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Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

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6.2. The state elects to provide the following forms of coverage to children: (Check all that apply. If an item is checked, describe the coverage with respect to the amount, duration and scope of services covered, as well as any exclusions or limitations) (Section 2110(a)) (42CFR 457.490)

Pennsylvania assures that the benefit package described below is identical to the coverage offered as of August 5, 1997 except for the addition of benefits which have been approved in subsequent state plan amendments

6.2.1.

Inpatient services (Section 2110(a)(1)) CHIP enrollees are entitled to 90 days of hospitalization per year (combined physical and mental health).

6.2.2.

Outpatient services (Section 2110(a)(2))

6.2.3.

Physician services (Section 2110(a)(3))

6.2.4.

Surgical services (Section 2110(a)(4))

Cosmetic surgery not included

6.2.5.

Clinic services (including health center services) and other ambulatory health care services. (Section 2110(a)(5))

6.2.6.

Prescription drugs (Section 2110(a)(6))

6.2.7.

Over-the-counter medications (Section 2110(a)(7))

6.2.8.

Laboratory and radiological services (Section 2110(a)(8))

6.2.9.

Prenatal care and prepregnancy family services and supplies (Section 2110(a)(9))

Includes counseling, education and related services to prevent and address the consequences of at-risk behaviors related to sexually transmitted diseases (STDs) and pregnancy.

6.2.10.

Inpatient mental health services, other than services described in 6.2.18., but including services furnished in a state-operated mental hospital and including residential or other 24-hour therapeutically planned structural services (Section 2110(a)(10))

Inpatient mental health services are subject to the same 90-day limitation as physical health services