Section 170. Payment of Medicare Part a and Part B Deductible/Coinsurance

Except for a nominal recipient copayment (as specified in 12VAC30-20-150 and 12VAC30-20-160), if applicable, the Medicaid agency uses the following general method for payment:

1. Payments are limited to state plan rates and payment methodologies for the groups and payments listed below and designated with the letters "SP."

For specific Medicare services which are not otherwise covered by this state plan, the Medicaid agency uses Medicare payment rates unless a special rate or method is set out.

Not applicable. There are no special rates or methods used for specific Medicare services which are not otherwise covered by this state plan.

2. Payments are up to the full amount of the Medicare rate for the groups and payments listed below and designated with the letters "MR."

3. Payments are up to the amount of a special rate, or according to a special method, for the groups and payments listed below and designated with the letters "NR."

4. Any exceptions to the general methods used for a particular group or payment are specified.

	Payment of Medicare Part A and Part B Deductible/Coinsurance
	QMBs:	Part A	SP	Deductibles	SP	Coinsurance
		Part B	SP	Deductibles	SP	Coinsurance
	Other Medicaid Recipients (Other Dual Eligibles)	Part A	SP	Deductibles	SP	Coinsurance
		Part B	SP	Deductibles	SP	Coinsurance
	Dual Eligible (QMB Plus)	Part A	SP	Deductibles	SP	Coinsurance
		Part B	SP	Deductibles	SP	Coinsurance

Historical Notes

Derived from VR460-03-4.1922, eff. June 16, 1993; amended, Volume 12, Issue 05, eff. December 5, 1995; Volume 12, Issue 18, eff. July 1, 1996; Volume 15, Issue 18, eff. July 1, 1999.

Statutory Authority

§ 32.1-325 of the Code of Virginia.