Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 10 - STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM; GENERAL PROVISIONS › Part III - Services; General Provisions › Section 12VAC30-10-140 - Amount, duration, and scope of services: Categorically needy

Current through Register Vol. 40, No. 24, July 15, 2024
Medicaid is provided in accordance with the requirements of
					 42 CFR 440, Subpart B and § 1902(a), 1902(e), 1905(a), 1905(p), 1915,
					 1920, and 1925 of the Act.
Services for the categorically needy are described below
					 and in 12VAC30-50-10 et seq. These
					 services include:
1. Each item or
				  service listed in § 1905(a)(1) through (5) and (21) of the Act, is
				  provided as defined in 42 CFR Part 440, Subpart A, or, for EPSDT services,
				  § 1905(r) and 42 CFR Part 411, Subpart B.
2. Nurse-midwife services listed in §
				  1905(a)(17) of the Act, are provided to the extent that nurse-midwives are
				  authorized to practice under state law or regulation and without regard to
				  whether the services are furnished in the area of management of the care of
				  mothers and babies throughout the maternity cycle. Nurse-midwives are permitted
				  to enter into independent provider agreements with the Medicaid agency without
				  regard to whether the nurse-midwife is under the supervision of, or associated
				  with, a physician or other health care provider.
3. Pregnancy-related, including family
				  planning service, and postpartum services for a 60-day period (beginning on the
				  day pregnancy ends) and any remaining days in the month in which the 60th day
				  falls are provided to women who, while pregnant, were eligible for, applied
				  for, and received medical assistance on the day the pregnancy ends.
4. Services for medical conditions that may
				  complicate the pregnancy (other than pregnancy-related or postpartum services)
				  are provided to pregnant women.
5.
				  Services related to pregnancy (including prenatal, delivery, postpartum, and
				  family planning services) and to other conditions that may complicate pregnancy
				  are the same services provided to poverty level pregnant women eligible under
				  the provision of § 1902(a)(10)(A)(i)(IV) and 1902(a)(10)(A)(ii)(IX) of the
				  Act.
6. Home health services are
				  provided to individuals entitled to nursing facility services as indicated in
				  12VAC30-10-220 of this plan.
7.
				  Inpatient services that are being furnished to infants and children described
				  in § 1902(l)(1)(B) through (D), or § 1905(n)(2) of the Act, on the
				  date the infant or child attains the maximum age for coverage under the
				  approved State plan will continue until the end of the stay for which the
				  inpatient services are furnished.
8. Respiratory care services are not provided
				  to ventilator dependent individuals as indicated in
				  12VAC30-10-300 of this
				  plan.
9. Services are provided to
				  families eligible under § 1925 of the Act as indicated in
				  12VAC30-10-350 of this
				  plan.
10. Home and community care
				  for functionally disabled elderly individuals is not covered.
11. Program of All-Inclusive Care for the
				  Elderly (PACE) services as described and limited in Supplement 6 to Attachment
				  3.1-A (12VAC30-50-320,
				  12VAC30-50-321,
				  12VAC30-50-325, and
				  12VAC30-50-328 ).
12VAC30-50-10 et seq. identifies
					 the medical and remedial services provided to the categorically needy,
					 specifies all limitations on the amount, duration, and scope of those service,
					 and lists the additional coverage (that is in excess of established service
					 limits) for pregnancy-related services and services for conditions that may
					 complicate the pregnancy.
Statutory Authority
§ 32.1-325 of the Code of Virginia.