Section 5. Applicability of utilization review requirements.

Section 10. Institutional care

Section 20. Utilization control: general acute care hospitals; enrolled providers

Section 21. Utilization control of nonparticipating out-of-state inpatient hospitals

Section 25. Utilization control: freestanding psychiatric hospitals

Section 30. Utilization control: Long-stay acute care hospitals (nonmental hospitals)

Section 40. Utilization control: Nursing facilities

Section 50. Utilization control: Intermediate Care Facilities for the Mentally Retarded (ICF/MR) and Institutions for Mental Disease (IMD)

Section 60. [Repealed]

Section 61. Services related to the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT); community mental health services for children

Section 70. Utilization control: Home health services

Section 75. Durable medical equipment (DME) and supplies

Section 80. Utilization control: Optometrists' services

Section 90. [Repealed]

Section 100. Utilization control: Incorporation of specialized quality standards

Section 110. Utilization control: Effect of geographic boundaries on provision of care

Section 120. Quality management: Intensive physical rehabilitative services and CORF services

Section 130. Hospice services

Section 140. Community mental health services

Section 143. Mental health services utilization criteria; definitions

Section 145. Mental retardation utilization criteria

Section 147. Substance abuse treatment services utilization review criteria

Section 150. Quality management review of outpatient rehabilitation therapy services

Section 160. Utilization review of case management for recipients of auxiliary grants

Section 170. Utilization review of treatment foster care (TFC) case management services

Section 180. Utilization review of community substance abuse treatment services

Section 185. Utilization review of case management

Section 200. Ticket to Work and Work Incentives Improvement Act (TWWIIA) basic coverage group: alternative benefits for Medicaid Buy-In program

Section 300. Nursing facility criteria

Section 303. Preadmission screening criteria for long-term care

Section 307. Summary of pre-admission nursing facility criteria

Section 310. [Reserved]

Section 312. Evaluation to determine eligibility for Medicaid payment of nursing facility or home and community-based care services

Section 316. Criteria for continued nursing facility care using the Minimum Data Set (MDS)

Section 318. Definitions to be applied when completing the MDS

Section 320. Adult ventilation/tracheostomy specialized care criteria

Section 330. [Reserved]

Section 340. Pediatric and adolescent specialized care criteria

Section 350. Criteria for coverage of specialized treatment beds

Section 360. Criteria for care in facilities for mentally retarded persons

Section 500. [Repealed]

Appendix 9998. FORMS (12VAC30-60)

Appendix 9999. DOCUMENTS INCORPORATED BY REFERENCE (12VAC30-60)