Which Of The Following Services Are Mandated Medicaid Basic Benefits


Who Can Get Medicaid

ITU webinar: Medicaid 101

Many people with low incomes would be unable to afford health insurance without government assistance. This is where Medicaid comes into play. The U.S. Department of Health and Human Services determines the federal poverty level every year, and these values are used to set the eligibility standards for Medicaid.

All states cover certain categories of people, including low-income families, children, pregnant women, the elderly, and people with disabilities. The federal government sets the standard, but individual states can choose to expand coverage beyond these limits, such as to all individuals below a certain income level. States can increase income thresholds to include more people. You can learn more information about what your state program covers on the Medicaid.gov website.

Immigration Status And Eligibility

Being an American citizen assures that you can get Medicaid coverage as long as the other requirements are also met. The same cannot be said for those with immigrant status.

Qualified non-citizens are generally eligible for Medicaid once they meet state requirements for income and length of residency. Often, the residency requirement is five years after attaining lawful permanent residency status.

There are exceptions for refugees and those granted asylum, currently or before becoming lawful permanent residents .

Immigrants who have entered the country illegally may be eligible for emergency services only, not the full Medicaid benefit.

A Icrs Regarding The Of Development Of Policies And Procedures For Ascs 41651 Covid

1. Policies and Procedures

At §416.51, we require ASCs to develop and implement policies and procedures to ensure their staff are vaccinated for COVID-19 and track and maintain documentation of their vaccination status. Each ASC must also have a contingency plan for any staff that are not fully vaccinated according to this rule.

The ICRs for this section would require each ASC to develop the policies and procedures needed to satisfy all of the requirements in this section. Based upon our experience with ASCs, we believe some centers have already developed policies and procedures requiring COVID-19 vaccination for staff. However, each ASC will need to review their current policies and procedures and modify them, if necessary, to ensure compliance with the requirements in this IFC, especially that their policies and procedures cover all of the center staff as identified in this IFC. Hence, we will base our estimate for this ICR on all 6,071 ASCs. We believe activities associated with this IFC would be performed by the RN functioning as the designated and qualified infection control professional and ASC administrator as analyzed below.

Therefore, for all 6,071 ASCs, the estimated burden associated with the requirement for policies and procedures would be 67,010 hours at a cost of $4,929,652 .

2. Documentation and Storage

The total burden for all 6,071 ASCs for this IFC would be 83,670 hours at an estimated cost of $6,212,472 .

Recommended Reading: Medicaid Requirements For Gastric Sleeve

Does Canada Have A National Health Insurance Plan

Canada does not have a single national health care plan, but rather a national health insurance program, which is achieved by a series of thirteen interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage. Under the Canada Health Act, our national health insurance program is designed to ensure that all residents of Canada have reasonable access to medically necessary hospital and physician services on a prepaid basis, and on uniform terms and conditions.

What Does A Managed Long

Medicaid Prescription Drug Pricing and Policy

A Long Term Care Plan provides services to people with a disability or long-lasting health problem. Your plan will make sure you get the long term care services you need. Long term care includes help with day-to-day and personal activities, home health aides, adult day health, and other services. You will continue to use your Medicaid card for any services no covered by your Managed Long-Term Care Plan.

You May Like: Psychiatrist That Accept Medicaid In Houston Tx

Chapter 1an Overview Of Medicaid Managed Care

Medicaid plays an integral role in financing health care services in the United States, accounting for 16 percent of total health spending and providing coverage for one out of every six Americans. Among the more than 60 million citizens who rely on Medicaid are about 9 million nonelderly people with disabilities, including 1.4 million children. While people with disabilities constituted 16.5 percent of Medicaid enrollees in fiscal year 2008, expenditures on their behalf represented 44 percent of total Medicaid outlays.

The Medicaid program serves a diverse array of people with disabilities, ranging widely in age and type and severity of disability, and has an extraordinary impact on the health and quality of life of beneficiaries with disabilities. The program rolls include children with physical, sensory, intellectual, and developmental disabilities working-age adults with spinal cord and traumatic brain injuries children and adults with severe and persistent mental illnesses and low-income adults with other serious, chronic illnesses and disorders such as diabetes and cardiac and pulmonary diseases.

B Icrs Regarding The Development Of Policies And Procedures For Hospices 41860 Covid

1. Policies and Procedures

At §418.60, we require hospices to develop and implement policies and procedures to ensure their staff are vaccinated for COVID-19 and that appropriate documentation of those vaccinations are tracked and maintained. The hospice must also have a contingency plan for all staff not fully vaccinated according to this rule.

The ICRs for this section would require each hospice to develop the policies and procedures needed to satisfy all of the requirements in this section. Current regulations are set forth at §418.60 Condition of participation: Infection control, and require each hospice to maintain and document an infection control program to prevent and control infections and communicable diseases. The hospice must also follow accepted standards of practice, including the use of standard precautions to prevent the transmission of infections and communicable diseases. Thus, all hospices should already have infection prevention and control policies and procedures, but they likely do not comply with all of the requirements in this IFC.

Thus, the total burden for hospices to comply with the requirements for policies and procedures in this IFC is 55,560 hours at an estimated cost of $4,867,056 .

2. Documentation and Storage

Therefore, the total burden for all 5,556 hospices for this rule would be 83,882 hours at an estimated cost of $7,104,494 .

The requirements and burden will be submitted to OMB under OMB control number 0938-1067 .

Don’t Miss: Assisted Living That Accepts Medicaid In Nj

What Other Health Care Services Do Provinces And Territories Provide

Provinces and territories may also offer “additional benefits” under their respective health insurance plans, funded and delivered on their own terms and conditions. These benefits are often targeted to specific population groups , and may be partially or fully covered. While these services vary across different provinces and territories, examples include prescription drugs, dental care, optometric, chiropractic, and ambulance services.

C Icrs Regarding The Development Of Policies And Procedures For Pace Organizations 46074 Covid

Medicaid Basics & Eligibility

1. Policies and Procedures

Section 460.74 requires that programs for all-inclusive care for the elderly organizations to develop and implement policies and procedures to ensure their staff are vaccinated for COVID-19 and that appropriate documentation of those vaccinations are tracked and maintained. Each PACE organization must also have a contingency plan for all staff not fully vaccinated according to this rule.

The ICRs for this section would require each PACE organization to develop the policies and procedures needed to satisfy all of the requirements in this section. Current regulations at §460.74 already require that each PACE organization follow accepted policies and standard procedures with respect to infection control in place. Thus, all PACE organizations should have policies and procedures regarding infection prevention and control. We also believe that many have already addressed COVID-19 vaccination policies for their staff. However, since we do not have a reliable method to estimate how many have, we will assess the burden for all 141 PACE organizations.

Thus, the total burden for all 141 PACE organizations to comply with the requirements for the policies and Start Printed Page 61591 procedures is 1,410 hours at an estimated cost of $117,876 .

2. Documentation and Storage

Therefore, the total burden for all 141 PACE organizations for this rule would be 2,243 hours at an estimated cost of $179,518 .

Don’t Miss: Inpatient Alcohol Rehab Colorado Medicaid

Office Of Mental Health

The Office of Mental Health provides a way for people to get the mental health treatment they need in a variety of settings, depending on age and conditions. However, several of our programs are limited to children under age 21. Some services are not covered, while others may require a specific diagnosis to be covered. Additionally, some services require prior authorization for coverage. Geriatric psychiatric services are not covered. The Office of Mental Health is comprised of three divisions: Mental Health Programs, Special Mental Health Initiatives, and Mental Health Services.

The Mental Health Programs division oversees the following programs:

  • Intermediate Care Facilities for Individuals with Intellectual Disabilities

The Special Mental Health Initiatives division oversee the following programs:

  • Autism Spectrum Disorder Services
  • Community Support Program 1915

The Mental Health Services division oversees the following programs:

  • Acute Freestanding Psychiatric Facilities
  • Community/Private Mental Health Centers
  • Federally Qualified Health Centers and Rural Health Clinics
  • Outpatient Mental Health Hospital Services
  • Psychiatric Residential Treatment Facilities
  • Psychiatric Units at General Hospitals
  • Psychiatric Services by Physicians or Nurse Practitioners
  • Therapeutic and Evaluative Mental Health Services for Children

H Cms Authority To Require Staff Vaccinations

CMS has broad statutory authority to establish health and safety regulations, which includes authority to establish vaccination requirements. Section 1102 of the Act grants the Secretary of Health and Human Services authority to make and publish such rules and regulations, not inconsistent with the Act, as may be necessary to the efficient administration of the functions with which the Secretary is charged under the Act. Section 1871 of the Act grants the Secretary of Health and Human Services authority to prescribe regulations as may be necessary to carry out the administration of the Medicare program. The statutory authorities to establish health and safety requirements for COVID-19 vaccination for each provider and supplier included in this IFC are listed in Table 1 and discussed in sections II.C. through II.F. of this IFC.

Recommended Reading: How Do I Apply For Medicaid In Massachusetts

Medicaid Managed Care Programs

The majority of Medicaid beneficiaries nationwide receive Medicaid program health care services through Medicaid Managed Care Programs as states can significantly reduce state Medicaid program costs and better manage utilization of health services by contracting with various types of Managed Care Organizations to deliver services to their beneficiaries. These MCOs accept a set per member per month payment for providing health care services to the state Medicaid beneficiaries.

Some states are implementing a range of initiatives to coordinate and integrate care beyond traditional Medicaid Managed Care. These initiatives focus on improving care for populations with chronic and complex conditions, aligning payment incentives with performance goals, and building in accountability for high quality care.

Presentation Main Points:

Essential Health Benefits Ensure That Health Plans Cover Care That Patients Need

Professional Geriatric Care Management (GERO 5350) Test Bank For Basic ...

EHB requirements ensure that everyone in the individual and small group health insurance markets has access to comprehensive coverage that actually covers the services they need. These essential health benefits fall into 10 categories:

  • Ambulatory patient services
  • Emergency services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Recommended Reading: What Are The Medicaid Plans In Texas

F Stakeholder Response To Vaccines

There has been growing national interest in COVID-19 vaccination requirements among health care workers, including requests from various national health care stakeholders. In a joint statement released on July 26, 2021, more than 50 health care professional societies and organizations called for all health care employers and facilities to require that all their staff be vaccinated against COVID-19. Included as signatories to this statement were organizations representing millions of workers throughout the U.S. health care industry, including those representing doctors, nurses, pharmacists, physician assistants, public health workers, and epidemiologists as well as long term care, home care, and hospice workers.

In September 2021, Jeffrey Zients, the White House Coronavirus Response Coordinator, noted that âvaccination requirements work . . . and are the best path out of the pandemic.â He further noted that vaccination requirements are not only key to the nation’s path out of the pandemic, but also accelerate our economic recovery, keeping workplaces safer, and helping to curb the spread of the virus in communities, and boost job growth, the labor market, and the nation’s overall economy.

About This Data Collection

Federal Medicaid rules allow states flexibility to design their own benefit packages beyond meeting core federal requirements. These requirements specify certain mandatory services that each states Medicaid program must provide, that the services be adequate in amount, duration and scope, and that coverage not vary according to an individuals diagnosis or condition. Beyond these minimum requirements, states have discretion in choosing which services to offer and the scope and range of the services. A list of mandatory and optional benefits is available here, and federal definitions of these benefits are available here.

Read Also: Can You Have Va Benefits And Medicaid

How Did The Affordable Care Act Change Medicaid

Medicaid plays an even more important role in insuring low-income Americans due to the Affordable Care Act. As noted, the ACA provides coverage for poor and low-income adults by expanding eligibility for Medicaid to 138 percent of the poverty line. As of April 2020, 35 states plus the District of Columbia have implemented the Medicaid expansion to serve poor and low-income adults. By 2029, 14 million more low-income adults will have enrolled in Medicaid and gained access to affordable comprehensive health coverage due to the ACA, CBO estimates.

The expansion is a very good financial deal for states. After picking up all expansion costs for the first three years, the federal government now pays 90 percent of expansion costs on a permanent basis. And by greatly reducing the number of uninsured, the expansion will save states and localities substantial sums on uncompensated care for the uninsured. Some expansion states have also experienced savings in mental health programs, criminal justice systems, and other budget areas.

Appendix: Mandated Epsdt Services 155

Nebraska Medicaid – Opioid Treatment Program

The Early and Periodic Screening, Diagnostic and Treatment benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services.

States are required to provide comprehensive services and furnish all Medicaid coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions, based on certain federal guidelines. EPSDT is made up of the following screening, diagnostic, and treatment services:

Screening Services

Comprehensive health and developmental history

Comprehensive unclothed physical exam

Appropriate immunizations

Laboratory tests (including lead toxicity screening

Health Education Other Necessary Health Care Services

States are required to provide any additional health care services that are coverable under the Federal Medicaid program and found to be medically necessary to treat, correct or reduce illnesses and conditions discovered regardless of whether the service is covered in a states Medicaid plan. It is the responsibility of states to determine medical necessity on a case-by-case basis.

Diagnostic Services

comprehensive care is provided.


Periodicity Schedule

Also Check: Pediatric Dental Office That Accept Medicaid

Exploring Medicaid Coverage For Medical Nutrition Therapy

The Medicaid content provided on this web page is designed to assist RDNs with understanding Medicaid coverage for Medical Nutrition Therapy services. Although Medicaid programs will vary greatly as they are designed and managed at the state level, the Patient Protection and Affordable Care Act , has created expanded opportunities for RDNs to provide MNT under the essential health benefit category of “Preventive and Wellness Services.”

Under the ACA, preventive care services related to MNT provided by RDNs include:

  • Dietary counseling for adults at higher risk for chronic disease
  • Obesity screening and counseling for all age groups

Individual state Medicaid plans are offered in a variety of delivery models which could include a traditional fee-for-service plan or Managed Medicaid plan. Within a particular state, and even between different delivery models of Medicaid plans in that particular state, Medicaid coverage for MNT can vary in how the plans cover MNT benefits including the specifics on the who, what, when, where and how the MNT benefit is defined. The Academy is working with Affiliate and DPG Nutrition Services Payment Specialists and other RDNs who bill Medicaid to define Medicaid coverage by state and to make this information available on the Academy’s Medicaid MNT web page. More information will be uploaded by state as reliable MNT coverage information is available.

Ehb Benchmark Plan Prescription Drug Coverage By Category And Class

Please note that in some cases a prescription drug category is listed without a United States Pharmacopeia class because there are some drugs within the category that have not been assigned to a specific class.

Please also note that, pursuant to 45 CFR 156.122, if the EHB-benchmark plan does not include any coverage in a USP category and/or class , EHB plans must cover at least one drug in that USP category and/or class.

Read Also: Arkansas Medicaid Program Phone Number

Institutional Long Term Care

Civil Money Penalty Grant Awards ProgramThe goal of the Mississippi Division of Medicaid Civil Money Penalty Grant program is to facilitate the use of Federally Imposed Civil Money Penalty Funds to support activities that support, protect and benefit residents living in nursing facilities. Only CMP fund applications that meet the statutory intent of the regulations, Federal law and policy will be considered.

Transition to Community Referral Effective April 5, 2021, the Mississippi Access to Care Center is replacing Mississippi Division of Medicaid as the designated Local Contact Agency to receive and distribute Transition to Community Referrals to the appropriate case management agencies . Please see the following link for the new fillable form and instructions. .

Long Term Care Pre-Admission ScreeningTo enter a Long Term Care program , an eligible Beneficiary must have a Pre-Admission Screening Application completed by a health care professional . A score of 50 or above is the required threshold to be considered for entry into the Long Term Care programs of Nursing Homes Elderly and Disabled Waiver, Independent Living Waiver and Traumatic Brain Injury/Spinal Cord Injury Waiver and Assisted Living Waiver programs. Any exceptions are noted in the Administrative Code Title 23 Medicaid, Part 207.

All Medicaid certified nursing facilities are surveyed and receive a case mix review annually.


More like this

How Do I Sign Up For Pregnancy Medicaid

Can Uninsured...

Dentist Who Accept Medicaid For Braces

Why Medicaid...

Can Medicaid Take My Settlement Money

What Are...