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STATE CHILD HEALTH PLAN UNDER TITLE XXI OF THE SOCIAL SECURITY ACT

STATE: Virginia Page 6-24

Effective Date: 07/01/05

24 Approval Date: _____________/06

6.1.4. ⌧ Secretary-Approved Coverage. (Section 2103(a)(4)) (42 CFR 457.450) 6.1.4.1. Coverage the same as Medicaid State plan 6.1.4.2. Comprehensive coverage for children under a Medicaid Section 1115 demonstration project

6.1.4.3. Coverage that either includes the full EPSDT benefit or that the state has extended to the entire Medicaid population 6.1.4.4. ⌧ Coverage that includes benchmark coverage plus additional coverage 6.1.4.5. Coverage that is the same as defined by existing comprehensive state-based coverage 6.1.4.6. Coverage under a group health plan that is substantially equivalent to or greater than benchmark coverage through a benefit by benefit comparison (Please provide a sample of how the comparison will be done) 6.1.4.7. ⌧ Other (Describe)

A child will receive Secretary-approved coverage modeled after the state employee plan if the child lives in an area in which there is a contracted MCO to offer Secretary-approved coverage modeled after the state employee plan.

Secretary-approved coverage through a modified Title XIX look-alike (a fee-for- service component or the PCCM Program) is the delivery system provided in geographic areas not served by a contracted MCO until such time as a system to offer the Secretary-approved coverage modeled after the state employee plan is implemented.

Secretary-approved coverage modeled after the state employee plan provides coverage using the Key Advantage Plan. This plan is the PPO option for state employees that was offered statewide in June 2000. Several enhanced benefits are added to the plan. The services under the Key Advantage Member Handbook are briefly outlined in the checklist in § 6.2. The enhanced benefits that are provided in addition to the Key Advantage Plan are listed at the end of this checklist.

For children in families receiving the Secretary-Approved coverage through the