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

STATE: Virginia Page 6-36

Effective Date: 07/01/05

36 Approval Date: _____________/06 authorization, non-institutionalized recipients do not include recipients of services at Hiram Davis Medical Center.

6.2.7.A ⌧ Over-the-counter medications (Section 2110(a)(7)) Non-legend drugs shall be covered for insulin, syringes and needles, and diabetic test strips and family planning supplies. Designated non-legend drugs which are prescribed by licensed prescribers to be used as less expensive therapeutic alternatives to covered legend drugs are also covered. Designated categories of non-legend drugs for recipients in nursing homes are covered.

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

Services must be ordered or prescribed and directed or performed within the scope of a license of the practitioner of the healing arts.

Effective 08-01-03, prior authorization of the following specific high-cost non- emergency outpatient procedures is required: Magnetic Resonance Imaging (MRI), Computer Axial Tomography (CAT) Scans and Positron Emission Tomography (PET) Scans.

6.2.9.A ⌧ Prenatal care and prepregnancy family services and supplies (Section 2110(a)(9)) A. Family planning services and supplies for individuals of child-bearing age must be ordered or prescribed and directed or performed within the scope of the license of a practitioner of the healing arts. Family planning services shall be defined as those services which delay or prevent pregnancy. Such services shall not include services to treat infertility or services to promote fertility. B. Pregnancy-related and postpartum services shall be covered for any medical condition that may complicate pregnancy if otherwise covered under the Title XXI state plan. Enhanced prenatal care services include nutrition, patient education, homemaker services, blood glucose meters (including test strips). 6.2.10.A ⌧ 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 will be offered in general acute care hospitals.