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

STATE: Virginia Page 6-26

Effective Date: 07/01/05

26 Approval Date: _____________/06 6.2.7. Over-the-counter medications (Section 2110(a)(7))

Optional - May be covered at the discretion of the health plan.

6.2.8. ⌧ Laboratory and radiological services (Section 2110(a)(8))

Outpatient diagnostic tests, X-rays, and laboratory services covered in a physician's office, hospital, independent and clinical reference lab.

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

Maternity service including routine prenatal care is covered. Prepregnancy family services include coverage for prescription drugs and devices approved by the U.S. Food and Drug Administration for use as contraceptives. Contraceptive drugs and devices eligible for reimbursement are oral contraceptives, depo provera, cervical caps, diaphragms, intrauterine devices and Norplant.

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 acute mental health services other than those (a) services furnished in a state-operated mental hospital, (b) services furnished by IMDs, or (c) residential services or other 24-hour therapeutically planned structural services.

Includes 30 days total for inpatient hospital care and partial day services per benefit period.

6.2.11. ⌧ Outpatient mental health services, other than services described in 6.2.19, but including services furnished in a state-operated mental hospital and including community-based services (Section 2110(a)(11)

A. Outpatient mental health services, other than services furnished in a state- operated mental hospital.

B. Effective 08-01-2003, the following community mental health services are covered under this state plan and reimbursed directly by DMAS to providers:

1. Intensive in-home services to children and adolescents under age 19 shall be time-limited interventions provided typically but not solely in the