TITLE 12. HEALTH
Title of Regulation: 12VAC30-50. Amount, Duration,
and Scope of Medical and Remedial Care Services (amending 12VAC30-50-220).
Statutory Authority: § 32.1-325 of the Code of
Virginia; 42 USC §1396 et seq.
Effective Dates: December 6, 2016, through June 5, 2018.
Agency Contact: Emily McClellan, Regulatory Supervisor,
Department of Medical Assistance Services, Policy Division, 600 East Broad
Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-4300, FAX (804)
786-1680, or email firstname.lastname@example.org.
Section 2.2-4011 of the Code of Virginia states that
agencies may adopt emergency regulations in situations in which Virginia
statutory law or the appropriation act or federal law or federal regulation
requires that a regulation be effective in 280 days or less from its enactment,
and the regulation is not exempt under the provisions of § 2.2-4006 A 4 of the
Code of Virginia. Item 306 OOOO of Chapter 780 of the 2016 Acts of Assembly,
the 2016 Appropriation Act, directs the Department of Medical Assistance
Services (DMAS) to cover low-dose computed tomography lung cancer screenings
for high-risk adults. The amendments conform the regulation to this
Other diagnostic Diagnostic,
screening, preventive, and rehabilitative services , i.e., other than
those provided elsewhere in this plan.
A. Diagnostic services are provided but only when necessary
to confirm a diagnosis.
B. Screening services.
1. Screening mammograms for the female recipient population
aged 35 and over shall be covered, consistent with the guidelines published by
the American Cancer Society.
2. Screening PSA (prostate specific antigen) and the related
DRE (digital rectal examination) for males shall be covered, consistent with
the guidelines published by the American Cancer Society.
3. Screening Pap smears shall be covered annually for females,
consistent with the guidelines published by the American Cancer Society.
4. Screening services for colorectal cancer, specifically
screening with an annual fecal occult blood test, flexible sigmoidoscopy or
colonoscopy, or in appropriate circumstances radiologic imaging, in accordance
with the most recently published recommendations established by the American
College of Gastroenterology, in consultation with the American Cancer Society,
for the ages, family histories, and frequencies referenced in such
5. Low-dose computed tomography lung cancer screening shall
be covered annually for individuals between the ages of 55 years and 79 years
who are current smokers, have quit smoking within the last 15 years, or have a
history of smoking at least one pack of cigarettes per day for 30 or more
C. Maternity length of stay and early discharge.
1. If the mother and newborn, or the newborn alone, are
discharged earlier than 48 hours after the day of delivery, DMAS will cover one
early discharge follow-up visit as recommended by the physicians in accordance
with and as indicated by the "Guidelines for Perinatal Care," 4th
Edition, August 1997, as developed by the American Academy of Pediatrics and
the American College of Obstetricians and Gynecologists. The mother and
newborn, or the newborn alone if the mother has not been discharged, must meet
the criteria for early discharge to be eligible for the early discharge
follow-up visit. This early discharge follow-up visit does not affect or apply
to any usual postpartum or well-baby care or any other covered care to which
the mother or newborn is entitled; it is tied directly to an early discharge.
2. The early discharge follow-up visit must be provided as
directed by a physician. The physician may coordinate with the provider of his
choice to provide the early discharge follow-up visit, within the following
limitations. Qualified providers are those hospitals, physicians, nurse
midwives, nurse practitioners, federally qualified health clinics, rural health
clinics, and health departments' clinics that are enrolled as Medicaid providers
and are qualified by the appropriate state authority for delivery of the
service. The staff providing the follow-up visit, at a minimum, must be a
registered nurse having training and experience in maternal and child health.
The visit must be provided within 48 hours of discharge.
VA.R. Doc. No. R17-4949; Filed December 6, 2016, 2:48 p.m.