Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

Prescription Drugs

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: Nevada (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		Specified services		Prospective cost based rate per episode of care using Medicare methodology and upper limits, ancillaries paid fee for service	CN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes		Specified services		Fee for service	CN
Federally Qualified Health Center Services
Yes				Prospective all-inclusive cost based rate/visit	CN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes		Non-emergency admissions except maternity	Continuing stay authorizations required	Prospective all-inclusive per diem by type of admission, cost based payment for critical access hospitals and hospital LTC units, swing beds paid statewide average nursing facility per diem	CN
Outpatient Hospital Services
Yes		Specified services		Fee for service with surgical procedures grouped using Medicare methodology	CN
Rehabilitation Services: Mental Health and Substance Abuse
Yes			Rehab potential required	Fee for service	CN
Rural Health Clinic Services
Yes				Prospective all-inclusive cost based rate/visit	CN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes				Fee for service	CN
Chiropractor Services
No
Dental Services
Yes			Limited to trauma care and emergency treatment for relief of pain and infection, periodontia covered for pregnant women	Fee for service	CN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes				Fee for service	CN
Nurse Midwife Services
Yes				Fee for service	CN
Nurse Practitioner Services
Yes				Fee for service	CN
Optometrist Services
Yes			Limited to treatment of medical conditions, including glaucoma and cataracts	Fee for service	CN
Physician Services
Yes				Fee for service	CN
Podiatrist Services
No
Psychologist Services
Yes		Yes	Scope of coverage based on intensity of need	Fee for service	CN
Prescription Drugs
Prescription Drugs
Yes		Specified drugs		AWP-15%, plus $4.76 dispensing fee	CN
Physical Therapy and Other Services
Occupational Therapy Services
Yes		Yes	Rehab potential required	Fee for service	CN
Physical Therapy Services
Yes		Yes	Rehab potential required	Fee for service	CN
Services for Speech, Hearing and Language Disorders
Yes		Yes	Rehab potential required, audiological testing and evaluation requires physician order	Fee for service	CN
Products and Devices
Dentures
Yes		Yes	1 full upper and/or lower denture or 1 partial upper and/or lower denture/5 years	Fee for service	CN
Eyeglasses
No
Hearing Aids
Yes		New or replacement aid costing more than $350	1 hearing aid/2 years	Acquisition cost plus dispensing fee	CN
Medical Equipment and Supplies
Yes		Specified items		Fee for service	CN
Prosthetic and Orthotic Devices
Yes		Specified services/items		Fee for service	CN
Transportation Services
Ambulance Services
Yes				Fee for service	CN
Non-Emergency Medical Transportation Services
Yes		Yes		See service-specific FN	CN
Other Services
Diagnostic, Screening and Preventive Services
Yes			Limited to screening and preventive services only, specified coverage criteria for mammography and annual gynecological exams	Fee for service	CN
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		Specified services		Fee for service	CN
Targeted Case Management
Yes				Prospective cost based rate	CN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 2, 4 & 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 ongoing certification of need		Fee for service	CN
Hospice Care
Yes			Prospective rates based on Medicare methodology	CN
Personal Care Services
Yes	Yes	Approved hours of care dependent upon need	Fee for service	CN
Private Duty Nursing Services
Yes	Yes	Approved hours of care dependent on medical necessity	Fee for service	CN
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, therapeutic leave limited to rehabilitative and pre-discharge transitional home and community visits up to 24 days/year	Cost based payment	CN
Inpatient Psychiatric Services, under age 21
Yes	For admission	Continuing stay authorizations required	Cost based payment, negotiated rate for residential treatment facilities	CN
Intermediate Care Facility Services for the Mentally Retarded
Yes		Hosp leave days not covered, therapeutic leave limited to rehabilitative and pre-discharge transitional home and community visits up to 24 days/year	Prospective cost based per diem with limits	CN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes		Hosp leave days not covered, therapeutic leave limited to rehabilitative and pre-discharge transitional home and community visits up to 24 days/year	Prospective price-based per diem	CN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: This State has added the optional Medicaid buy-in group of disabled adults permissible through the Ticket to Work and Work Incentives Improvement Act (TWWIIA) in a program called Health Insurance for Work Advancement. These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, irrespective of annual income, however they are responsible for applicable copayments and an income-based monthly premium.