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

STATE: Virginia Page 6-29

Effective Date: 07/01/05

29 Approval Date: _____________/06 services. Effective 12/1/02, the benefit limits for orthodontic services increased to mirror Medicaid. 6.2.18. ⌧ Inpatient substance abuse treatment services and residential substance abuse treatment services (Section 2110(a)(18)) Other than (a) services furnished in a state-operated mental hospital, (b) services furnished in IMDs, or (c) residential services or other 24-hour therapeutically planned structural services. Inpatient rehabilitation in a substance abuse treatment facility up to 90 days, maximum lifetime benefit. 6.2.19. ⌧ Outpatient substance abuse treatment services (Section 2110(a)(19)) Outpatient substance abuse treatment services, other than services furnished in a state-operated mental hospital. Substance abuse services and psychiatric services are limited to no more than a combined total of 50 medically necessary visits for treatment with a licensed mental health or substance abuse professional each calendar year. 6.2.20. ⌧ Case management services (Section 2110(a)(20))

The State may elect to offer benefits for an approved, alternative treatment plan for a recipient who would otherwise require more expensive services. These services will be offered on a case-by-case-basis. 6.2.21. Care coordination services (Section 2110(a)(21))

6.2.22. ⌧ Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders (Section 2110(a)(22))

Medically necessary services used to treat or promote recovery from an illness or injury are covered with limitations.

6.2.23. ⌧ Hospice care (Section 2110(a)(23))

Hospice services include a program of a home and inpatient care provided directly under the direction of a licensed hospice. Hospice care programs include palliative and supportive physician, psychological, psychosocial, and other health services to individuals utilizing a medically directed interdisciplinary team. Hospice care services are available if the enrollee is diagnosed with a terminal illness with a life expectancy of six months or fewer.

6.2.24. ⌧ Any other medical, diagnostic, screening, preventive, restorative,