Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

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Products and Devices

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Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: New Hampshire (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
No
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes			Mental Health Clinics covered under Rehab benefit	Fee for service	CN & MN
Federally Qualified Health Center Services
Yes				Cost based payment, with limits	CN & MN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes		Admissions for specified purposes	LOS limited by state's Utilization Review authority, transplants limited to approved facilities and 2 transplants of same type/lifetime	Prospective payment/discharge using DRG, payment ceiling for transplants	CN & MN
Outpatient Hospital Services
Yes			12 visits/year, visits for therapy included in limits with other specified practitioners	Percentage of charge	CN & MN
Rehabilitation Services: Mental Health and Substance Abuse
Yes			Community mental health care limited to $1,800/year unless specified criteria met, low service utilizer with severe or persistent mental illness limited to $4,000/year	Fee for service	CN & MN
Rural Health Clinic Services
Yes				Prospective cost based rate/visit with ancillaries paid fee for service	CN & MN
Practitioner Services
Certified Registered Nurse Anesthetist Services
No
Chiropractor Services
Yes			6 visits/year	Fee for service	CN & MN
Dental Services
Yes			Limited to trauma care and emergency treatment for relief of pain and infection	Fee for service	CN & MN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes				Fee for service	CN & MN
Nurse Midwife Services
Yes				Fee for service	CN & MN
Nurse Practitioner Services
Yes			18 ambulatory visits/year irrespective of setting	Fee for service	CN & MN
Optometrist Services
Yes			1 refractive exam/year	Fee for service	CN & MN
Physician Services
Yes			18 ambulatory visits/year	Fee for service with payment ceiling for transplants	CN & MN
Podiatrist Services
Yes			12 visits/year, routine foot care covered only for specified systemic conditions	Fee for service	CN & MN
Psychologist Services
Yes			12 visits/year, psychotherapy visits included in limits with other specified practitioners, must be by independent psychologist	Fee for service	CN & MN
Prescription Drugs
Prescription Drugs
Yes	$1/generic Rx, $2/brand or compound Rx	Specified drugs		AWP-16%, plus $1.75 dispensing fee	CN & MN
Physical Therapy and Other Services
Occupational Therapy Services
Yes			Eighty 15-minute time units/year included in limits with other therapy providers	Fee for service	CN & MN
Physical Therapy Services
Yes			Eighty 15-minute time units/year included in limits with other therapy providers	Fee for service	CN & MN
Services for Speech, Hearing and Language Disorders
Yes			Eighty 15-minute time units/year included in limits with other therapy providers	Fee for service	CN & MN
Products and Devices
Dentures
No
Eyeglasses
Yes			1 pair eyeglasses/year if minimum .50 diopter correction criteria met in both eyes, one repair/year	Fee for service	CN & MN
Hearing Aids
Yes		Specified hearing aids	Coverage and replacement only if hearing loss exceeds specified decibel criteria	Fee for service	CN & MN
Medical Equipment and Supplies
Yes		Disposable incontinence supplies and med equipment items		Fee for service, adjusted retail price or individual pricing	CN & MN
Prosthetic and Orthotic Devices
Yes				Fee for service	CN & MN
Transportation Services
Ambulance Services
Yes				Fee for service	CN & MN
Non-Emergency Medical Transportation Services
Yes			24 wheelchair van trips/year	See service-specific FN	CN & MN
Other Services
Diagnostic, Screening and Preventive Services
Yes			Preventive services to newborns and their mothers are counted in the 18 visit physician limit	Fee for service or negotiated rate	CN & MN
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 x-ray services	15 diagnostic x-ray services/year	Fee for service	CN & MN
Targeted Case Management
Yes				Fee for service or cost based payment	CN & MN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 1, 2, 4 & 8 - See service-specific FN	Dependent upon the services provided	CN & MN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes			Fee for service	CN & MN
Hospice Care
No
Personal Care Services
Yes		Care plan must be developed by RN, beneficiary must be chronically wheelchair bound and able to select and direct attendant	Fee for service	CN & MN
Private Duty Nursing Services
Yes	Yes	8 hours/day	Fee for service	CN & MN
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	Admission to nursing facility		Prospective cost based per diem	CN & MN
Inpatient Psychiatric Services, under age 21
Yes		Psych services limited to approved facilities	Prospective cost based per diem	CN & MN
Intermediate Care Facility Services for the Mentally Retarded
No
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes		30 reserve bed days/year if established criteria met	Prospective per diem based on cost, acuity adjusted	CN & MN
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 Medicaid for Employed Adults with Disabilities. These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below 450 percent of the federal poverty level (FPL), however they are responsible for applicable copayments and an income-based monthly premium is charged based on income above 150 percent of the FPL.