{
  "id": "RL32628",
  "type": "CRS Report",
  "typeId": "REPORTS",
  "number": "RL32628",
  "active": false,
  "source": "EveryCRSReport.com",
  "versions": [
    {
      "source": "EveryCRSReport.com",
      "id": 100194,
      "date": "2004-10-12",
      "retrieved": "2016-04-07T20:06:45.595610",
      "title": "Coverage of Vision Services under the State Children's Health Insurance Program (SCHIP)",
      "summary": "A small but significant proportion of children have visual impairments. When detected early,\nmany\nchildhood vision abnormalities are treatable, but the potential for correction and normal visual\ndevelopment diminishes with age. Under SCHIP, states may provide coverage by expanding\nMedicaid or creating a separate SCHIP program or both. Medicaid and SCHIP provide access to an\narray of vision-related services, including vision screening services that can help children in low-\nto moderate-income families overcome these difficulties.\n  Medicaid's mandatory Early, and Periodic, Screening, Diagnosis, and Treatment (EPSDT)\nbenefit ensures access to vision screening services for children. However, there are several other\nMedicaid benefit categories where vision screening services may be delivered. Often such services\nare billed as a part of a well-child visit. Under SCHIP, state-specific benefit packages must provide\nwell-baby and well-child care, which includes a vision screening component. As with Medicaid, the\nwell-child coverage requirement is not the only service category where children could receive vision\nscreening under SCHIP. Children may also receive vision screening services under other\nSCHIP-covered services such as physician services.\n  A June 2000 CRS benefits survey provides some clues as to access to vision services under\nSCHIP Medicaid expansion and separate state programs. At that time, nearly all Medicaid and\nSCHIP programs covered vision services for children, and most also covered eye glasses. The\nsurvey data indicates that the breadth of vision-related benefits available under these two programs\nlikely differs within and across states.\n  Coverage policies and benefit limits for the lowest-income children as described in state\nMedicaid plans are seldom absolute because of EPSDT. For nearly all Medicaid children, states are\nrequired to provide all federally allowed treatment to correct identified problems, even if the specific\ntreatment needed is not otherwise covered under a state's Medicaid plan. As a result, when a\nMedicaid agency reports that a specific benefit is not covered for children, that means the service is\navailable only when delivery of that service meets the EPSDT requirement. \n  Services for higher-income children under SCHIP are sometimes more restrictive. Unlike\nMedicaid, but consistent with federal statute, separate SCHIP programs are modeled after private\nsector, commercial insurance products. The requirement to use benchmark plans (or actuarial\nequivalents of those plans), most of which are state employee health plans or commercial HMO\nplans, provides the framework for defining benefit limits. Under commercial insurance products,\nbenefits are always limited by medical necessity, but other limits may apply and will vary by\ninsurance product, as do procedures to monitor for medical need and appropriateness. Payments to\nproviders participating in these plans may be altered based on the outcome of such service utilization\nreviews, which can in turn affect access to care. This report will not be updated.",
      "type": "CRS Report",
      "typeId": "REPORTS",
      "active": false,
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          "url": "http://www.crs.gov/Reports/pdf/RL32628",
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      "topics": []
    }
  ],
  "topics": [
    "Domestic Social Policy",
    "Health Policy"
  ]
}