12 Va. Admin. Code § 5-71-160 - Availability of assistance for obtaining metabolic formula, low protein modified foods, and metabolic supplements
A. The
department shall maintain a protocol to assist eligible persons in obtaining
metabolic formula, low protein modified foods, and metabolic
supplements.
B. Expenditures shall
be limited to available funding.
C. Resident children and resident adults
under the age of 21 who have a diagnosis of a heritable disorder or genetic
disease listed in
12VAC5-71-30 D and meet financial
eligibility criteria for the Children with Special Health Care Needs Program
pool of funds in accordance with the State Board of Health Regulations
Governing Eligibility Standards and Charges for Medical Care Services to
Individuals (12VAC5-200) may qualify to receive metabolic formula at no cost.
Applicants who qualify must demonstrate that they are not eligible for
available state and federal medical assistance programs and must demonstrate
that they do not have insurance coverage for metabolic formula .
D. Resident children and resident adults
under the age of 21 who have a diagnosis of a heritable disorder or genetic
disease listed in
12VAC5-71-30 D and do not meet
financial eligibility criteria for the Children with Special Health Care Needs
Program pool of funds in accordance with the State Board of Health Regulations
Governing Eligibility Standards and Charges for Medical Care Services to
Individuals (12VAC5-200) may be eligible to purchase metabolic formula through
the Virginia Department of Health.
E. Resident adults ages 21 or older who have
a diagnosis of a heritable disorder or genetic disease listed in
12VAC5-71-30 D and who have a
gross family income at or below 300% of the federal poverty level in accordance
with the State Board of Health Regulations Governing Eligibility Standards and
Charges for Medical Care Services to Individuals (12VAC5-200) may qualify to
receive metabolic formula at no cost. Applicants who qualify must demonstrate
that they are not eligible for available state and federal medical assistance
programs and must demonstrate that they do not have current insurance coverage
for metabolic formula .
F. Resident
adults ages 21 or older who have a diagnosis of a heritable disorder or genetic
disease listed in
12VAC5-71-30 D and who do not meet
financial criteria or other eligibility criteria in accordance with the State
Board of Health Regulations Governing Eligibility Standards and Charges for
Medical Care Services to Individuals (12VAC5-200) may qualify to purchase
metabolic formula through the Virginia Department of Health.
G. Residents who have a diagnosis of a
heritable disorder or genetic disease listed in
12VAC5-71-30 D and who have a
gross family income at or below of 300% of the federal poverty level in
accordance with the State Board of Health Regulations Governing Eligibility
Standards and Charges for Medical Care Services to Individuals (12VAC5-200) may
be eligible to receive reimbursement from the department up to $1,500 per year
for purchase of low protein modified foods and metabolic supplements.
Applicants who qualify must demonstrate that they are not eligible for
available state and federal medical assistance programs and must demonstrate
that they do not have current insurance coverage for low protein modified foods
or metabolic supplements for which they are seeking reimbursement.
Notes
Statutory Authority: §§ 32.1-12 and 32.1-67 of the Code of Virginia.
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