Virginia Administrative Code
Title 12 - HEALTH
Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES
Chapter 70 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES - INPATIENT HOSPITAL SERVICES
Part V - Inpatient Hospital Payment System
Article 3 - Other Provisions for Payment of Inpatient Hospital Services
Section 12VAC30-70-418 - Reimbursement for residential and inpatient substance use treatment services

Universal Citation: 12 VA Admin Code 12VAC30-70-418

Current through Register Vol. 41, No. 3, September 23, 2024

A. The following substance use disorder treatment services for adults and adolescents are provided in a residential or inpatient setting:

(i) clinically managed population-specific high intensity residential service (ASAM Level 3.3);

(ii) clinically managed high intensity residential services (adult) and clinically managed medium intensity residential services (adolescent) (ASAM Level 3.5);

(iii) medically monitored intensive inpatient services (adult) and medically monitored high intensity inpatient services (adolescent) (ASAM Level 3.7); and

(iv) medically managed intensive inpatient services (ASAM Level 4.0).

B. If one of the services in subsection A of this section is furnished to an individual in a freestanding psychiatric hospital or inpatient psychiatric unit of an acute care hospital, reimbursement shall be based on the hospital reimbursement described in 12VAC30-70-241 and the reimbursement of services provided under the arrangement described in 12VAC30-80.

C. If one of the services in subsection A of this section is furnished to an individual in an appropriately licensed residential setting, reimbursement shall be based on the psychiatric residential treatment facility (Level C) reimbursement described in 12VAC30-70-417.

Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.

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