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 12VAC30-50-10 - Services provided to the categorically needy with limitations

Current through Register Vol. 40, No. 24, July 15, 2024
The following services are provided with limitations as
					 described in Part III (12VAC30-50-100 et
					 seq.) of this chapter:
1. Inpatient
				  hospital services other than those provided in an institution for mental
				  diseases.
2. Outpatient hospital
				  services.
3. Other laboratory and
				  x-ray services; nonemergency outpatient Magnetic Resonance Imaging (MRI),
				  including Magnetic Resonance Angiography (MRA), Computerized Axial Tomography
				  (CAT) scans, including Computed Tomography Angiography (CTA), and Positron
				  Emission Tomography (PET) scans performed for the purpose of diagnosing a
				  disease process or physical injury require prior authorization.
4. Rural health clinic services and other
				  ambulatory services furnished by a rural health clinic.
5. Federally Qualified Health Center (FQHC)
				  services and other ambulatory services that are covered under the plan and
				  furnished by an FQHC in accordance with § 4231 of the State Medicaid
				  Manual (HCFA Pub. 45-4).
6. Early
				  and periodic screening and diagnosis of individuals under 21 years of age, and
				  treatment of conditions found.
7.
				  Family planning services and supplies for individuals of child-bearing
				  age.
8. Physicians' services
				  whether furnished in the office, the patient's home, a hospital, a skilled
				  nursing facility, or elsewhere.
9.
				  Medical and surgical services furnished by a dentist (in accordance with §
				  1905(a)(5)(B) of the Act).
10.
				  Medical care or any other type of remedial care recognized under state law,
				  furnished by licensed practitioners within the scope of their practice as
				  defined by state law: podiatrists, optometrists and other
				  practitioners.
11. Home health
				  services: intermittent or part-time nursing service provided by a home health
				  agency or by a registered nurse when no home health agency exists in the area;
				  home health aide services provided by a home health agency; and medical
				  supplies, equipment, and appliances suitable for use in the home; physical
				  therapy, occupational therapy, or speech pathology and audiology services
				  provided by a home health agency or medical rehabilitation facility.
12. Clinic services.
13. Dental services.
14. Physical therapy and related services,
				  including occupational therapy and services for individuals with speech,
				  hearing, and language disorders (provided by or under supervision of a speech
				  pathologist or audiologist).
15.
				  Prescribed drugs, prosthetic devices, and eyeglasses prescribed by a physician
				  skilled in diseases of the eye or by an optometrist.
16. Other rehabilitative services, screening
				  services, preventive services.
17.
				  Nurse-midwife services.
18. Case
				  management services as defined in, and to the group specified in,
				  12VAC30-50-95 et seq. (in
				  accordance with § 1905(a)(19) or § 1915(g) of the Act).
19. Extended services to pregnant women:
				  pregnancy-related and postpartum services for a 60-day period after the
				  pregnancy ends and any remaining days in the month in which the 60th day falls
				  (see 12VAC30-50-510 ). (Note:
				  Additional coverage beyond limitations.)
20. Pediatric or family nurse practitioners'
				  service.
21. Any other medical care
				  and any other type of remedial care recognized by state law, specified by the
				  Secretary: transportation.
Statutory Authority
§§ 32.1-324 and 32.1-325 of the Code of
						Virginia.