Standards Established and Methods Used to Assure High Quality Care | Midpage

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Virginia Administrative Code

Chapter 60

Standards Established and Methods Used to Assure High Quality Care

5Applicability of utilization review requirements..10Institutional care.20Utilization control: general acute care hospitals; enrolled providers.21Utilization control of nonparticipating out-of-state inpatient hospitals.25Utilization control: freestanding psychiatric hospitals.30Utilization control: Long-stay acute care hospitals (nonmental hospitals).40Utilization control: Nursing facilities.50Utilization control: Intermediate care facilities for persons with intellectual and developmental disabilities and institutions for mental disease.61Services related to the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT); community mental health and behavioral therapy services for youth.65Electronic visit verification.70Utilization control: home health services.75Durable medical equipment (DME) and supplies.80Utilization control: Optometrists' services.100Utilization control: Incorporation of specialized quality standards.110Utilization control: Effect of geographic boundaries on provision of care.120Quality management: Intensive physical rehabilitative services and  comprehensive outpatient rehabilitation facility services.130Hospice services.140Community mental health services.143Mental health services utilization criteria; definitions.145Developmental disability utilization criteria.150Quality management review of outpatient rehabilitation therapy services.170Utilization review of treatment foster care case management services.181Utilization review of addiction and recovery treatment services.185Utilization review of substance use case management.200Ticket to Work and Work Incentives Improvement Act (TWWIIA) basic coverage group: alternative benefits for Medicaid Buy-In program.301Definitions.302Access to Medicaid-funded long-term services and supports.303Screening criteria for Medicaid-funded long-term services and supports.304Requests and referrals for LTSS screening for adults and children living in the community; adults and children in hospitals; and adults and children in nursing facilities.305Screenings in the community and hospitals and nursing facilities for Medicaid-funded long-term services and supports.306Submission of LTSS screenings.308Nursing facility admission for LTSS and level of care determination requirements.310Competency training and testing requirements.313Individuals determined to not meet criteria for Medicaid-funded long-term services and supports.315Periodic evaluations for individuals receiving Medicaid-funded long-term services and supports.316Criteria for continued nursing facility care using the Minimum Data Set (MDS).318Definitions to be applied when completing the MDS.320Adult ventilation/tracheostomy specialized care criteria.330[Reserved]. (Reserved)340Pediatric and adolescent specialized care criteria.350Criteria for coverage of specialized treatment beds.361Criteria for supports and services in intermediate care facilities for individuals with intellectual disabilities.9998Forms (12Vac30-60).