WV State Medicaid Plan

Sections
S10​ MAGI Based Methodologies​
​S88 Residency Requirements
​S89 Non-Financial Eligibility Requirements
​S94 General Eligibility Process
     • Attachment 1 Single State Streamline Application
     ​• Attachment 2 On-line Application​
​1.0 MEDICAID ADMINISTRATION
​1.1.    Designation and Authority 
​1.2    Organization for Administration
1.3     Assurances
​1.5      Pediatric Immunization Program
​2.0 COVERAGE AND ELIGIBILITY
​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
​3.0 SERVICES: GENERAL PROVISIONS
​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)
​4.0 GENERAL PROGRAM ADMINISTRATION
​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 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, Facilities Providing Inpatient Psychiatric Services for Individuals Under 21, and Mental Health Hospitals
​4.16    Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees
​4.17    Liens and Adjustments 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
​5.0 PERSONNEL ADMINISTRATION
​5.1    Standards of Personnel Administration
​5.2    (Reserved)
​5.3    Training Programs; Sub professional and Volunteer Programs
​6.0 FINANCIAL ADMINISTRATION
6​.1    Fiscal Policies and Accountability
​6.2    Cost Allocation
​6.3    State Financial Participation
​7.0 GENERAL PROVISIONS
​7.1    Plan Amendments
​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 of Administration
​2.1 - A Health Maintenance Organization
​2.2 - A Groups Covered and Agencies Responsible for Eligibility Determination
     ​•  Pages 1-9b2 - Mandatory Coverage - Categorically Needy and Other Required Special Groups
​     ​•  Pages 9c-23d - Optional Groups Other than the Medically Needy
     ​•  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
​2.6 - A Eligibility Conditions and Requirements
     ​•  Pages 1-3c - General Conditions of Eligibility
     ​​•  Pages 4-5a - Post Eligibility Treatment of Institutionalized Individuals
     ​​•  Pages 6-26 - Financial Eligibility
​     ​•  Supplement 1 - Income Eligibility Levels
     ​•  Supplement 1a - Income Eligibility Levels - Categorically Needy
     ​•  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 with Income Related to 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 re 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
     ​​• 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 Beneficiaries
     ​•  Supplement 12 - Eligibility Under Section 1931 of the Act
​     ​•  Supplement 13 - Spousal Impoverishment - Undue Hardship
​     ​​•  Supplement 16 - Asset Verification System  
​     ​•  Supplement 17 - Home Equity
     ​​• Supplement 18 -Methodology for Identification of Applicable FMAP Rates
​3.1      ​• Attachment 2 - WV Medicaid Redesign Benefit Package
​3.1 - A Amount, Duration and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy
​     ​•  Supplement 1 - Case Management Services
     ​​• Attachment for A, D, and E of Supplement 1 to Attachment 3.1-A 
​     ​• 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
​3.1 - A & 3.1 - B Amount, Duration, Scope of Medical and Remedial Care And Services Provided to the Medically Needy - Methods of Providing Transportation
​Updated 4/2017 & 7/2017 ​     ​•  Supplement 2 to Attachments 3.1 -A and 3.1 - B Amount, Duration and Scope of Assistance (See 7/14/17 update SPA 09-02 Reimbursement Methodology of Services for individuals with speech, hearing and language disorders at http://www.dhhr.wv.gov/bms/CMS/SMP/Pages/Recent-State-Plan-Amendments-(SPAs).aspx),
​3.1 - C ​Alternative Benefits Benchmark Equivalent Quality Package
​3.1 - D Methods of Providing Transportation
​3.1 - E Standards for the Coverage of Organ Transplant Procedures
​3.1 - H Health Homes
​NEW 5/17 ​Statewide Health Home for Bipolar disorder at risk for Hepatitis B & C (See SPA 16-0007 at http://www.dhhr.wv.gov/bms/CMS/SMP/Pages/Recent-State-Plan-Amendments-(SPAs).aspx)
​NEW 5/17 ​Pilot Health Home for Pre-diabetes, diabetes, obesity and at risk for anxiety and/or depression (See SPA 16-0008 at http://www.dhhr.wv.gov/bms/CMS/SMP/Pages/Recent-State-Plan-Amendments-(SPAs).aspx)
​3.1 - L Alternative Benefit Plan
​3.2 - A Coordination of Title XIX with Part A and Part B of Title XVIII
​4.5 Recovery Audit Contractor
​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
​4.19 - A Inpatient Hospital Services  
​   ​•  Supplement 1 - Transition Percentage for Operating Payments
​   • Supplement 2 - Transition Percentage for Capitol Payment Amounts
​Updated 7/10/17 ​4.19 - A -1 Payments for Medical and Remedial Care and Services-Inpatient Hospitals Services - Disproportionate Share Hospitals  (Please see SPA 16-0004 for updated information at http://www.dhhr.wv.gov/bms/CMS/SMP/Pages/Recent-State-Plan-Amendments-(SPAs).aspx.)
​4.19 - A -2 Payment for Medical and Remedial Care and Services-Inpatient Psychiatric Facility Services for Individual Under 22 Years of Age
​Updated 4/2017 & 7/2017 ​4.19 - B Payments for Medical and Remedial Care and Services   (See 7/14/17 update SPA 09-02 Reimbursement Methodology of services for individuals with speech, hearing and language disorders at http://www.dhhr.wv.gov/bms/CMS/SMP/Pages/Recent-State-Plan-Amendments-(SPAs).aspx).
​   ​•  Supplement 1 - Methods and Standards for Establishing Payment Rates-Other Types of Care
​   • Supplement 2 - Payment Adjustment for Other Provider Preventable Conditions​
​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 MCOs 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 Additional Registry Information
​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 
​5.1 - A Standards of Personnel Administration
​7.2 - A ​Nondiscrimination
​S14 ​AFDC Income Standards
​S21 Presumptive Eligibility by Hospitals
Eligibility Groups - Mandatory
​S25 Parents and Other Caretaker Relatives
S28 Pregnant Women
​S30 Infants and Children Under Age 19
​S32 Adult Group
​S33 Former Foster Care Children
Eligibility Groups - Optional Coverage
​S50 ​Individuals above 133% of FPL
​S51 Optional Coverage of Parents and Other Caretaker Relatives
​S53 Children With Non-IV-E Adoption Assistance
​S54 Optional Targeted Low Income Children
​S55 Individuals With Tuberculosis
​S57 Independent Foster Care Adolescents
​S59 Individuals Eligible for Family Planning Services
​Cost Sharing
​G1 to G3 Medicaid Cost Sharing
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