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

STATE: Virginia Page 6-46

Effective Date: 07/01/05

46 Approval Date: _____________/06

A. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). Consistent with the Omnibus Budget Reconciliation Act of 1989 §6403, Early and Periodic Screening, Diagnostic, and Treatment services means the following services: screening services, vision services, dental services, hearing services, and such other necessary health care, diagnostic services, treatment, and other measures described in Social Security Act §1905(a) to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services and which are medically necessary, whether or not such services are covered under the Virginia Title XIX State Plan subject to the requirements and limits of Title XXI.

B. Physical therapy, occupational therapy, speech language pathology, skilled nursing services, and psychology/psychiatry services for special education students. The Department reimburses the school divisions directly for these services.

6.3 The state assures that, with respect to pre-existing medical conditions, one of the following two statements applies to its plan: (42CFR 457.480)

6.3.1. ⌧ The state shall not permit the imposition of any pre-existing medical condition exclusion for covered services (Section 2102(b)(1)(B)(ii)); OR

6.3.2. The state contracts with a group health plan or group health insurance coverage, or contracts with a group health plan to provide family coverage under a waiver (see Section 6.4.2. of the template). Pre-existing medical conditions are permitted to the extent allowed by HIPAA/ERISA (Section 2103(f)). Please describe: Previously 8.6