1 How to Access Health and Mental Health Services For Children Under Maryland Medical Assistance Getting Children What They Need Cathy Surace Maryland Disability Law Center
2 Goals of Today s s Training Learn how the Medical Assistance (or Medicaid) Program is organized and where to go to get help Learn what services are covered and not covered by Medicaid Know the steps to access mental health services and various physical health care services Understand the role of different governmental agencies, health plans, and contractors
3 Goals of Today s s Training (cont d) Know when you need a referral from the primary care physician or mental health professional to access services Learn what to do when a service is denied, delayed, or not available Understand the legal rights that foster children have as Medicaid recipients Know what EPSDT means and what a strong entitlement children have to receive the health care services that treating professionals recommend for them
4 Who is MDLC? Maryland Disability Law Center is a non-profit organization of lawyers and paralegals dedicated to protecting the rights of people with disabilities. The State of Maryland s s protection and advocacy organization Provide free legal services and advice See our website for more information: Call our intake line to seek information or legal help for a child with a disability.
5 Medicaid Eligibility for Children in DSS custody Virtually all children in foster care will be eligible for Medicaid while in DSS custody and out of the parent s s home. When children return home, eligibility will depend on family income in most cases.
6 Medicaid Eligibility Children are eligible for Medicaid if they: Receive Supplemental Security Income (SSI) benefits Live outside their parent s s home in foster homes, group homes, residential treatment centers, etc. in most cases Are in subsidized adoptions Are 18 years old or over, have a disability, and meet the income and asset requirements (regardless of family s s income) Are in a Medicaid waiver program- Waiver participants are eligible for all Medicaid services in addition to waiver services Are in Maryland Children s s Health Program (MCHP) or MCHP Premium (program allowing families to buy in to MCHP)
7 Medical Assistance Program Organization Under Control of Department of Health and Mental Hygiene (DHMH)
8 HealthChoice Managed Care Program Most recipients are in a managed care program called HealthChoice. Must join a health plan called Managed Care Organization (MCO, like a HMO) 7 MCOs MCO Primary Care Doctor is key for referrals For some referrals doctor must also get MCO approval Generally must use in network providers but exceptions can be made
9 Fee-for for-service System Some people are still in the Fee-for for-service System (FFS). Can go to any doctor or other provider who accepts Medicaid DHMH still must approve or authorize some services in advance Finding a doctor or provider can be a problem Children in the REM Program are in FFS.
10 REM: Rare and Expensive Case Management Program A specialized program for children and adults on Medical Assistance with qualifying diagnoses Call DHMH at (410) for an application. Individuals in REM are not in an MCO but in fee-for for-service Medicaid. Benefits include an assigned case manager and additional covered services that can be particularly important when a child turns 21.
11 Carve-Outs Even children in HealthChoice access some carved- out services through FFS because MCOs do not cover these services. Children do not need MCO approvals or MCO doctor referrals to access these services: Mental Health Services Dental Services Personal Care Physical, Occupational, and Speech Therapy Initial substance abuse assessment Limited Residential Care for persons with developmental disabilities
12 Medicaid Waiver Programs Some children receive Medicaid benefits under a federal waiver program. These programs enable children from families that are not low income to qualify for Medicaid. These programs provide specialized community- based services that are not available under the regular Medicaid Program in addition to all of the regular Medicaid services. These programs have limited slots.
13 Existing Maryland Waiver Programs Children Autism Waiver Model Waiver Children and Adults Developmental Disability Waiver Adults Older Adults Waiver Living at Home Waiver Traumatic Brain Injury Waiver
14 Children s s Rights Under Medicaid
15 Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) EPSDT provides a broad entitlement for children or young adults (under 21) on Medicaid to receive a wide variety of services including virtually any medically necessary service recommended by a licensed health care professional. This broad entitlement is the most important right children have under Medicaid.
16 EPSDT s s Two Components Periodic Check-ups (7 before 1 yr, 3 from 1yr -22 yrs, 1 per yr from 3-21) Check ups include unclothed physical exam, developmental screening, mental health screening, lead testing at 12 & 24 months, vision testing, hearing screening, immunizations, dental screening, health education, and lab tests Any medically necessary treatment or service covered by the federal Medicaid Program
17 The only legitimate limitation on covered services is medical necessity According to DHMH, Medically necessary" means that the service or benefit is: (a) Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition; (b) Consistent with current accepted standards of good medical practice; (c) The most cost efficient service that can be provided without sacrificing effectiveness or access to care; and (d) Not primarily for the convenience of the consumer, family, or provider.
18 Other Legal Rights Under Medicaid The State cannot put children on waitlists for services (but providers can) Services should be available throughout the State even in rural areas Services should be approved or denied, and provided with reasonable promptness The State should ensure that providers are available
19 Legal Rights (cont d) Families should have the freedom to choose providers. The amount, length, and frequency of services provided can be limited only by medical necessity and not by arbitrary caps or rules imposed by the State. Deference should be given to the recommendations of the child s s treating physician or health care professional. Services denials and delays can be appealed.
20 Reasonable Promptness Timely service delivery is required by federal law. No clear definition of reasonable promptness (RP) Depends on the facts and circumstances of each case and the type of service For urgent services RP could mean immediately With mental health services, Maryland regulations specify the timelines for service approval and delivery.
21 Covered Medicaid Services Examples of services and how to access them
22 Services Covered By Medical Almost any service deemed Medically Necessary by a doctor or licensed health care practitioner Assistance Regular Well-Child Check-ups Sick Child Visits Case Management Physical, Occupational and Speech Therapy Home Health/ In-home Nursing Personal Care Durable Medical Equipment Disposable Medical Supplies Dental and Vision Care Specialty Mental Health Services Therapeutic Behavioral Services Limited Residential Services Prescription Drugs Long Term Care (nursing home) Inpatient Care Substance Abuse Treatment
23 Services Not Covered By Medical Assistance Respite Care Habilitation (as opposed to rehabilitation) Vocational Services Above services can be covered under a Waiver Room and Board in community-based residential programs such as therapeutic foster homes and group homes
24 Services from the Developmental Disabilities Administration Applies to children with intellectual disability, autism, cerebral palsy, traumatic brain injuries, or other disabilities that are not a mental illness Apply to DDA for service eligibility having this eligibility on file will speed the process of applying for specific services as they are needed, such as when a child is turning 21 and needs residential care. Person must be found DD eligible as opposed to ISS eligible to qualify later for residential and day services as an adult. DDA services can either be discretionary when not covered by Medicaid (respite) or an entitlement if covered by Medicaid (residential services and services for DD waiver recipients)
25 Case Management Children with special health care needs (developmental disabilities or mental illness) are entitled to receive a case manager Children with mental illness may be eligible for Mental Health Targeted Case Management through a referral by a licensed health care professional to ValueOptions Maryland. Assists families to obtain needed Medicaid services by locating providers, obtaining referrals from the primary care doctor, obtaining approval from the MCO or DHMH, and securing transportation Identifies community resources even outside of Medicaid system Even though foster children have a DSS case worker, they may still need a case manager to navigate the complicated Medicaid system You call the MCO s s special needs coordinator to request a case manager
26 Personal Care Unskilled assistance in the home with feeding, toileting, bathing, dressing and mobility Contact the personal care program within the local health department No waiting list should be maintained Not a substitute for childcare Friends, neighbors, etc. can become personal care providers through the health department Contact MDLC if health department cannot find a provider
27 Medical Equipment and Supplies ALL medically necessary equipment and supplies are covered Get a referral from the child s s doctor Approval by the MCO or DHMH is often needed Assistive Technology Augmentative communication devices Wheelchairs Orthotics Monitors Prosthetics Seating and positioning devices Transfer equipment Oxygen equipment Nebulizers Diapers for incontinent older children Diabetic supplies Formula for feeding disorders More
28 Dental and Vision Dental Teeth cleaning twice per year Fluoride Exams Emergency care Preventive Services Sealants Orthodontic care where it is medically necessary (not just cosmetic) Contact DentaQuest for information and participating dentists at Vision One eye exam per year One pair of glasses per year, replacement if prescription changes, or if glasses are lost, stolen, broken (even within the year) Specialized goggles Call the health plan for a list of doctors
29 Physical, Occupational, and Speech Therapy You can schedule an appointment with any participating Medicaid provider delivering these services if you believe a child needs PT, OT or speech therapy or more frequent or intensive PT, OT or speech therapy than they receive in school. No referral is needed by the doctor nor is any approval needed by the MCO or DHMH for these carved-out services. At the first appointment, the provider will do an assessment to determine if the therapy they provide is medically necessary.
30 Physical, Occupational, and Speech Therapy Providers The hardest part may be finding a provider to deliver PT, OT, and/or Speech Therapy services. Hospital outpatient programs are good sources for these therapies Contact DHMH for a list of providers Ask for a Medicaid case manager to find a provider Call MDLC if you cannot find a provider Home health providers deliver these therapies in the home if there is a medical reason that the child cannot go out of the home to receive these services.
31 Home Health and Private Duty Nursing (PDN) Provides skilled in-home nursing and/or home health aide assistance with activities of daily living Mechanism by which children can receive services at home physical, occupational or speech therapy mental health services Medical supplies for home use Get a referral from the child s s doctor and receive approval from the health plan or DHMH Refer families denied sufficient PDN to MDLC.
32 Transportation Children (and their parents) are eligible for transportation to and from medical appointments if they have no other means of transportation. Contact the local health department. Contact the CSA for transportation assistance for parents to attend therapy sessions at a residential treatment center. DSS also can provide transportation to medical and mental health appointments.
33 Substance Abuse Treatment for Alcohol/Drug Dependence Covered by MCO under HealthChoice Family may self refer child to any DHMH approved provider even outside the MCO network for an assessment. Initial assessment does not require MCO approval and MCO must pay. Problems reported about MCO denials of follow-up services such as residential care. Contact MDLC if child is denied these services. MCOs may not deny residential treatment determined necessary during an assessment because a child has not first tried outpatient treatment. Covered under Fee For Service Medicaid Call for a list of providers Comprehensive Substance Abuse Assessment Individual counseling Group counseling Methadone maintenance Inpatient and Outpatient Detox Partial hospitalization Intensive Outpatient Services Residential Care in Intermediate Care Facilities
34 Mental Health Services Diagnostic evaluation and Assessment Medication Management Individual Therapy Group Therapy Family Therapy Intensive Outpatient Services Mental Health Targeted Case Management Therapeutic Behavioral Services Transportation Assistance Psychiatric Rehabilitation Program Services Therapeutic Nursery Services Inpatient Hospitalization Residential Treatment Center Care Residential Rehabilitation in a therapeutic foster home or group home (not room and board) Partial Hospitalization/ Day Treatment Home Health Care Mobile Treatment Psychological Testing
35 Mental Health Services are Carved Out and Administered by ValueOptions The Mental Hygiene Administration contracts with ValueOptions, a private organization, to administer the public mental health system. ValueOptions handles approvals, denials, and internal appeals of mental health services under Medicaid in Maryland. The ValueOptions website has a searchable provider directory. ValueOptions can be reached 24 hours a day at Review MDLC brochure and DHMH brochure on Accessing Mental Health Services under Medicaid in your hand-outs and at
36 How to Access Mental Health Services through VlueOptions The first twelve outpatient visits do not require a referral to or approval by ValueOptions. Go to any participating provider Problem can be finding one Ask ValueOptions or the Core Service Agency (CSA) for help Core Service Agency is the local mental health authority (contact information for each CSA is found in our materials). All other services require a referral by a licensed clinician to ValueOptions through their Care Connection website or by fax to See Sample Service Request Letter in MDLC s s materials, also available at and-resources/publications/ Families can call ValueOptions on their own to request services but ValueOptions may deny them without a professional referral.
37 Timelines for Approval and Delivery of Mental Health Services Approval or denial for urgently needed services shall take place within 1 hour Approval or denial where the need is not urgent shall take place within 24 hours. Service shall be initiated as soon as clinically appropriate for urgently needed services Service shall be initiated within 10 business days of authorization if the need is not urgent, ValueOptions may document a clinical rationale for extending the time for not more than 30 days.
38 Therapeutic Behavioral Services (TBS) Provides a behavior plan developed by a licensed clinician and a one-to to-one one aide in the home and community to implement the behavior plan. To be eligible client must be under 21 and have difficult behaviors related to a developmental disability or symptoms related to a mental illness that place the living situation at risk or prevent transition to a less restrictive environment Available for up to 24 hours per day (As many hours as medically necessary but typically hours per week) Available during the school day through an IEP
39 TBS (cont d) Any licensed treating professional can refer to ValueOptions for this service but typically referrals come from a child s s therapist or psychiatrist Can be part of discharge planning from hospital. See sample letter in hand-out Children in need of TBS cannot be denied 1:1 aide because they are in foster care under state custody. TBS is not a discretionary service that depends on the availability of DHR or DSS funds. Not a substitute for child care, foster parent/caretaker should be present If delay in obtaining, contact MDLC.
40 Psychiatric Rehabilitation Program Services (PRP) PRP is provided in therapeutic after-school programs and on a one-to to-one one basis in the home and community. Typically the number of hours and frequency are much more limited than TBS. PRP is only for children with a psychiatric diagnosis. A child can receive both PRP and TBS if both services are medically necessary.
41 Mobile Treatment Services Intensive, community-based services providing outreach, treatment, and support to individuals with mental illness for whom more traditional forms of outpatient treatment is ineffective, such as children who refuse to go to therapy or medication management appointments Service is provided by a multidisciplinary team, is mobile, and is provided in the child s s home or community. Services provided include psychiatric evaluation and treatment, clinical assessment, medication management/monitoring, interactive therapies, and support with daily living skills.
42 Psychological Testing The administration of valid and reliable psychological tests Available under Medicaid to answer questions about a child s s diagnosis and to determine the future course of treatment Educational testing, vocational testing, testing to rule out a medical condition or specifically for the purpose of placement is not covered Contact MDLC regarding denials or partial authorizations
43 Residential Services for Children with Mental Illness If a child with a developmental disability and/or a mental illness is having behavioral problems in a foster home, before the child is referred for placement in a more m restrictive setting, consider if an in-home behavioral aide would help (TBS) and see if wraparound services are available in your county. Other residential options include: Residential Rehabilitation services in a therapeutic foster home or group home All Medicaid recipients under 21 who meet medical necessity criteria have a right to these services (but there is a co-pay for parents so a VPA may be necessary) Residential Treatment Center Care Process (Professional Recommendation, CSA, ValueOptions) DSS should handle the application process. School System approval is not required but approval for a non-public school can expedite placement MA recipients not approved for an IEP or a non-public school still have right to RTC care
44 What happens when a child has private insurance and Medicaid? Medicaid is the payer of last resort Medicaid will pay the private insurer s s co-pay due on services and prescription drugs if the provider participates in Medicaid Try to find a provider who accepts both the private insurance and Medicaid Always inform doctors and pharmacists about dual coverage so that co-pays will be covered Call MDLC if co-pays are not covered
45 Appeal Rights
46 Service Denials in Writing Any time a child is denied a Medicaid service, you have a right to receive a written denial letter explaining why the service was denied and how to appeal. Managed Care Organizations must send these letters and cannot just give verbal denials. MAPS-MD MD must send these letters when denying mental health services.
47 Denials and Other Types of Problems Accessing Services Service found not to be medically necessary Service not covered (rare) Ambiguous (e.g., Denial verbal, Inaction, Request for more information) Lack of reasonable promptness in service delivery Can t t find a provider (e.g., TBS, DME, PT, OT and speech) Illegal Caps on Service frequency, length or amount Interplay with Private Insurance coverage Provider problems (e.g. not delivering, poor quality, miscommunication) Disputes Between Managed Care System and Mental Health Carve-Out over who is responsible for a service
48 HealthChoice Appeals Right to appeal MCO denials or delays regardless of whether a formal written denial letter is received The first step is to file a complaint with the DHMH Health Enrollee Action Line (HEAL) by calling MDLC can help you call the HEAL line. DHMH sends a letter 10 business days after a call to the HEAL line about the right to request a Medicaid Fair Hearing even if they still are trying to resolve the complaint. Internal MCO appeal option is not recommended
49 Mental Health Appeals Right to appeal if there is a denial or delay in obtaining any mental health service requested through ValueOptions There are time deadlines for filing appeals and receiving decisions on appeals. Internal appeals can be filed first through ValueOptions and then through the Core Service Agency (CSA). Your client has the option of requesting a Medicaid Fair Hearing immediately or at any time during the internal appeals process up u to 45 days after the last decision. You can pursue a Medicaid Fair Hearing and internal appeals at the same time.
50 Fee-for for-service Appeals In case of a denial, the family should receive a denial letter from DHMH. Right to appeal DHMH denials or delays regardless of whether a formal written denial letter is received Request a Fair Hearing by sending a letter to DHMH.
51 Medicaid Fair Hearings Who can request a Medicaid Fair Hearing? Foster parents should talk to DSS caseworker before requesting a hearing. Medicaid Fair Hearings are requested by writing a letter to DHMH and are held before an administrative law judge. Legal representation is not required but is highly recommended. MDLC can provide free representation or refer you to a pro bono attorney. Judge must make decision within 90 days of the date hearing requested or even faster in expedited cases. Hearing location can be requested in any county. Case likely to be resolved by a settlement agreement before the hearing.
52 Right to Continued Benefits Pending a Hearing Only applies if a service a child has been receiving has just been terminated or is about to be terminated, not if a new service is denied. When requesting the hearing, request that the service continue (or be reinstated) pending the outcome of the hearing. Warning: If you lose at the hearing the state can bill the recipient for any continued benefits received.
53 Things to Save and Read Included in your hand-outs are: MDLC s s booklets and pamphlets on Accessing Services for Children with Developmental Disabilities and Accessing Mental Health Services under Medical Assistance/Medicaid and MCHP available at and- resources/publications/ Department of Health and Mental Hygiene brochures on Accessing Services under Medicaid for Children with Special Health Care Needs available at Show these materials to the DSS caseworker and the child s doctor or mental health professional.
54 Contact MDLC Please contact MDLC with any questions regarding children s s Medicaid services. MDLC is able to accept some cases and refers other cases to pro bono or private attorneys For new case referrals, ask for intake. For questions, e me at Our website is
Accessing Services for Children with Developmental Disabilities through Maryland Medical Assistance/Medicaid and MCHP A Guide from the Maryland Disability Law Center April 2012 2 Table of Contents What
Accessing Services for Children with Developmental Disabilities through Maryland Medical Assistance/Medicaid and MCHP A guide from the Maryland Disability Law Center September 2009 Edition Accessing Services
MEDICAL ASSISTANCE (MEDICAID) in MARYLAND Workshop for Parents and Providers A Partnership between The Parents Place of Maryland and Georgetown University Center for Child and Human Development 1 About
Early and Periodic Screening, Diagnosis, and Treatment Services (EPSDT) What is EPSDT? A Medicaid program for children up to the age of 21 with a preventive treatment approach Diagnosis or screening services
Maryland Medicaid Program: An Overview Stacey Davis Planning Administration Department of Health and Mental Hygiene May 22, 2007 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Colorado As of July 2003, 377,123 people were covered under Colorado s Medicaid and SCHIP programs. There were 330,499 enrolled in the
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland As of July 2003, 638,662 people were covered under Maryland's Medicaid/SCHIP programs. There were 525,080 enrolled in the Medicaid
NJ FamilyCare ABP BENEFIT Abortions & Related Services COVERAGE by Horizon NJ Health for spontaneous abortions/miscarriages. by Fee-for-Service for elective/induced abortions. Acupuncture Audiology (see
Primary Care Services Specialist Services Laboratory & X-ray Services Hospital Services Pharmacy Services (prescription drugs) Emergency Services Preventive, acute, and chronic health care Services generally
Accessing Mental Health Services for Children in Maryland through Medical Assistance/Medicaid and MCHP What is EPSDT and who is eligible? EPSDT stands for Early & Periodic Screening, Diagnosis & Treatment.
Service Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ Division of Developmental Disabilities (DDD) NJ FamilyCare B NJ FamilyCare C NJ FamilyCare D Abortions and related services (covered
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Kansas As of July 2003, 262,791 people were covered under Kansas's Medicaid and SCHIP programs. There were 233,481 enrolled in the Medicaid
Ryan White Program Services Definitions CORE SERVICES Service categories: a. Outpatient/Ambulatory medical care (health services) is the provision of professional diagnostic and therapeutic services rendered
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida As of July 2003 2,441,266 people were covered under Florida's Medicaid and SCHIP programs. There were 2,113,820 enrolled in the
Overview of the Maryland Primary Adult Care (PAC) Program Rhode Island Policy Makers Breakfast November 17, 2010 Stacey Davis Deputy Director of Planning Maryland Medicaid Program Maryland Medicaid Provides
The Federal Employees Health Benefits Program and Medicare This booklet answers questions about how the Federal Employees Health Benefits (FEHB) Program and Medicare work together to provide health benefits
STATE AGENCY WAIVER PROGRAMS: COMMUNITY LONG TERM CARE Jocelin Dawson, SCDHHS Lori Manos, SCDDSN Susan Bolt, SCDHHS Presentation is current as of November 26, 2013 UPDATES ON MEDICAID LONG TERM CARE PROGRAMS
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan documents at www.dbm.maryland.gov/benefits or by calling 410-767-4775
Rhode Island Medical Assistance Guide to Covered Services For Your Child with Special Needs Rhode Island Department of Human Services Table of Contents Page Frequently Asked Questions...3 Medical Assistance
The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). Eligibility for this program will be determined
Maryland s Autism Waiver: A Practical Guide for Families In July 2001, the Maryland State Department of Education (MSDE) started enrolling children into its ambitious new Autism Waiver. A limited number
J. PATRICK HACKNEY ALABAMA DISABILITIES ADVOCACY PROGRAM WHAT IS MEDICAID? Medicaid is a joint state/federal program that provides medical assistance for certain individuals and families with low income
Florida Medicaid and Implementation of SB 2654 Shachi Mankodi Counsel to the Chief of Staff Florida Agency for Health Care Administration Autism Compact Presentation September 18, 2008 Overview What is
MAWD or Marketplace? What Pennsylvanians with Disabilities Need to Know About Choosing Health Insurance Coverage Summary Choosing health insurance coverage that best meets one s needs is important, especially
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Utah As of July 2003, 196,600 people were covered under Utah s Medicaid/SCHIP programs. There were 157,322 enrolled in the Medicaid program,
Schedule of s HARVARD PILGRIM LAHEY HEALTH VALUE HMO MASSACHUSETTS ID: MD0000003378_ X Please Note: In this plan, Members have access to network benefits only from the providers in the Harvard Pilgrim-Lahey
Harvard Pilgrim Health Care, Inc. The Harvard Pilgrim Best Buy Tiered Copayment ChoiceNet HMO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Massachusetts Coverage Period: 7/1/2013
Maryland Children s Health Program MCHP Premium Overview In Maryland, the option to purchase coverage for children is part of the approved expansion of the Maryland Children s Health Program (MCHP) effective
Resources and Services Directory for Head Injury and Other Conditions Section 2: Accessing and Paying for TBI and Related Services 1000 NE 10 TH ST. OKC, OK 73117 TEL 405.271-3430 OR 800.522.0204 (OK only)
Habilitative Services Senate Bill 701 Who? The IFSP or IEP team must present the information to the family. When? Transition from ITP to preschool special education Initial IEP At least annually Upon the
ASSISTIVE TECHNOLOGY: HOW TO PAY FOR THE DEVICE OR SERVICE THAT YOU NEED COMMUNICATION HEARING MOBILITY LEARNING VISION Prepared by: Disability Rights Network of Pennsylvania www.drnpa.org 1414 N. Cameron
Health Insurance Coverage for Autism: Diagnosis and Treatments Karen Fessel, Dr P.H., For more information visit please visit: www.autismhealthinsurance.org ww.asdhealth.com Feda Almaliti, Overview & Topics
HMO-1 Primary Care Physician Visits Office Hours After-Hours/Home Specialty Care Office Visits Diagnostic OP Lab/X Ray Testing (at facility) with PCP referral. Diagnostic OP Lab/X Ray Testing (at specialist)
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Oregon As of July 2003, 398,874 people were covered under Oregon s Medicaid/SCHIP programs. There were 380,546 enrolled in the Medicaid
CHAPTER 5 SERVICE DESCRIPTIONS Inpatient Hospital Psychiatric Services Service Coverage Inpatient psychiatric care involves skilled psychiatric services in a hospital setting. The care delivered includes
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) EPSDT is a special health care program for children and youth. It makes sure they get the right preventive, dental, behavioral health, developmental
ASSISTIVE TECHNOLOGY FOR PERSONS WITH DISABILITIES: AN OVERVIEW Figure 1: Man in manual wheelchair going up ramp to building. Prepared by: Disability Rights Network of Pennsylvania www.drnpa.org 1414 N.
California s Protection & Advocacy System Toll-Free (800) 776-5746 Getting Medi-Cal Outpatient Specialty Mental Health Services August 2010, Pub #5084.01 I was told that I need Medi-Cal specialty mental
Glossary of Health Coverage and Medical Terms This glossary defines many commonly used terms, but isn t a full list. These glossary terms and definitions are intended to be educational and may be different
Important Benefi ts for Medicaid Eligible Children: EPSDT EARLY & PERIODIC SCREENING DIAGNOSIS & TREATMENT Ohio Legal Rights Service On October 26, 2005, Ohio Legal Rights Service (OLRS) fi led a lawsuit
MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT RESOURCE GUIDE May 2014 THE UNIVERSITY OF MARYLAND CAREY SCHOOL OF LAW DRUG POLICY AND PUBLIC HEALTH STRATEGIES CLINIC 2 PARITY ACT RESOURCE GUIDE TABLE OF
10.09.79.00 Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 79 Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Authority: Health-General
Introduction to One Care MassHealth plus Medicare www.mass.gov/masshealth/onecare Overview of One Care Starting in fall 2013, MassHealth and Medicare will join together with health plans in Massachusetts
or after 9/7/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: PPO This is only a summary. If you want more detail about your coverage and
Benefits At A Glance Plan C HIGHLIGHTS OF WELFARE FUND BENEFITS WELFARE FUND BENEFITS IN BRIEF Medical and Hospital Benefits Empire BlueCross BlueShield Plan C-1 Empire BlueCross BlueShield Plan C-2 All
DEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW North Carolina General Assembly Fiscal Research Division February 2005 Overview Purpose of Medicaid Impact of Medicaid - On the State Economy
Preface Care at Home: A Handbook for Parents is a guide that is intended to help parents/guardians meet some of the challenges of caring for a physically disabled child at home. It includes information
Inpatient General Acute and Inpatient Rehabilitation Hospital Unlimited. Includes: Hospital-provided physician services Semi-private room and board (or private if medically necessary as certified by attending)
UnitedHealthcare Life Ins Co: Platinum Copay Select Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family
Glossary of Health Coverage and Medical Terms This glossary defines many commonly used terms, but isn t a full list. These glossary terms and definitions are intended to be educational and may be different
Summary of Services and Cost Shares This summary does not describe benefits. For the description of a benefit, including any limitations or exclusions, please refer to the identical heading in the Benefits
RIGHTS UNDER THE LANTERMAN ACT Services And Supports For People With Dual Diagnosis Chapter 10 This chapter explains: Dual diagnosis Mental health services and supports Regional Center responsibilities
NC Health Choice Publication date: September 1999 OVERVIEW What is it? NC Health Choice is a free or reduced cost health insurance program for uninsured children birth through age 18. Who is it for? Children
CHAPTER 13 NC HEALTH CHOICE FOR CHILDREN What is it? Who is it for? NC Health Choice is a free or reduced-cost health insurance program for uninsured children from birth through age 18. NC Health Choice
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Connecticut As of July 2003, 378,961 people were covered under Connecticut Medicaid/SCHIP programs. There were 364,692 enrolled in the
You may receive covered services that are performed, prescribed or directed by a participating provider. As an Enrollee, you must receive your healthcare services from a participating PCP or medical provider.
New York State Benchmark Plan Recommendations Introduction The Patient Protection and Affordable Care Act (ACA) includes Rehabilitative and Habilitative Services and Devices as one of the ten categories
Maryland Medicaid s Partnership in Improving Behavioral Health Services Susan Tucker Executive Director, Office of Health Services May 14, 2014 Began in 1966 Maryland Medicaid By FY 14, we provided full
Aetna Life Insurance Company Hartford, Connecticut 06156 Extraterritorial Certificate Rider (GR-9N-CR1) Policyholder: Choctaw Enterprises Group Policy No.: GP-819977 Rider: Kentucky ET Medical (OAMC) Issue
5.5 Mobile Treatment Services (MTS)/Assertive Community Treatment (ACT) Service Coverage Mobile Treatment Services are community-based, intensive, outpatient services rendered by providers approved under
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.pekininsurance.com or by calling 1-800-322-0160. Important
THE CELTIC HEALTH PLAN Celtic makes health insurance easy and worry free. CELTIC MAKES IT EASY For information at your fingertips, go to www.celtic-net.com: Check billing information Look for pharmacies
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions
: MyPriority POS RxPlus Silver 1800 Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Subscriber/Dependent Plan Type:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/cuhealthplan or by calling 1-800-735-6072.
Cal MediConnect Plan Guidebook Medicare and Medi-Cal RG_0004006_ENG_0214 Cal MediConnect Plans RIVERSIDE & SAN BERNARDINO COUNTIES IEHP Dual Choice 1-877-273-IEHP (4347) (TTY: 1-800-718-4347) www.iehp.org
: VIVA HEALTH Access Plan Coverage Period: 01/01/2015 12/31/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document
Hospitalization Medical Expenses Blood Hospice 2013 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010 These charts show
Frequently Asked Questions and Answers: Managed Care Organizations and HCS/TxHmL Program Providers Pharmacy/Medication Related Questions: 1) Question: After the initial transition pre-authorization period,
Members Handbook 2015 HELPFUL INFORMATION Maryland Physicians Care Office Hours Monday - Friday, 8 a.m. to 5 p.m. Member Services Center 1-800-953-8854 Maryland TDD Relay Service 1-800-735-2258 Superior
Covered services for NHP MassHealth members Neighborhood Health Plan Covered Services for MassHealth Standard & CommonHealth, Family Assistance, and CarePlus Issued and Effective May 1, 2014 nhp.org/member
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.pekininsurance.com or by calling 1-800-371-9622. Important
WHO IS COVERED Requires both Medicare A & B enrollment. Type of Coverage Offered Single only Single only MEDICAL NECESSITY Pre-Certification Requirement None None Medical Benefit Management Program Not
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.samhealth.org/healthplansor by calling 1-800-832-4580.
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 2.0 Eligible Recipients... 1 2.1 Provisions... 1 2.2 EPSDT Special Provision: Exception to Policy Limitations for Recipients
Medical Day Care Report on Medical Eligibility Determinations At the request of the Maryland General Assembly s budget committees, the Department of Health and Mental Hygiene is reporting on the medical
GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN OUTLINE OF MEDICARE SELECT POLICY 2015 MEDICARE SELECT POLICY The Wisconsin Insurance Commissioner has set standards for Select insurance. This policy
CONNECTICUT MEDICAID Summary of Services Medical Care Administration Department of Social Services TABLE OF CONTENTS 1. Overview 3 2. Ambulatory Surgery 4 3. Dental Services 4 4. Dialysis Services 5 5.
Massachusetts Harvard Pilgrim Health Care, Inc. The Harvard Pilgrim Best Buy Tiered Copayment ChoiceNet HMO-WSHG Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period:
FUND FEATURES HealthFund Amount $500 Individual $1,000 Employee + 1 Dependent $1,000 Employee + 2 Dependents $1,000 Family Amount contributed to the Fund by the employer Fund Coinsurance 100% Percentage
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsvt.com/standard-cdhp-cert or by calling (800) 255-4550.
Medicare Benefit Review What is Medicare? Medicare is Health Insurance For people 65 or older For people under 65 with certain disabilities For people at any age with End-Stage Renal Disease (permanent
BlueCross BlueShield of North Carolina: Blue Advantage Platinum 500 (broad network) $$start$$ Coverage Period: 01/01/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.ibx.com or by calling 1-800-ASK-BLUE. Important Questions