National Academy of Sciences | 150 Year Anniversary

Questions? Call 800-624-6242

| Items in cart [0]

The National Academies Press

PAPERBACK
price:$47.95
add to cart

Rights & Permissions

topleft topright

America's Children: Health Insurance and Access to Care (1998)
Institute of Medicine (IOM)

Citation Manager

. "3 Health Insurance and Access to Care." America's Children: Health Insurance and Access to Care. Washington, DC: The National Academies Press, 1998.

Please select a format:

BibTeX EndNote RefMan


Page
61
bottomleft bottomright

The following HTML text is provided to enhance online readability. Many aspects of typography translate only awkwardly to HTML. Please use the page image as the authoritative form to ensure accuracy.


BOX 3.4 Services Allowed Under SCHIP

States can choose to expand Medicaid or offer one of the following: (1) one of three "benchmark" packages mentioned identified in the SCHIP legislation; (2) a package actuarially equivalent to one of the benchmark packages; (3) a comprehensive benefits package under an existing child health insurance program [available only to Florida, New York, and Pennsylvania.]; or (4) another benefit package approved by DHHS,

Actuarially equivalent packages must include four minimum benefits:

*  

inpatient and outpatient hospital services,

*  

physicians' surgical and medical services,

*  

laboratory and X-ray services, and

*  

well-baby and well-child care that includes age-appropriate immunizations.

Equivalent coverage must have an actuarial value that is 75% of the costs of the following categories:

*  

prescription medications,

*  

mental health services,

*  

vision services, and

*  

hearing services.

The following are optional services:

*  

clinic services;

*  

over-the-counter medications;

*  

prenatal care and family planning supplies;

*  

inpatient mental health services;

*  

durable medical equipment and other medical devices;

*  

disposable medical supplies;

*  

home- and community-based services;

*  

nursing-care services;

*  

dental services;

*  

inpatient and outpatient substance abuse treatment and services;

*  

case management services;

*  

care coordination;

*  

physical, occupational, and speech therapy;

*  

hospice care;

*  

medical transportation;

*  

enabling services (e.g., transportation and translation services); and

*  

any other services specified by DHHS or recognized by state law and prescribed by a licensed physician or practitioner.

SOURCE: Johnson and McDonough, 1998.

Page
61