With respect to agreements between the Medicaid agency and
each provider furnishing services under the plan:
A. For all providers, the requirements of
42 CFR
431.107 and Subparts A and B of 42 CFR Part
442 (if applicable) are met.
B. For
providers of NF services, the requirements of Subpart B of 42 CFR Part
483 and
§ 1919 of the Act are also met in addition to the requirements in
subsections C, D, and E of this subsection.
C. For providers of ICF/IID services, the
requirements of participation in Subpart I of 42 CFR Part
483 are also
met.
D. Ambulatory prenatal care is
not provided to pregnant women during a presumptive eligibility
period.
E. For each provider
receiving funds under the plan, all the requirements for advance directives of
§ 1902(w) are met:
1. Hospitals, nursing
facilities, providers of home health care or personal care services, hospice
programs, health maintenance organizations and health insuring organizations
are required to do the following:
a. Maintain
written policies and procedures with respect to all adult individuals receiving
medical care by or through the provider or organization about their rights
under state law to make decisions concerning medical care, including the right
to accept or refuse medical or surgical treatment and the right to formulate
advance directives;
b. Provide
written information to all adult individuals on their policies concerning
implementation of such rights;
c.
Document in the individual's medical records whether or not the individual has
executed an advance directive;
d.
Not to discriminate against an individual based on whether or not the
individual has executed an advance directive including the provision of
care;
e. Ensure compliance with
requirements of state law (whether statutory or recognized by the courts)
concerning advance directives; and
f. Provide (individually or with others) for
education for staff and the community on issues concerning advance
directives.
2. Providers
will furnish the written information described in subdivision 1 a of this
subsection to all adult individuals at the time specified in this subdivision:
a. Hospitals at the time an individual is
admitted as an inpatient;
b.
Nursing facilities when the individual is admitted as a resident;
c. Providers of home health or personal care
services before the individual comes under the care of the provider;
d. Hospice program at the time of initial
receipt of hospice care by the individual from the program; and
e. Health maintenance organizations at the
time of enrollment of the individual with the organization.
3.12VAC30-20-240 describes law of
the state (whether statutory or as recognized by the courts of the state)
concerning advance directives.
As a condition of participation in the Virginia Medical
Assistance Program all nursing facilities must agree that when an individual is
discharged to a hospital, the nursing facility from which the individual is
discharged shall ensure that the individual shall be given an opportunity to be
readmitted to the facility at the time of the next available vacancy.
The only acceptable reasons for failure to readmit a
specific individual who has been discharged to a hospital shall be the
individual is certified for a level of care not provided by the facility, the
individual is judged by a physician to be a danger to himself or others, or the
individual, who at the time of readmission has an outstanding payment to the
nursing facility for which he is responsible in accordance with Medicaid
regulations.
F.
The Department of Medical Assistance Services (DMAS) shall conduct provider
screening according to the requirements of Subpart E of 42 CFR Part
455 . DMAS
shall terminate or deny enrollment to any provider in accordance with the
requirements of 42 CFR
455.416.
Notes
12
Va. Admin. Code §
30-10-520
Paragraphs A-D
derived from VR460-01-45, eff. June 16, 1993; paragraph E 1 (a)-(e) derived
from VR460-01-45.1, eff. June 16, 1993; paragraph E 1 (f), E 2, and E 3 derived
from VR460-01-45.2, eff. June 16, 1993; Amended,
Virginia
Register Volume 33, Issue 02, eff.
10/19/2016;
Amended,
Virginia
Register Volume 34, Issue 01, eff.
10/19/2017.
Statutory Authority: §
32.1-325 of the Code of
Virginia; 42 USC §
1396 et
seq.
