12VAC30-50-220: Diagnostic, screening, preventive, and rehabilitative services other than those provided elsewhere in this plan

A. Diagnostic services are provided but only when necessary to confirm a diagnosis.

B. Preventive services.

1. Screening PSA (i.e., prostate specific antigen) and the related DRE (i.e., digital rectal examination) for males shall be covered, consistent with the guidelines of the American Cancer Society.

2. Maternity length of stay and early discharge.

a. If the mother and newborn, or the newborn alone, are discharged earlier than 48 hours after the day of delivery, DMAS will cover one early discharge follow-up visit. The mother and newborn, or the newborn alone if the mother has not been discharged, must meet the criteria for early discharge to be eligible for the early discharge follow-up visit. This early discharge follow-up visit does not affect or apply to any usual postpartum or well-baby care or any other covered care to which the mother or newborn is entitled; it is tied directly to an early discharge.

b. The early discharge follow-up visit must be provided as directed by a physician. The physician may coordinate with the provider of the physician's choice to provide the early discharge follow-up visit, within the following limitations. Qualified providers are those hospitals, physicians, nurse midwives, nurse practitioners, federally qualified health clinics, rural health clinics, and health department clinics that are enrolled as Medicaid providers and are qualified by the appropriate state authority for delivery of the service. The staff providing the follow-up visit, at a minimum, must be a registered nurse having training and experience in maternal and child health. The visit must be provided within 48 hours of discharge.

3. Any clinical preventive services that are assigned a grade of A or B by the United States Preventive Services Task Force (USPSTF) along with approved vaccines and vaccine administration recommended by the Advisory Committee on Immunization Practices (ACIP) for adult, full-Medicaid individuals.