Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 71 - REGULATIONS GOVERNING VIRGINIA NEWBORN SCREENING SERVICES › Section 12VAC5-71-160 - Availability of assistance for obtaining metabolic formula, low protein modified foods, and metabolic supplements

Current through Register Vol. 40, No. 24, July 15, 2024
A. The department
				shall maintain a protocol to assist eligible persons in obtaining metabolic
				formula, low protein modified foods, and metabolic supplements.
B. Expenditures shall be limited to available
				funding.
C. Resident children and
				resident adults under the age of 21 who have a diagnosis of a heritable
				disorder or genetic disease listed in
				12VAC5-71-30 D and meet financial
				eligibility criteria for the Children with Special Health Care Needs Program
				pool of funds in accordance with the State Board of Health Regulations
				Governing Eligibility Standards and Charges for Medical Care Services to
				Individuals (12VAC5-200) may qualify to receive metabolic formula at no cost.
				Applicants who qualify must demonstrate that they are not eligible for
				available state and federal medical assistance programs and must demonstrate
				that they do not have insurance coverage for metabolic formula.
D. Resident children and resident adults
				under the age of 21 who have a diagnosis of a heritable disorder or genetic
				disease listed in
				12VAC5-71-30 D and do not meet
				financial eligibility criteria for the Children with Special Health Care Needs
				Program pool of funds in accordance with the State Board of Health Regulations
				Governing Eligibility Standards and Charges for Medical Care Services to
				Individuals (12VAC5-200) may be eligible to purchase metabolic formula through
				the Virginia Department of Health.
E. Resident adults ages 21 or older who have
				a diagnosis of a heritable disorder or genetic disease listed in
				12VAC5-71-30 D and who have a
				gross family income at or below 300% of the federal poverty level in accordance
				with the State Board of Health Regulations Governing Eligibility Standards and
				Charges for Medical Care Services to Individuals (12VAC5-200) may qualify to
				receive metabolic formula at no cost. Applicants who qualify must demonstrate
				that they are not eligible for available state and federal medical assistance
				programs and must demonstrate that they do not have current insurance coverage
				for metabolic formula.
F. Resident
				adults ages 21 or older who have a diagnosis of a heritable disorder or genetic
				disease listed in
				12VAC5-71-30 D and who do not meet
				financial criteria or other eligibility criteria in accordance with the State
				Board of Health Regulations Governing Eligibility Standards and Charges for
				Medical Care Services to Individuals (12VAC5-200) may qualify to purchase
				metabolic formula through the Virginia Department of Health.
G. Residents who have a diagnosis of a
				heritable disorder or genetic disease listed in
				12VAC5-71-30 D and who have a
				gross family income at or below of 300% of the federal poverty level in
				accordance with the State Board of Health Regulations Governing Eligibility
				Standards and Charges for Medical Care Services to Individuals (12VAC5-200) may
				be eligible to receive reimbursement from the department up to $1,500 per year
				for purchase of low protein modified foods and metabolic supplements.
				Applicants who qualify must demonstrate that they are not eligible for
				available state and federal medical assistance programs and must demonstrate
				that they do not have current insurance coverage for low protein modified foods
				or metabolic supplements for which they are seeking reimbursement.
Statutory Authority: §§ 32.1-12 and 32.1-67 of
					 the Code of Virginia.