Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

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Physical Therapy and Other Services

Products and Devices

Transportation Services

Other Services

Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Alabama (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes	$3/visit		3 surgical procedures/year if hospitalization not required	Reasonable charge	CN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes			Mental Health Clinic therapy, day treatment and other services with varying limits, Public Health Clinics not covered	Negotiated rate	CN
Federally Qualified Health Center Services
Yes	$1/visit		14 visits/year included in physician visit limitation - limit doesn't apply to family planning	Prospective cost based rate per service with ancillaries paid fee for service	CN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes	$50/admission		16 days/year for other than pregnancy-related services	Capitated per eligible per month payment or prospective cost based payment with rate ceilings	CN
Outpatient Hospital Services
Yes	$3/non-emergency visit in ER		3 non-emergency visits/year unless outpatient surgery, lab, dialysis, radiation or chemotherapy, non-emergency visit to ER counts toward both outpatient and physician visit limits	Fee for service	CN
Rehabilitation Services: Mental Health and Substance Abuse
Yes				Fee for service	CN
Rural Health Clinic Services
Yes	$1/visit		14 visits/year	Provider based: prospective cost based rate/service with ancillaries paid fee for service, Independent: prospective cost based rate/visit with ancillaries paid fee for service	CN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes				Fee for service at 85% of physician fee	CN
Chiropractor Services
No
Dental Services
No
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes			14 visits/year included in physician visit limitation	Fee for service	CN
Nurse Midwife Services
Yes				Fee for service, some services paid at 50% or 85% of physician fee	CN
Nurse Practitioner Services
Yes	$1/office visit		14 ambulatory visits/year irrespective of setting, 16 inpatient hospital visits/year, visits included in physician visit limitation - limit doesn't apply to family planning	Fee for service, some services paid 85% of physician fee	CN
Optometrist Services
Yes	$1/visit	Orthoptics and orthoptic training	1 refractive exam/2 years	Fee for service	CN
Physician Services
Yes	$1/office visit - See state-specific FN		14 ambulatory or nursing facility visits/year; 16 inpatient hospital visits/year; 1 psych evaluation/year; pregnancy, family planning and mental health visits excluded from limit; non-emergency visit to ER counts toward both outpatient and physician visit limits	Fee for service	CN
Podiatrist Services
No
Psychologist Services
Yes	$1/visit		Specified set of procedures billable and only for diagnoses in 290-316 range, varying frequency limits	Fee for service	CN
Prescription Drugs
Prescription Drugs
Yes	$.50-$3/Rx depending on drug cost		5 brand Rxs/month except brand antipsychotics and antiretrovirals up to 10 Rxs/month	Lower of AWP-10% or WAC+9.2%, plus $5.40 dispensing fee, hemophilia factor drugs paid ASP+6%	CN
Physical Therapy and Other Services
Occupational Therapy Services
No
Physical Therapy Services
No
Services for Speech, Hearing and Language Disorders
No
Products and Devices
Dentures
No
Eyeglasses
Yes			1 pair eyeglasses/2 years	Products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN
Hearing Aids
No
Medical Equipment and Supplies
Yes	$1-$3/ service or item, depending on payment			Fee for service using Medicare payment ceilings, some items paid cost plus percentage	CN
Prosthetic and Orthotic Devices
Yes		Yes	Limited to basic level prosthetic and orthotic devices determined medically necessary; prosthetic eyes or lenses, devices to close oral cavity created by congenital defect or surgery, internal life-supporting devices are also covered	Reasonable charge using Medicare payment ceilings	CN
Transportation Services
Ambulance Services
Yes				Fee for service	CN
Non-Emergency Medical Transportation Services
Yes			2 trips/month	See service-specific FN	CN
Other Services
Diagnostic, Screening and Preventive Services
No
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes				Reasonable charge	CN
Targeted Case Management
Yes			Services provided for multiple populations - See service-specific FN	Negotiated rate	CN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 2, 4, 5, 6 & 8 - See service-specific FN	Dependent upon the services provided	CN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes	Initiation of care and for medical equipment	104 visits/year with no more than 2 home health aide visits/week, therapies not covered	Cost based payment for government providers, fee for service using time units for private providers, med equipment and supplies paid fee for service	CN
Hospice Care
Yes	Yes		Prospective rates based on Medicare methodology	CN
Personal Care Services
No
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
No
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes		Hosp leave days not covered, 6 therapeutic leave days/quarter limited to 3 days/leave up to 24 days/year	Prospective cost based per diem	CN
Inpatient Psychiatric Services, under age 21
Yes			Prospective cost based per diem	CN
Intermediate Care Facility Services for the Mentally Retarded
Yes		Hosp leave days not covered, 14 therapeutic leave days/month, may be consecutive	Prospective cost based per diem with limits	CN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes		4 hosp leave days/hospitalization, 6 therapeutic leave days/quarter limited to 3 days/leave up to 24 days/year	Prospective per diem based on cost and facility class	CN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: This State imposes its copayment requirements on dually eligible Medicare and Medicaid beneficiaries for services for which the State is asked to pay the coinsurance and/or deductible amount. The State does not require a copayment for physician office visits during which surgical procedures are performed.