12 Va. Admin. Code § 30-50-20 - Services provided to the categorically needy without limitation
The following services as described in Part III (12VAC30-50-100 et seq.) of this chapter are provided to the categorically needy without limitation:
1. Nursing facility
services (other than services in an institution for mental diseases) for
individuals 21 years of age or older.
2. Services for individuals 65 years of age
or older in institutions for mental diseases: inpatient hospital services;
skilled nursing facility services; and services in an intermediate care
facility.
3. Intermediate care
facility services (other than such services in an institution for mental
diseases) for persons determined, in accordance with § 1902(a)(31)(A) of
the Social Security Act (the Act), to be in need of such care, including such
services in a public institution (or distinct part thereof) for persons with
intellectual or developmental disability or related conditions.
4. Hospice care (in accordance with §
1905(o) of the Act).
5. Any other
medical care and any type of remedial care recognized under state law,
specified by the U.S. Secretary of Health and Human Services: care and services
provided in religious nonmedical health care institutions, nursing facility
services for patients younger than 21 years of age, or emergency hospital
services.
6. Private health
insurance premiums, coinsurance, and deductibles when cost effective (pursuant
to P.L. No. 101-508 § 4402).
7. Program of All-Inclusive Care for the
Elderly (PACE) services are provided for eligible individuals as an optional
State Plan service for categorically needy individuals without
limitation.
8. Pursuant to P.L. No.
111-148 § 4107, counseling and pharmacotherapy for cessation of tobacco
use by pregnant women shall be covered.
a.
Counseling and pharmacotherapy for cessation of tobacco use by pregnant women
means diagnostic, therapy, and counseling services and pharmacotherapy
(including the coverage of prescription and nonprescription tobacco cessation
agents approved by the U.S. Food and Drug Administration) for cessation of
tobacco use by pregnant women who use tobacco products or who are being treated
for tobacco use that is furnished (i) by or under the supervision of a
physician, (ii) by any other health care professional who is legally authorized
to provide tobacco cessation services under state law and is authorized to
provide Medicaid coverable services other than tobacco cessation services, or
(iii) by any other health care professional who is legally authorized to
provide tobacco cessation services under state law and who is specifically
designated by the U.S. Secretary of Health and Human Services in federal
regulations for this purpose.
b. No
cost sharing shall be applied to these services. In addition to other services
that are covered for pregnant women,
12VAC30-50-510
also provides for other smoking cessation services that are covered for
pregnant women.
9.
Inpatient psychiatric facility services and residential psychiatric treatment
services (including therapeutic group homes and psychiatric residential
treatment facilities) for individuals younger than 21 years of age.
10. Coverage of routine patient cost for
items and services as defined in § 1905(gg) of the Social Security Act
(42 USC §
1396 et seq.) that are furnished in
connection with participation in a qualifying clinical trial.
Notes
Statutory Authority: § 32.1-325 of the Code of Virginia, 42 USC § 1396 et seq.
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