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

STATE: Virginia Page 6-42

Effective Date: 07/01/05

42 Approval Date: _____________/06

6.2.20.A ⌧ Case management services (Section 2110(a)(20)) Targeted case management for high risk pregnant women and infants up to age 2; individuals with mental retardation; children with serious emotional disturbance and youth at risk for serious emotional disturbance; and children with behavioral disorder or emotional disturbances who are referred to treatment foster care by the Family Assessment and Planning Team of Comprehensive Services Act for Youth and Family.

6.2.21.A Care coordination services (Section 2110(a)(21))

May be a component of another service.

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

Effective 08-01-03, home health and outpatient rehabilitation services are limited to five visits for each rehabilitative therapy without prior authorization in each state fiscal year. Service extensions beyond the initial five visits must be prior- authorized. A. Under home health, physical therapy, occupational therapy, or speech pathology and audiology services provided by a home health agency or medical rehabilitation facility covered as ordered by a physician in consultation with a physical therapist who has been licensed by the Board of Medicine. Limits shall apply per recipient regardless of the number of providers rendering services. Annually shall be defined as July 1 through June 30 for each recipient. If the physician determines that additional services are needed, the provider shall request prior authorization. B. Physical therapy and related services:

1. Services for individuals requiring physical therapy are provided only as an element of hospital inpatient or outpatient services, nursing facility service, home health service, or when otherwise included as an authorized service by a cost provider who provides rehabilitation services.

2. The services shall be of a level of complexity and sophistication, or the condition of the patient shall be of a nature that the services can