12VAC30-95 Standards Established and Methods Used for Fee-For-Service Reimbursement

REGULATIONS

Vol. 31 Iss. 2 - September 22, 2014

TITLE 12. HEALTH

DEPARTMENT OF MEDICAL ASSISTANCE SERVICES

Chapter 95

Final Regulation

REGISTRAR'S NOTICE: The following regulatory action is exempt from Article 2 of the Administrative Process Act in accordance with § 2.2-4006 A 4 c of the Code of Virginia, which excludes regulations that are necessary to meet the requirements of federal law or regulations, provided such regulations do not differ materially from those required by federal law or regulation. The Department of Medical Assistance Services will receive, consider, and respond to petitions by any interested person at any time with respect to reconsideration or revision.

Titles of Regulations: 12VAC30-80. Methods and Standards for Establishing Payment Rates; Other Types of Care.

12VAC30-95. Standards Established and Methods Used for Fee-For-Service Reimbursement (amending 12VAC30-95-5).

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

Effective Date: October 22, 2014.

Agency Contact: Brian McCormick, Regulatory Supervisor, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone [phone], FAX [phone], TTY (800) 343-0634, or email [e-mail].

Summary:

This regulatory action amends the definition of "ICD" and accordingly updates references throughout 12VAC30 to the 10th edition of the International Classification of Diseases for claims with dates of service on or after October 1, 2015. The amendments to the regulation conform to changes in federal regulation (79 FR 45134 (August 4, 2014)).

DOCUMENTS INCORPORATED BY REFERENCE (12VAC30-80)

Approved Drug Products with Therapeutic Equivalence Evaluations, 25th Edition, 2005, U.S. Department of Health and Human Services

International Classification of Diseases, ICD-9-CM 2007 (effective for claims with dates of service through September 30, 2014) 2015), Physician, Volumes 1 and 2, 9th Revision-Clinical Modification, American Medical Association

Virginia Medicaid Durable Medical Equipment and Supplies Provider Manual, Appendix B (rev. 1/11), Department of Medical Assistance Services

12VAC30-95-5. General definitions.

The following words and terms when used in 12VAC30 shall have the following meanings unless the context clearly indicates otherwise:

"ASAM" means the American Society of Addiction Medicine.

"ICD" means (i) for claims with dates of service on or prior to September 30, 2014 2015, the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) Volumes 1, 2, and 3, OptumInsight, Inc., and (ii) for claims with dates of service on or after October 1, 2014 2015, the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and Procedure Coding System (ICD-10-PCS) pursuant to 45 CFR 162.1002, OptumInsight, Inc.

VA.R. Doc. No. R15-4124; Filed August 28, 2014, 12:58 p.m.