Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 50 - AMOUNT, DURATION, AND SCOPE OF MEDICAL AND REMEDIAL CARE SERVICES › Part I - Categorically Needy › Section 12VAC30-50-20 - Services provided to the categorically needy without limitation

Current through Register Vol. 40, No. 24, July 15, 2024
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.