                                 CODE OF VIRGINIA

BOARD TO SUBMIT PLAN FOR MEDICAL ASSISTANCE SERVICES TO U.S. SECRETARY OF HEALTH
AND HUMAN SERVICES PURSUANT TO FEDERAL LAW; ADMINISTRATION OF PLAN; CONTRACTS
WITH HEALTH CARE PROVIDERS (§ 32.1-325)

A. The Board, subject to the approval of the Governor, is authorized to prepare,
amend from time to time, and submit to the U.S. Secretary of Health and Human
Services a state plan for medical assistance services pursuant to Title XIX of
the United States Social Security Act and any amendments thereto. The Board
shall include in such plan:

   1. A provision for payment of medical assistance on behalf of individuals, up
   to the age of 21, placed in foster homes or private institutions by private,
   nonprofit agencies licensed as child-placing agencies by the Department of
   Social Services or placed through state and local subsidized adoptions to the
   extent permitted under federal statute;

   2. A provision for determining eligibility for benefits for medically needy
   individuals which disregards from countable resources an amount not in excess
   of $3,500 for the individual and an amount not in excess of $3,500 for his
   spouse when such resources have been set aside to meet the burial expenses of
   the individual or his spouse. The amount disregarded shall be reduced by (i)
   the face value of life insurance on the life of an individual owned by the
   individual or his spouse if the cash surrender value of such policies has been
   excluded from countable resources and (ii) the amount of any other revocable
   or irrevocable trust, contract, or other arrangement specifically designated
   for the purpose of meeting the individual&#8217;s or his spouse&#8217;s burial
   expenses;

   3. A requirement that, in determining eligibility, a home shall be
   disregarded. For those medically needy persons whose eligibility for medical
   assistance is required by federal law to be dependent on the budget
   methodology for Aid to Families with Dependent Children, a home means the
   house and lot used as the principal residence and all contiguous property. For
   all other persons, a home shall mean the house and lot used as the principal
   residence, as well as all contiguous property, as long as the value of the
   land, exclusive of the lot occupied by the house, does not exceed $5,000. In
   any case in which the definition of home as provided here is more restrictive
   than that provided in the state plan for medical assistance services in
   Virginia as it was in effect on January 1, 1972, then a home means the house
   and lot used as the principal residence and all contiguous property essential
   to the operation of the home regardless of value;

   4. A provision for payment of medical assistance on behalf of individuals up
   to the age of 21, who are Medicaid eligible, for medically necessary stays in
   acute care facilities in excess of 21 days per admission;

   5. A provision for deducting from an institutionalized recipient&#8217;s
   income an amount for the maintenance of the individual&#8217;s spouse at home;

   6. A provision for payment of medical assistance on behalf of pregnant women
   which provides for payment for inpatient postpartum treatment in accordance
   with the medical criteria outlined in the most current version of or an
   official update to the &#8220;Guidelines for Perinatal Care&#8221; prepared by
   the American Academy of Pediatrics and the American College of Obstetricians
   and Gynecologists or the &#8220;Standards for Obstetric-Gynecologic
   Services&#8221; prepared by the American College of Obstetricians and
   Gynecologists. Payment shall be made for any postpartum home visit or visits
   for the mothers and the children which are within the time periods recommended
   by the attending physicians in accordance with and as indicated by such
   Guidelines or Standards. For the purposes of this subdivision, such Guidelines
   or Standards shall include any changes thereto within six months of the
   publication of such Guidelines or Standards or any official amendment thereto;

   7. A provision for the payment for family planning services on behalf of women
   who were Medicaid-eligible for prenatal care and delivery as provided in this
   section at the time of delivery. Such family planning services shall begin
   with delivery and continue for a period of 24 months, if the woman continues
   to meet the financial eligibility requirements for a pregnant woman under
   Medicaid. For the purposes of this section, family planning services shall not
   cover payment for abortion services and no funds shall be used to perform,
   assist, encourage or make direct referrals for abortions;

   8. A provision for payment of medical assistance for high-dose chemotherapy
   and bone marrow transplants on behalf of individuals over the age of 21 who
   have been diagnosed with lymphoma, breast cancer, myeloma, or leukemia and
   have been determined by the treating health care provider to have a
   performance status sufficient to proceed with such high-dose chemotherapy and
   bone marrow transplant. Appeals of these cases shall be handled in accordance
   with the Department&#8217;s expedited appeals process;

   9. A provision identifying entities approved by the Board to receive
   applications and to determine eligibility for medical assistance, which shall
   include a requirement that such entities (i) obtain accurate contact
   information, including the best available address and telephone number, from
   each applicant for medical assistance, to the extent required by federal law
   and regulations, and (ii) provide each applicant for medical assistance with
   information about advance directives pursuant to Article 8 (&#xA7; 54.1-2981
   et seq.) of Chapter 29 of Title 54.1, including information about the purpose
   and benefits of advance directives and how the applicant may make an advance
   directive;

   10. A provision for breast reconstructive surgery following the medically
   necessary removal of a breast for any medical reason. Breast reductions shall
   be covered, if prior authorization has been obtained, for all medically
   necessary indications. Such procedures shall be considered noncosmetic;

   11. A provision for payment of medical assistance for annual pap smears;

   12. A provision for payment of medical assistance services for prostheses
   following the medically necessary complete or partial removal of a breast for
   any medical reason;

   13. A provision for payment of medical assistance which provides for payment
   for 48 hours of inpatient treatment for a patient following a radical or
   modified radical mastectomy and 24 hours of inpatient care following a total
   mastectomy or a partial mastectomy with lymph node dissection for treatment of
   disease or trauma of the breast. Nothing in this subdivision shall be
   construed as requiring the provision of inpatient coverage where the attending
   physician in consultation with the patient determines that a shorter period of
   hospital stay is appropriate;

   14. A requirement that certificates of medical necessity for durable medical
   equipment and any supporting verifiable documentation shall be signed, dated,
   and returned by the physician, physician assistant, or advanced practice
   registered nurse and in the durable medical equipment provider&#8217;s
   possession within 60 days from the time the ordered durable medical equipment
   and supplies are first furnished by the durable medical equipment provider;

   15. A provision for payment of medical assistance to (i) persons age 50 and
   over and (ii) persons age 40 and over who are at high risk for prostate
   cancer, according to the most recent published guidelines of the American
   Cancer Society, for prostate cancer screening, which includes one
   prostate-specific antigen test in a 12-month period and digital rectal
   examinations;

   16. A provision for payment of medical assistance for low-dose screening
   mammograms for determining the presence of occult breast cancer. Such coverage
   shall make available one screening mammogram to persons age 35 through 39, one
   such mammogram biennially to persons age 40 through 49, and one such mammogram
   annually to persons age 50 and over. The term &#8220;mammogram&#8221; means an
   X-ray examination of the breast using equipment dedicated specifically for
   mammography, including but not limited to the X-ray tube, filter, compression
   device, screens, film and cassettes, with an average radiation exposure of
   less than one rad mid-breast, two views of each breast;

   17. A provision, when in compliance with federal law and regulation and
   approved by the Centers for Medicare &amp; Medicaid Services (CMS), for
   payment of medical assistance services delivered to Medicaid-eligible students
   when such services qualify for reimbursement by the Virginia Medicaid program
   and may be provided by school divisions, regardless of whether the student
   receiving care has an individualized education program or whether the health
   care service is included in a student&#8217;s individualized education
   program. Such services shall include those covered under the state plan for
   medical assistance services or by the Early and Periodic Screening,
   Diagnostic, and Treatment (EPSDT) benefit as specified in &#xA7; 1905(r) of
   the federal Social Security Act, and shall include a provision for payment of
   medical assistance for health care services provided through telemedicine
   services, as defined in &#xA7; 38.2-3418.16. No health care provider who
   provides health care services through telemedicine shall be required to use
   proprietary technology or applications in order to be reimbursed for providing
   telemedicine services;

   18. A provision for payment of medical assistance services for liver, heart
   and lung transplantation procedures for individuals over the age of 21 years
   when (i) there is no effective alternative medical or surgical therapy
   available with outcomes that are at least comparable; (ii) the transplant
   procedure and application of the procedure in treatment of the specific
   condition have been clearly demonstrated to be medically effective and not
   experimental or investigational; (iii) prior authorization by the Department
   of Medical Assistance Services has been obtained; (iv) the patient selection
   criteria of the specific transplant center where the surgery is proposed to be
   performed have been used by the transplant team or program to determine the
   appropriateness of the patient for the procedure; (v) current medical therapy
   has failed and the patient has failed to respond to appropriate therapeutic
   management; (vi) the patient is not in an irreversible terminal state; and
   (vii) the transplant is likely to prolong the patient&#8217;s life and restore
   a range of physical and social functioning in the activities of daily living;

   19. A provision for payment of medical assistance for colorectal cancer
   screening, 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 recommendations;

   20. A provision for payment of medical assistance for custom ocular
   prostheses;

   21. A provision for payment for medical assistance for infant hearing
   screenings and all necessary audiological examinations provided pursuant to
   &#xA7; 32.1-64.1 using any technology approved by the United States Food and
   Drug Administration, and as recommended by the national Joint Committee on
   Infant Hearing in its most current position statement addressing early hearing
   detection and intervention programs. Such provision shall include payment for
   medical assistance for follow-up audiological examinations as recommended by a
   physician, physician assistant, advanced practice registered nurse, or
   audiologist and performed by a licensed audiologist to confirm the existence
   or absence of hearing loss;

   22. A provision for payment of medical assistance, pursuant to the Breast and
   Cervical Cancer Prevention and Treatment Act of 2000 (P.L. 106-354), for
   certain women with breast or cervical cancer when such women (i) have been
   screened for breast or cervical cancer under the Centers for Disease Control
   and Prevention (CDC) Breast and Cervical Cancer Early Detection Program
   established under Title XV of the Public Health Service Act; (ii) need
   treatment for breast or cervical cancer, including treatment for a
   precancerous condition of the breast or cervix; (iii) are not otherwise
   covered under creditable coverage, as defined in &#xA7; 2701 (c) of the Public
   Health Service Act; (iv) are not otherwise eligible for medical assistance
   services under any mandatory categorically needy eligibility group; and (v)
   have not attained age 65. This provision shall include an expedited
   eligibility determination for such women;

   23. A provision for the coordinated administration, including outreach,
   enrollment, re-enrollment and services delivery, of medical assistance
   services provided to medically indigent children pursuant to this chapter,
   which shall be called Family Access to Medical Insurance Security (FAMIS) Plus
   and the FAMIS Plan program in &#xA7; 32.1-351. A single application form shall
   be used to determine eligibility for both programs;

   24. A provision, when authorized by and in compliance with federal law, to
   establish a public-private long-term care partnership program between the
   Commonwealth of Virginia and private insurance companies that shall be
   established through the filing of an amendment to the state plan for medical
   assistance services by the Department of Medical Assistance Services. The
   purpose of the program shall be to reduce Medicaid costs for long-term care by
   delaying or eliminating dependence on Medicaid for such services through
   encouraging the purchase of private long-term care insurance policies that
   have been designated as qualified state long-term care insurance partnerships
   and may be used as the first source of benefits for the participant&#8217;s
   long-term care. Components of the program, including the treatment of assets
   for Medicaid eligibility and estate recovery, shall be structured in
   accordance with federal law and applicable federal guidelines;

   25. A provision for the payment of medical assistance for otherwise eligible
   pregnant women during the first five years of lawful residence in the United
   States, pursuant to &#xA7; 214 of the Children&#8217;s Health Insurance
   Program Reauthorization Act of 2009 (P.L. 111-3);

   26. A provision for the payment of medical assistance for medically necessary
   health care services provided through telemedicine services, as defined in
   &#xA7; 38.2-3418.16, regardless of the originating site or whether the patient
   is accompanied by a health care provider at the time such services are
   provided. No health care provider who provides health care services through
   telemedicine services shall be required to use proprietary technology or
   applications in order to be reimbursed for providing telemedicine services.
   				For the purposes of this subdivision, a health care provider duly licensed
   by the Commonwealth who provides health care services exclusively through
   telemedicine services shall not be required to maintain a physical presence in
   the Commonwealth to be considered an eligible provider for enrollment as a
   Medicaid provider.
   				For the purposes of this subdivision, a telemedicine services provider
   group with health care providers duly licensed by the Commonwealth shall not
   be required to have an in-state service address to be eligible to enroll as a
   Medicaid vendor or Medicaid provider group.
   				For the purposes of this subdivision, &#8220;originating site&#8221; means
   any location where the patient is located, including any medical care facility
   or office of a health care provider, the home of the patient, the
   patient&#8217;s place of employment, or any public or private primary or
   secondary school or postsecondary institution of higher education at which the
   person to whom telemedicine services are provided is located;

   27. A provision for the payment of medical assistance for the dispensing or
   furnishing of up to a 12-month supply of hormonal contraceptives at one time.
   Absent clinical contraindications, the Department shall not impose any
   utilization controls or other forms of medical management limiting the supply
   of hormonal contraceptives that may be dispensed or furnished to an amount
   less than a 12-month supply. Nothing in this subdivision shall be construed to
   (i) require a provider to prescribe, dispense, or furnish a 12-month supply of
   self-administered hormonal contraceptives at one time or (ii) exclude coverage
   for hormonal contraceptives as prescribed by a prescriber, acting within his
   scope of practice, for reasons other than contraceptive purposes. As used in
   this subdivision, &#8220;hormonal contraceptive&#8221; means a medication
   taken to prevent pregnancy by means of ingestion of hormones, including
   medications containing estrogen or progesterone, that is self-administered,
   requires a prescription, and is approved by the U.S. Food and Drug
   Administration for such purpose;

   28. A provision for payment of medical assistance for remote patient
   monitoring services provided via telemedicine, as defined in &#xA7;
   38.2-3418.16, for (i) high-risk pregnant persons; (ii) medically complex
   infants and children; (iii) transplant patients; (iv) patients who have
   undergone surgery, for up to three months following the date of such surgery;
   and (v) patients with a chronic or acute health condition who have had two or
   more hospitalizations or emergency department visits related to such health
   condition in the previous 12 months when there is evidence that the use of
   remote patient monitoring is likely to prevent readmission of such patient to
   a hospital or emergency department. For the purposes of this subdivision,
   &#8220;remote patient monitoring services&#8221; means the use of digital
   technologies to collect medical and other forms of health data from patients
   in one location and electronically transmit that information securely to
   health care providers in a different location for analysis, interpretation,
   and recommendations, and management of the patient. &#8220;Remote patient
   monitoring services&#8221; includes monitoring of clinical patient data such
   as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other
   patient physiological data, treatment adherence monitoring, and interactive
   videoconferencing with or without digital image upload;

   29. A provision for the payment of medical assistance for provider-to-provider
   consultations that is no more restrictive than, and is at least equal in
   amount, duration, and scope to, that available through the fee-for-service
   program;

   30. A provision for payment of the originating site fee to emergency medical
   services agencies for facilitating synchronous telehealth visits with a
   distant site provider delivered to a Medicaid member. As used in this
   subdivision, &#8220;originating site&#8221; means any location where the
   patient is located, including any medical care facility or office of a health
   care provider, the home of the patient, the patient&#8217;s place of
   employment, or any public or private primary or secondary school or
   postsecondary institution of higher education at which the person to whom
   telemedicine services are provided is located;

   31. A provision for the payment of medical assistance for targeted case
   management services for individuals with severe traumatic brain injury;

   32. A provision for payment of medical assistance for the initial purchase or
   replacement of complex rehabilitative technology manual and power wheelchair
   bases and related accessories, as defined by the Department&#8217;s durable
   medical equipment program policy, for patients who reside in nursing
   facilities. Initial purchase or replacement may be contingent upon (i)
   determination of medical necessity; (ii) requirements in accordance with
   regulations established through the Department&#8217;s durable medical
   equipment program policy; and (iii) exclusive use by the nursing facility
   resident. Recipients of medical assistance shall not be required to pay any
   deductible, coinsurance, copayment, or patient costs related to the initial
   purchase or replacement of complex rehabilitative technology manual and power
   wheelchair bases and related accessories;

   33. A provision for payment of medical assistance for remote ultrasound
   procedures and remote fetal non-stress tests. Such provision shall utilize
   established CPT codes for these procedures and shall apply when the patient is
   in a residence or other off-site location from the patient&#8217;s provider
   that provides the same standard of care. The provision shall provide for
   reimbursement only when a provider uses digital technology (i) to collect
   medical and other forms of health data from a patient and electronically
   transmit that information securely to a health care provider in a different
   location for interpretation and recommendation; (ii) that is compliant with
   the federal Health Insurance Portability and Accountability Act of 1996 (42
   U.S.C. &#xA7; 1320d et seq.); and (iii) that is approved by the U.S. Food and
   Drug Administration. For fetal non-stress tests under CPT Code 59025, the
   provision shall provide for reimbursement only if such test (a) is conducted
   with a place of service modifier for at-home monitoring and (b) uses remote
   monitoring solutions that are approved by the U.S. Food and Drug
   Administration for on-label use to monitor fetal heart rate, maternal heart
   rate, and uterine activity;

   34. A provision for payment of medical assistance for the prophylaxis,
   diagnosis, and treatment of pediatric autoimmune neuropsychiatric disorders
   associated with streptococcal infections and pediatric acute-onset
   neuropsychiatric syndrome. Such provision shall include payment for treatment
   using antimicrobials, medication, and behavioral therapies to manage
   neuropsychiatric symptoms, immunomodulating medicines, plasma exchange, and
   intravenous immunoglobulin therapy. For the purposes of this subdivision:
   				&#8220;Pediatric acute-onset neuropsychiatric syndrome&#8221; or
   &#8220;PANS&#8221; means a clinically defined disorder characterized by the
   sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions,
   concomitant with acute behavioral deterioration in at least two designated
   domains. Comorbid PANS symptoms may include anxiety, sensory amplification or
   motor abnormalities, behavioral regression, deterioration in school
   performance, mood disorder, urinary symptoms, or sleep disturbances. PANS does
   not require a known trigger, although it is believed to be triggered by one or
   more pathogens.
   				&#8220;Pediatric autoimmune neuropsychiatric disorders associated with
   streptococcal infections&#8221; or &#8220;PANDAS&#8221; means a subset of PANS
   that has five distinct criteria for diagnosis, including (i) abrupt
   &#8220;overnight&#8221; OCD or dramatic, disabling tics; (ii) a
   relapsing-remitting, episodic symptom course; (iii) young age at onset; (iv)
   presence of neurologic abnormalities; and (v) temporal association between
   symptom onset and Group A streptococcal infection. The five criteria of PANDAS
   are usually accompanied by similar comorbid symptoms as found in PANS;

   35. A provision for payment of medical assistance for rapid whole genome
   sequencing for children three years of age or younger who are receiving
   inpatient hospital services in an intensive care unit. For the purposes of
   this subdivision, &#8220;rapid whole genome sequencing&#8221; is defined as an
   investigation of the entire human genome to identify disease-causing genetic
   changes that returns preliminary positive results within seven days and final
   results within 15 days from the date of receipt of the sample by the lab
   performing the test. &#8220;Rapid whole genome sequencing&#8221; includes
   patient-only whole genome sequencing and duo and trio whole genome sequencing
   of the patient and biological parent or parents;

   36. A provision for payment of medical assistance for comprehensive dental
   care services for pregnant women. Such services shall include (i) preventive
   services, such as cleanings, oral exams, and x-rays; (ii) diagnostic services,
   including periodontal assessments and consultations; (iii) restorative
   procedures, including fillings, root canals, and crowns; (iv) emergency dental
   care to address acute pain and infection; (v) periodontal treatment for gum
   disease, including deep cleanings; and (vi) any other dental services deemed
   medically necessary by the Department in consultation with dentists, other
   dental professionals, and public health experts. Such provision shall provide
   for at least four dental visits during pregnancy, with additional visits
   permitted upon recommendation from a licensed dentist or obstetrician. The
   Department of Medical Assistance Services shall report annually to the
   Governor and the General Assembly on the implementation and outcomes of this
   act. The report shall include (i) the number of pregnant women who utilized
   expanded dental services; (ii) analysis of the impact of the expanded dental
   services on maternal and infant health outcomes; (iii) any barriers to access
   or service delivery; and (iv) recommendations for further improvement; and

   37. A provision for payment of medical assistance for postpartum doula care.
   Postpartum doula care covered under such provision shall include (i) emotional
   and physical support for the birthing individual and family during the
   postpartum period; (ii) assistance with infant care, breastfeeding, and safe
   sleeping practices; (iii) education on postpartum mental health and referrals
   to mental health resources as needed; (iv) guidance on physical recovery,
   nutrition, and self-care for the birthing individual; (v) connection to
   community resources and social support systems; and (vi) culturally
   appropriate and individualized care tailored to the birthing
   individual&#8217;s needs. Such provision shall ensure that eligible
   individuals receive payment of medical assistance services for up to 10 doula
   visits, with up to four doula visits during pregnancy and up to six doula
   visits during the 12 months after the individual gives birth, with additional
   visits permitted if such visits are deemed medically necessary. The Department
   of Medical Assistance Services shall report annually to the Governor and the
   General Assembly on the implementation and outcomes of this act. The report
   shall include (i) the number of postpartum individuals who utilized doula care
   services; (ii) analysis of the impact of doula care services on maternal and
   infant health outcomes; (iii) feedback from birthing individuals, families,
   and doula service providers; and (iv) recommendations for improvement or
   expansion.

B. In preparing the plan, the Board shall:

   1. Work cooperatively with the State Board of Health to ensure that quality
   patient care is provided and that the health, safety, security, rights and
   welfare of patients are ensured.

   2. Initiate such cost containment or other measures as are set forth in the
   appropriation act.

   3. Make, adopt, promulgate and enforce such regulations as may be necessary to
   carry out the provisions of this chapter.

   4. Examine, before acting on a regulation to be published in the Virginia
   Register of Regulations pursuant to &#xA7; 2.2-4007.05, the potential fiscal
   impact of such regulation on local boards of social services. For regulations
   with potential fiscal impact, the Board shall share copies of the fiscal
   impact analysis with local boards of social services prior to submission to
   the Registrar. The fiscal impact analysis shall include the projected
   costs/savings to the local boards of social services to implement or comply
   with such regulation and, where applicable, sources of potential funds to
   implement or comply with such regulation.

   5. Incorporate sanctions and remedies for certified nursing facilities
   established by state law, in accordance with 42 C.F.R. &#xA7; 488.400 et seq.,
   Enforcement of Compliance for Long-Term Care Facilities With Deficiencies.

   6. On and after July 1, 2002, require that a prescription benefit card, health
   insurance benefit card, or other technology that complies with the
   requirements set forth in &#xA7; 38.2-3407.4:2 be issued to each recipient of
   medical assistance services, and shall upon any changes in the required data
   elements set forth in subsection A of &#xA7; 38.2-3407.4:2, either reissue the
   card or provide recipients such corrective information as may be required to
   electronically process a prescription claim.

C. In order to enable the Commonwealth to continue to receive federal grants or
reimbursement for medical assistance or related services, the Board, subject to
the approval of the Governor, may adopt, regardless of any other provision of
this chapter, such amendments to the state plan for medical assistance services
as may be necessary to conform such plan with amendments to the United States
Social Security Act or other relevant federal law and their implementing
regulations or constructions of these laws and regulations by courts of
competent jurisdiction or the United States Secretary of Health and Human
Services.
			In the event conforming amendments to the state plan for medical assistance
services are adopted, the Board shall not be required to comply with the
requirements of Article 2 (&#xA7; 2.2-4006 et seq.) of Chapter 40 of Title 2.2.
However, the Board shall, pursuant to the requirements of &#xA7; 2.2-4002, (i)
notify the Registrar of Regulations that such amendment is necessary to meet the
requirements of federal law or regulations or because of the order of any state
or federal court, or (ii) certify to the Governor that the regulations are
necessitated by an emergency situation. Any such amendments that are in conflict
with the Code of Virginia shall only remain in effect until July 1 following
adjournment of the next regular session of the General Assembly unless enacted
into law.

D. The Director of Medical Assistance Services is authorized to:

   1. Administer such state plan and receive and expend federal funds therefor in
   accordance with applicable federal and state laws and regulations; and enter
   into all contracts necessary or incidental to the performance of the
   Department&#8217;s duties and the execution of its powers as provided by law.

   2. Enter into agreements and contracts with medical care facilities,
   physicians, dentists and other health care providers where necessary to carry
   out the provisions of such state plan. Any such agreement or contract shall
   terminate upon conviction of the provider of a felony. In the event such
   conviction is reversed upon appeal, the provider may apply to the Director of
   Medical Assistance Services for a new agreement or contract. Such provider may
   also apply to the Director for reconsideration of the agreement or contract
   termination if the conviction is not appealed, or if it is not reversed upon
   appeal.

   3. Refuse to enter into or renew an agreement or contract, or elect to
   terminate an existing agreement or contract, with any provider who has been
   convicted of or otherwise pled guilty to a felony, or pursuant to Subparts A,
   B, and C of 42 C.F.R. Part 1002, and upon notice of such action to the
   provider as required by 42 C.F.R. &#xA7; 1002.212.

   4. Refuse to enter into or renew an agreement or contract, or elect to
   terminate an existing agreement or contract, with a provider who is or has
   been a principal in a professional or other corporation when such corporation
   has been convicted of or otherwise pled guilty to any violation of &#xA7;
   32.1-314, 32.1-315, 32.1-316, or 32.1-317, or any other felony or has been
   excluded from participation in any federal program pursuant to 42 C.F.R. Part
   1002.

   5. Terminate or suspend a provider agreement with a home care organization
   pursuant to subsection E of &#xA7; 32.1-162.13.
   				For the purposes of this subsection, &#8220;provider&#8221; may refer to
   an individual or an entity.

E. In any case in which a Medicaid agreement or contract is terminated or denied
to a provider pursuant to subsection D, the provider shall be entitled to appeal
the decision pursuant to 42 C.F.R. &#xA7; 1002.213 and to a post-determination
or post-denial hearing in accordance with the Administrative Process Act (&#xA7;
2.2-4000 et seq.). All such requests shall be in writing and be received within
15 days of the date of receipt of the notice.
			The Director may consider aggravating and mitigating factors including the
nature and extent of any adverse impact the agreement or contract denial or
termination may have on the medical care provided to Virginia Medicaid
recipients. In cases in which an agreement or contract is terminated pursuant to
subsection D, the Director may determine the period of exclusion and may
consider aggravating and mitigating factors to lengthen or shorten the period of
exclusion, and may reinstate the provider pursuant to 42 C.F.R. &#xA7; 1002.215.

F. When the services provided for by such plan are services which a marriage and
family therapist, clinical psychologist, clinical social worker, professional
counselor, or clinical nurse specialist is licensed to render in Virginia, the
Director shall contract with any duly licensed marriage and family therapist,
duly licensed clinical psychologist, licensed clinical social worker, licensed
professional counselor or licensed clinical nurse specialist who makes
application to be a provider of such services, and thereafter shall pay for
covered services as provided in the state plan. The Board shall promulgate
regulations which reimburse licensed marriage and family therapists, licensed
clinical psychologists, licensed clinical social workers, licensed professional
counselors and licensed clinical nurse specialists at rates based upon
reasonable criteria, including the professional credentials required for
licensure.

G. The Board shall prepare and submit to the Secretary of the United States
Department of Health and Human Services such amendments to the state plan for
medical assistance services as may be permitted by federal law to establish a
program of family assistance whereby children over the age of 18 years shall
make reasonable contributions, as determined by regulations of the Board, toward
the cost of providing medical assistance under the plan to their parents.

H. The Department of Medical Assistance Services shall:

   1. Include in its provider networks and all of its health maintenance
   organization contracts a provision for the payment of medical assistance on
   behalf of individuals up to the age of 21 who have special needs and who are
   Medicaid eligible, including individuals who have been victims of child abuse
   and neglect, for medically necessary assessment and treatment services, when
   such services are delivered by a provider which specializes solely in the
   diagnosis and treatment of child abuse and neglect, or a provider with
   comparable expertise, as determined by the Director.

   2. Amend the Medallion II waiver and its implementing regulations to develop
   and implement an exception, with procedural requirements, to mandatory
   enrollment for certain children between birth and age three certified by the
   Department of Behavioral Health and Developmental Services as eligible for
   services pursuant to Part C of the Individuals with Disabilities Education Act
   (20 U.S.C. &#xA7; 1471 et seq.).

   3. Utilize, to the extent practicable, electronic funds transfer technology
   for reimbursement to contractors and enrolled providers for the provision of
   health care services under Medicaid and the Family Access to Medical Insurance
   Security Plan established under &#xA7; 32.1-351.

I. The Director is authorized to negotiate and enter into agreements for
services rendered to eligible recipients with special needs. The Board shall
promulgate regulations regarding these special needs patients, to include
persons with AIDS, ventilator-dependent patients, and other recipients with
special needs as defined by the Board.

J. Except as provided in subdivision A 1 of &#xA7; 2.2-4345, the provisions of
the Virginia Public Procurement Act (&#xA7; 2.2-4300 et seq.) shall not apply to
the activities of the Director authorized by subsection I of this section.
Agreements made pursuant to this subsection shall comply with federal law and
regulation.

K. When the services provided for by such plan are services by a pharmacist,
pharmacy technician, or pharmacy intern (i) performed under the terms of a
collaborative agreement as defined in &#xA7; 54.1-3300 and consistent with the
terms of a managed care contractor provider contract or the state plan or (ii)
related to services and treatment in accordance with &#xA7; 54.1-3303.1, the
Department shall provide reimbursement for such service.

HISTORY: 1984, c. 781; 1985, cc. 519, 532, 535, 564; 1986, cc. 393, 455; 1987,
cc. 398, 446, 642; 1988, cc. 99, 215, 504, 790; 1989, c. 269; 1990, cc. 395,
793; 1993, cc. 298, 971; 1996, cc. 155, 201, 511, 788, 796, 946; 1997, cc. 671,
683, 730; 1998, cc. 56, 257, 459, 554, 558, 571, 631, 653, 709, 858, 875; 1999,
cc. 818, 878, 967, 1005, 1024; 2000, cc. 484, 855, 888; 2001, cc. 334, 534, 663,
859; 2003, cc. 66, 71; 2004, cc. 125, 246, 855; 2006, cc. 396, 425; 2007, cc.
536, 873, 916; 2009, cc. 813, 840; 2010, cc. 305, 785, 790; 2012, cc. 367, 646,
689; 2014, cc. 196, 750; 2017, c. 106; 2019, cc. 211, 219; 2020, cc. 1082, 1083;
2020, Sp. Sess. I, cc. 44, 53; 2021, Sp. Sess. I, cc. 245, 250, 301, 302; 2022,
cc. 269, 384, 790, 791; 2022, Sp. Sess. I, c. 11; 2023, cc. 112, 113, 183, 266,
412; 2024, c. 585; 2025, cc. 8, 147, 157, 237, 246, 461, 690, 701, 704, 706.