Medicaid Benefits: Online Database

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Acute Care Services

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Long-Term Care Services

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Benefits by State: Virgin Islands (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				Fee for service	CN
Federally Qualified Health Center Services
No
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes			Services in public health facilities only	Prospective all-inclusive per diem up to Medicare cost ceiling	CN
Outpatient Hospital Services
Yes			Services in public health facilities only	Fee for service	CN
Rehabilitation Services: Mental Health and Substance Abuse
No
Rural Health Clinic Services
No
Practitioner Services
Certified Registered Nurse Anesthetist Services
No
Chiropractor Services
Yes			Service in public health facilities only	Fee for service	CN
Dental Services
Yes			Services in public health facilities only	Fee for service	CN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes			Services in public health facilities only	Fee for service	CN
Nurse Midwife Services
No
Nurse Practitioner Services
Yes				Fee for service	CN
Optometrist Services
Yes			Limited to dispensing and fitting eyeglasses	Fee for service	CN
Physician Services
Yes				Fee for service	CN
Podiatrist Services
Yes				Fee for service	CN
Psychologist Services
No
Prescription Drugs
Prescription Drugs
Yes			Rxs must be dispensed by public health operated or contracted pharmacies	Acquisition cost plus dispensing fee	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
Yes		Yes	Strict criteria of medical necessity must be met	Fee for service	CN
Eyeglasses
Yes			Prescription must be written by public health facility physician	Fee for service	CN
Hearing Aids
No
Medical Equipment and Supplies
No
Prosthetic and Orthotic Devices
No
Transportation Services
Ambulance Services
Yes			Air ambulance not covered	Reasonable charge	CN
Non-Emergency Medical Transportation Services
Yes				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			Services in public health facilities only	Fee for service	CN
Targeted Case Management
No

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
No
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes	Fee for service	CN
Hospice Care
No
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
No
Inpatient Psychiatric Services, under age 21
No
Intermediate Care Facility Services for the Mentally Retarded
No
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes	Cost based per diem, up to Medicare limits	CN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: Like the other territories, the Virgin Islands has a federal Medicaid financial participation rate of 50 percent, payable up to a ceiling specified in law. The Deficit Reduction Act of 2005 provided additional funds to the Virgin Islands, thus increasing its payment ceiling for fiscal years 2006 and 2007. The ceilings for 2008 and subsequent years will be calculated by applying an adjustor, the medical care component of the Consumer Price Index, to the 2007 payment ceiling.