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WV State Medicaid Plan

 Complete State Plan
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 Table of Contents



  1.1      Designation and Authority
  1.2      Organization for Administration
    1.3      Statewide Operation    
    1.4      State Medical Care Advisory Committee    
    1.5      Pediatric Immunization Program    
    2.1      Application, Determination of Eligibility and Furnishing Medicaid    
    2.2      Coverage and Conditions of Eligibility    
    2.3      Residence    
    2.4      Blindness    
    2.5      Disability    
    2.6      Financial Eligibility    
    2.7      Medicaid Furnished Out of State    
    3.1      Amount, Duration, and Scope of Services    
    3.2      Coordination of Medicaid with Medicare and Other Insurance    
    3.3      Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases    
    3.4      Special Requirements Applicable to Sterilization Procedures    
    3.5      Families Receiving Extended Medicaid Benefits    
    3.7      Services to Families Receiving Extended Medicaid Benefits (Continued)    
    4.1      Methods of Administration    
    4.2      Hearings for Applicants and Recipients    
    4.3      Safeguarding Information on Applicants and Recipients    
    4.4      Medicaid Quality Control    
    4.5      Medicaid Agency Fraud Detection and Investigation Program    
    4.6      Reports    
    4.7      Maintenance of Records    
    4.8      Availability of Agency Program Manuals    
    4.9      Reporting Provider Payments to the Internal Revenue Service    
    4.10    Free Choice of Providers    
    4.11    Relations with Standard-Setting and Survey Agencies    
    4.12    Consultation to Medical Facilities    
    4.13    Required Provider Agreement    
    4.14    Utilization - Quality Control    
    4.15    Inspection of Care in Intermediate Care Facilities for Mentally Retarded    
    4.16    Relations with State Health and Vocational Rehabilitation Agencies and Title V 
    4.17    Liens and Recoveries    
    4.18    Recipient Cost Sharing and Similar Charges    
    4.19    Payment for Services    
    4.20    Direct Payments to Certain Recipients for Physicians' or Dentists' Services    
    4.21    Prohibition Against Reassignment of Provider Claims    
    4.22    Third Party Liability    
    4.23    Use of Contracts    
    4.24   Standards for Payments for Nursing Facility and Intermediate Care Facility for the 
           Mentally Retarded Services
    4.25    Program for Licensing Administrators of Nursing Homes    
    4.26    Drug Utilization Review Program    
    4.27    Disclosure of Survey Information and Provider or Contractor Evaluation    
    4.28    Appeals Process    
    4.29    Conflict of Interest Provisions    
    4.30    Exclusion of Providers and Suspension of Practitioners and Other Individuals    
    4.31    Disclosure of Information by Providers and Fiscal Agents    
    4.32    Income and Eligibility Verification System    
    4.33    Medicaid Eligibility Cards for Homeless Individuals    
    4.34    Systematic Alien Verification for Entitlements    
    4.35    Enforcement of Compliance for Nursing Facilities    
    4.36    Required Coordination Between the Medicaid and WIC Programs    
    4.38    Nurse Aide Training and Competency Evaluation for Nursing Facilities    
    4.39    Preadmission Screening and Annual Resident Review in Nursing Facilities    
    4.41    Resident Assessment for Nursing Facilities    
    4.42    Employee Education About False Claims Recoveries    
    5.1    Standards of Personnel Administration    
    5.2    (Reserved)    
    5.3    Training Programs; Subprofessional and Volunteer Programs    
    6.1    Fiscal Policies and Accountability    
    6.2    Cost Allocation    
    6.3    State Financial Participation    
    7.1    Plan Admendments    
    7.2    Nondiscrimination    
    7.3    Maintenance of AFDC Effort    
    7.4    State Governor's Review    
  Attachments and Supplements    
  1.1-A Attorney General's Certification    
  1.2-A Organization for Administration    

Organization for Administration

  1.2-C Organization for Staffing    
  1.2-D Organization for Administration     
  2.1-A Health Maintenance Organization     
 Updated 2.2-A Groups Covered and Agencies Responsible For Eligibility    
 Updated        •  Pages 1-9b1 - Mandatory Coverage - Categorically Needy and Other Required 
       Special Groups
        •  Pages 9c-23d - Optional Groups Other Than the Medically Needy    
 Updated       •  Pages 24-26a - Optional Coverage of the Medically Needy    
        •  Page 27 -Requirements Relating to Determining Eligibility for Medicare Prescription 
       Drug Low-Income Subsidies
        •  Supplement 1 - Reasonable Classification of Individuals Under the Ages of 21, 20, 
       19, and 18
        •  Supplement 3 - Method for Determining Cost Effectiveness of Caring for Certain 
       Disabled Children at Home
 Updated 2.6-A Eligibility Conditions and Requirements    
        •  Pages 1-3c - General Conditions of Eligibility    
        •  Pages 4-5a - Post Eligibility Treatment of Institutionalized Individuals    
 Updated       •  Pages 6-26 - Financial Eligibility    
        •  Supplement 1 - Income Eligibility Levels    
        •  Supplement 1a - Income Eligibility Levels - Categorically Needs    
        •  Supplement 2 - Resource Levels    
        •  Supplement 3 - Reasonable Limits on Amounts for Necessary Medical or Remedial 
       Care Not Covered Under Medicaid
        •  Supplement 5 - More Restrictive Methods of Treating Resources than those of the 
       SSI Program
        •  Supplement 5a - Methods of Treating Resources for Individuals with Incomes 
       Related to Federal Poverty Levels
        •  Supplement 6 - Standards for Optional State Supplementary Payments    
        •  Supplement 7 -  Income Levels for 1902 (f) States - Categorically Needy Who Are 
       Covered Under Requirements More Restrictive than SSI
        •  Supplement 8 - Resource Standards for 1902 (f) States - Categorically Needy    
        •  Supplement 8a - More Liberal Methods of Treating Income Under Section 1902 (r)
       (2) of the Act
        •  Supplement 8b - More Liberal Methods of Treating Resources Under Section 1902 
       (r) (2) of the Act
 New       • Supplement 8c - State Long-Term Care Insurance Partnership    
        •  Supplement 9 -  Transfer of Resources    
        •  Supplement 9a - Transfer of Assets    
        •  Supplement 9b - Transfer of Assets for Less Than Fair Market Value Made on or 
       After February 8, 2006
        •  Supplement 10 - Consideration of Medicaid Qualifying Trusts - Undue Hardship    
        •  Supplement 11 - Cost Effectiveness Methodology for Cobra Continuation 
        •  Supplement 12 - Eligibility Under Section 1931 of the Act    
        •  Supplement 13 - Spousal Impoverishment - Undue Hardship    
        •  Supplement 17 - Home Equity    
New       • Supplement 18 -Methodology for Identification of Applicable FMAP Rates    
New  3.1     • Attachment 2 - WV Medicaid Redesign Benefit Package    
Updated 3.1-A  Amount, Duration and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy    
        •  Supplement 1 - Case Management Services    
New       • Addendum - School-Based Health Services (Special Education)    
  3.1-B Amount, Duration and Scope of Services Provided for Medically Needy Group(s): All Covered Medically Needy Groups    
New 3.1-A & 3.1-B Amount, Duration, Scope of Medical and Remedical /Care And Services Provied to the Medically Needy - Methods of Providing Transportation    
  3.1-C Alternative Benefits    
        •  Attachment for A, D, and E of Supplement 1 to Attachment 3.1-A    
Updated       •  Supplement 2 to Attachments 3.1A and 3.1B    
Updated 3.1-D Methods of Providing Transportation    
  3.1-E Standards for the Coverage of Organ Transplant Procedures    
  3.2-A Coordination of Title XIX with Part A and Part B of Title XVIII    
  4.11-A Standards for Institutions    
  4.16-A Interrelationships with State Health and State Vocational Rehabilitation Agencies and with Title V Grantees    
  4.17-A Liens and Adjustments or Recoveries    
  4.18-A Charges Imposed on Categorically Needy for Services Other Than Those Provided Under Section 1905 (a) (1)    
  4.18-C Charges Imposes on the Medically Need for Services Other Than Those Provided Under Section 1905 (a) (1) through (5) and (7) Act    
Updated 4.19-A Inpatient Hospital Services    
        •  Supplement 1 - Transition Percentage for Operating Payments    
Updated       • Supplement 2 - Transition Percentage for Capitol Payment Amounts    
  4.19-A-1 Payments for Medical and Remedial Care and Services-Inpatient Hospitals Services - Disproportionate Share Hospitals      
  4.19-A-2 Payment for Medical and Remedial Care and Services-Inpatient Psychiatric Facility Services for Individual Under 22 Years of Age    
Updated   4.19-B Payments for Medical and Remedial Care and Services    
        •   Supplement 1 - Methods and Standards for Establishing Payment Rates-Other Types    
  4.19-D Methods and Standards for Determining Payment Rates for State-Owned Long Term Care Facilities (SNF, ICF, and ICF/MR Facilities)    
  4.19-D-1 Methods and Standards for Determining Payment Rates for Non-State-Owned Nursing Facilities Excludes State-Owned Facilities    
  4.19-D-2 Methods and Standards for Determining Payment Rates for  Intermediate Care Facilities for Mentally Retarded    
  4.19-E Timely-Claims Payment    
  4.22-A Requirements for Third Party Liability - Identifying Liable Resources    
  4.22-B Requirements for Third Party Liability - Payment of Claims    
  4.22-C State Method on Cost Effectiveness of Employer-Base Group Health Plans    
  4.30 Sanctions for MCDs and PCCMs    
  4.32-A Income and Eligibility Verification System Procedures: Requests to Other State Agencies    
  4.33-A Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals    
  4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance    
  4.35-A Eligibility Conditions and Requirements-Enforcement of Compliance for Nursing Facilities    
  4.35-B Eligibility Conditions and Requirements-Termination of Provider Agreement    
  4.35-C Eligibility Conditions and Requirements-Temporary Management    
  4.35-D Eligibility Conditions and Requirements-Denial of Payment for New Admission    
  4.35-E Eligibility Conditions and Requirements-Civil Money Penalty    
  4.35-F Eligibility Conditions and Requirements-State Monitoring    
  4.35-G Eligibility Conditions and Requirements-Transfer for Residents with Closure of Facility    
  4.35-H Eligibility Conditions and Requirements-Additional Remedies    
  4.38 Disclosure of Specialized Services     
  4.38-A Collection of Additional Registry Information    
  4.39 Definition of Specialized Services    
  4.39-A Categorical Determinations    
  4.42-A False Claims Act Attachment    
  4.43-A Medicaid Integrity Program Efforts    
  4.44 Prohibition on Payments to Entities Outside the US    
  4.46  Provider Screening and Enrollment      
  4.5 Recovery Audit Contractor     
  5.1-A Standards of Personal Administration    
  7.2-A Nondiscrimination    
New S21   Presumptive Elibility by Hospitals    

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