-60-304 - Requests and referrals for screening for adults and children living in the community and adults and children in hospitals
- Section 12VAC30-60-305 - Screenings in the community and hospitals for Medicaid-funded long-term services and supports
- Section 12VAC30-60-306 - Submission of screenings
- Section 12VAC30-60-307 - [Repealed]
- Section 12VAC30-60-308 - Nursing facility admission and level of care determination requirements
- Section 12VAC30-60-310 - Competency training and testing requirements
- Section 12VAC30-60-312 - [Repealed]
- Section 12VAC30-60-313 - Individuals determined to not meet criteria for Medicaid-funded long-term services and supports
- Section 12VAC30-60-315 - Periodic evaluations for individuals receiving Medicaid-funded long-term services and supports
- Section 12VAC30-60-316 - Criteria for continued nursing facility care using the Minimum Data Set (MDS)
- Section 12VAC30-60-318 - Definitions to be applied when completing the MDS
- Section 12VAC30-60-320 - Adult ventilation/tracheostomy specialized care criteria
- Section 12VAC30-60-330 - Reserved
- Section 12VAC30-60-340 - Pediatric and adolescent specialized care criteria
- Section 12VAC30-60-350 - Criteria for coverage of specialized treatment beds
- Section 12VAC30-60-360 - [Repealed]
- Section 12VAC30-60-361 - Criteria for supports and services in intermediate care facilities for individuals with intellectual disabilities
- Section 12VAC30-60-500 - [Repealed]
- Form - FORMS (12VAC30-60)
- Section - [Repealed effective 9/26/2024] DOCUMENTS INCORPORATED BY REFERENCE (12VAC30-60)