                                 CODE OF VIRGINIA

MEDICAID RECIPIENTS; TREATMENT INVOLVING PRESCRIPTION OF OPIOIDS; PAYMENT (§
54.1-2910.3:1)

A. No provider licensed pursuant to this chapter, regardless of whether the
provider participates in the state plan for medical assistance, shall request or
require a patient who is a recipient of medical assistance services pursuant to
the state plan for medical assistance and who is a recipient of health care
services involving (i) the prescription of an opioid for the management of pain
or (ii) the prescription of buprenorphine-containing products, methadone, or
other opioid replacements approved for the treatment of opioid addiction by the
U.S. Food and Drug Administration for medication-assisted treatment of opioid
addiction to pay costs associated with the provision of such service
out-of-pocket. The prohibition on payment of costs shall not apply to a
recipient&#8217;s cost-sharing amounts required by the state plan for medical
assistance.

B. Every provider who does not accept payment from the Department of Medical
Assistance Services for health care services who intends to provide health care
services described in subsection A to a patient who is a recipient of medical
assistance services pursuant to the state plan for medical assistance shall,
prior to providing such health care services, provide written notice to such
patient that (i) the Commonwealth&#8217;s program of medical assistance services
covers the health care services described in subsection A and the Department of
Medical Assistance Services will pay for such health care services if such
health care services are determined to meet the Department of Medical Assistance
Service&#8217;s medical necessity criteria and (ii) the provider does not
participate in the Commonwealth&#8217;s program of medical assistance and will
not accept payment from the Department of Medical Assistance Services for such
health care services. Such notice and the patient&#8217;s acknowledgment of such
notice shall be documented in the patient&#8217;s medical record and does not
exempt the provider from the requirements of subsection A.

HISTORY: 2019, cc. 223, 444; 2022, c. 214.