Common use of Autism Spectrum Disorder Clause in Contracts

Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of age in accordance with state mandated benefits as follows: • Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Child or well-baby screening and/or • Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. This benefit has one or more exclusions as specified in the Exclusions Section. Home Health Care Services are Health Care Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. Home Health Care Services shall include Medically Necessary skilled intermittent Health Care Services provided by a registered nurse or a licensed practical nurse; physical, occupational, and/or respiratory therapist and/or speech pathologist. Intermittent Home Health aide services are only Covered when part of an approved plan of care which includes skilled services. Such services may include collection of specimens to be submitted to an approved laboratory facility for analysis. Medical equipment, Prescription Drugs and Medications, laboratory services and supplies deemed Medically Necessary by a Practitioner/Provider for the provision of health services in the home, except Durable Medical Equipment, will be Covered. The following Home Health Care Services will be Covered when we approve a Prior Authorization request: • Home health care or home intravenous services as an alternative to Hospitalization, as determined by your Practitioner/Provider • Total parenteral and enteral nutrition as the sole source of nutrition • Medical Drugs: (Medications obtained through the medical benefit): A Medical Drug is any drug administered by a Health Care Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. o For a complete list of Medical Drugs to determine which require Prior Authorization and what drugs are mandated to our In-network Specialty network, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/%40phs/%40php/documents/phsconten t/pel_00052739.pdf. o You may call our Presbyterian Customer Service Center for more information at (000) 000-0000 or 0-000-000-0000, Monday through Friday, from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. This benefit has one or more exclusions as specified in the Exclusions Section.

Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of age in accordance with state mandated benefits as follows: • Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Child or well-baby screening and/or • Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. Limitation – Services received under the federal Individuals with Disabilities Education Improvement Act of 2004 and related state laws that place responsibility on state and local school boards for providing specialized education and related services to children 3 to 22 years of age who have Autism Spectrum Disorder are not Covered under this Plan. This benefit has one or more exclusions as specified in the Exclusions Section. Home Health Care Services are Health Care Healthcare Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. Home Health Care Services shall include Medically Necessary skilled intermittent Health Care Healthcare Services provided by a registered nurse or a licensed practical nurse; physical, occupational, and/or respiratory therapist and/or speech pathologist. Intermittent Home Health aide services are only Covered when part of an approved plan of care which includes skilled services. Such services may include collection of specimens to be submitted to an approved laboratory facility for analysis. Medical equipment, Prescription Drugs and Medications, laboratory services and supplies deemed Medically Necessary by a Practitioner/Provider for the provision of health services in the home, except Durable Medical Equipment, will be Covered. The following Home Health Care Services will be Covered when we approve a Prior Authorization request: • Home health care healthcare or home intravenous services as an alternative to Hospitalization, as determined by your Practitioner/Provider • Total parenteral and enteral nutrition as the sole source of nutrition • Medical Drugs: (Medications obtained through the medical benefit): A Medical Drug is any drug administered by a Health Care Healthcare Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. network.‌ o For a complete list of Medical Drugs to determine which require Prior Authorization and what drugs are mandated to our In-network Specialty network, please see the Presbyterian Pharmacy website at xxxxx://xxx.xxx.xxx/tools-resources/member/Pages/pharmacy.aspx or the drug list at xxxx://xxxx.xxx.xxx/idc/groups/public/%40phs/%40php/documents/phsconten t/pel_00052739.pdf. o You may call our Presbyterian Customer Service Center for more information at (000) 000-0000 or 0-000-000-0000, 0000 Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. This benefit has one or more exclusions as specified in the Exclusions Section.

Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of age in accordance with state mandated benefits as follows: • Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Child or well-baby screening and/or • Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. This benefit has one or more exclusions as specified in the Exclusions Section. Home Health Care Services are Health Care Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. Home Health Care Services shall include Medically Necessary skilled intermittent Health Care Services provided by a registered nurse or a licensed practical nurse; physical, occupational, and/or respiratory therapist and/or speech pathologist. Intermittent Home Health aide services are only Covered when part of an approved plan of care which includes skilled services. Such services may include collection of specimens to be submitted to an approved laboratory facility for analysis. Medical equipment, Prescription Drugs and Medications, laboratory services and supplies deemed Medically Necessary by a Practitioner/Provider for the provision of health services in the home, except Durable Medical Equipment, will be Covered. The following Home Health Care Services will be Covered when we approve a Prior Authorization request: • Home health care healthcare or home intravenous services as an alternative to Hospitalization, as determined by your Practitioner/Provider • Total parenteral and enteral nutrition as the sole source of nutrition • Medical Drugs: (Medications obtained through the medical benefit): A Medical Drug is any drug administered by a Health Care Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. network.‌ o For a complete list of Medical Drugs to determine which require Prior Authorization and what drugs are mandated to our In-network Specialty network, please see the Presbyterian Pharmacy website at xxxxx://xxx.xxx.xxx/tools-resources/member/Pages/pharmacy.aspx or the drug list at xxxx://xxxx.xxx.xxx/idc/groups/public/%40phs/%40php/documents/phsconten t/pel_00052739.pdf. o You may call our Presbyterian Customer Service Center for more information at (000) 000-0000 or 0-000-000-0000, 0000 Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. This benefit has one or more exclusions as specified in the Exclusions Section. Inpatient means you have been admitted by a healthcare Practitioner/Provider to a Hospital for the purposes of receiving Hospital services. Eligible Inpatient Hospital services are acute care services provided when you are a registered bed patient and there is a room and board charge. Admissions are considered Inpatient based on Medical Necessity, regardless of the length of time spent in the Hospital. Hospital admissions (Inpatient, non-emergent) require Prior Authorization. Inpatient Hospital benefits also include Acute medical detoxification. Hyperbaric Oxygen Therapy is a covered benefit only if the therapy is proposed for a condition recognized as one of the accepted indications as defined by the Hyperbaric Oxygen Therapy Committee of The Undersea and Hyperbaric Medical Society (UHMS). Hyperbaric Oxygen Therapy is Excluded for any other condition. Hyperbaric Oxygen Therapy requires Prior Authorization when provided by an In- network Practitioner/Provider in order to be Covered. This benefit has one or more exclusions as specified in the Exclusions Section. Diagnosis and medically indicated treatments for physical conditions causing infertility.

Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of for children, from birth to age nineteen (19) or up to age twenty-two (22) if enrolled in high school, in accordance with state mandated benefits as follows: • o Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Well-Child or well-baby screening and/or • o Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Habilitative Services for Autism Spectrum Disorder may require Prior Authorization and your Practitioner/Provider’s approved plan of care. The Health Services Department will review the treatment plans in accordance with state mandated benefits. Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. This benefit has one or more exclusions as specified in the Exclusions Section. Home Health Care Services are Health Care Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. • Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. • Home Health Care Services shall include Medically Necessary skilled intermittent Health Care Services provided by a registered nurse or a licensed practical nurse; physical, occupational, and/or respiratory therapist and/or speech pathologist. Intermittent Home Health aide services are only Covered when part of an approved plan of care which includes skilled services. • Such services may include collection of specimens to be submitted to an approved laboratory facility for analysis. • Medical equipment, Prescription Drugs and Medications, laboratory services and supplies deemed Medically Necessary by a Practitioner/Provider for the provision of health services in the home, except Durable Medical Equipment, will be Covered. • The following Home Health Care Services will be Covered when we approve a Prior Authorization request: • o Home health care or home intravenous services as an alternative to Hospitalization, as determined by your Practitioner/Provider • o Total parenteral and enteral nutrition as the sole source of nutrition • o Medical Drugs: (Medications obtained through the medical benefit): A Medical Drug is any drug administered by a Health Care Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. o For a complete list of Medical Drugs to determine which require Prior Authorization and what drugs are mandated to our In-network Specialty network, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/%40phs/%40php/documents/phsconten t/pel_00052739.pdfxxx.xxx.xxx. o You may call our Presbyterian Customer Service Center for more information at (000) 000-0000 or toll-free 0-000-000-0000, 0000 Monday through Friday, Friday from 7 7:00 a.m. to 6 6:00 p.m. Hearing impaired users may call our TTY number at 711. This benefit has one or more exclusions as specified in the Exclusions Section.➢ Hospital Services - Inpatient

Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of age in accordance with state mandated benefits as follows: • Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Child or well-baby screening and/or • Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. This benefit has one or more exclusions as specified in the Exclusions Section. Home Health Care Services are Health Care Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. Home Health Care Services shall include Medically Necessary skilled intermittent Health Care Services provided by a registered nurse or a licensed practical nurse; physical, occupational, and/or respiratory therapist and/or speech pathologist. Intermittent Home Health aide services are only Covered when part of an approved plan of care which includes skilled services. Such services may include collection of specimens to be submitted to an approved laboratory facility for analysis. Medical equipment, Prescription Drugs and Medications, laboratory services and supplies deemed Medically Necessary by a Practitioner/Provider for the provision of health services in the home, except Durable Medical Equipment, will be Covered. The following Home Health Care Services will be Covered when we approve a Prior Authorization request: • Home health care or home intravenous services as an alternative to Hospitalization, as determined by your Practitioner/Provider • Total parenteral and enteral nutrition as the sole source of nutrition • Medical Drugs: (Medications obtained through the medical benefit): A Medical Drug is any drug administered by a Health Care Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. o For a complete list of Medical Drugs to determine which require Prior Authorization and what drugs are mandated to our In-network Specialty network, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/%40phs/%40php/documents/phsconten t/pel_00052739.pdf. o You may call our Presbyterian Customer Service Center for more information at (000) 000-0000 or 0-000-000-0000, 0000 Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call our TTY 711. This benefit has one or more exclusions as specified in the Exclusions Section.

Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of age in agein accordance with state mandated benefits as follows: • Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Child or well-baby screening and/or • Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. This benefit has one or more exclusions as specified in the Exclusions Section. Home Health Care Services are Health Care Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. Home Health Care Services shall include Medically Necessary skilled intermittent Health Care Services provided by a registered nurse or a licensed practical nurse; physical, occupational, and/or respiratory therapist and/or speech pathologist. Intermittent Home Health aide services are only Covered when part of an approved plan of care which includes skilled services. Such services may include collection of specimens to be submitted to an approved laboratory facility for analysis. Medical equipment, Prescription Drugs and Medications, laboratory services and supplies deemed Medically Necessary by a Practitioner/Provider for the provision of health services in the home, except Durable Medical Equipment, will be Covered. The following Home Health Care Services will be Covered when we approve a Prior Authorization request: • Home health care or home intravenous services as an alternative to Hospitalization, as determined by your Practitioner/Provider • Total parenteral and enteral nutrition as the sole source of nutrition • Medical Drugs: (Medications obtained through the medical benefit): A Medical Drug is any drug administered by a Health Care Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. o For a complete list of Medical Drugs to determine which require Prior Authorization and what drugs are mandated to our In-network Specialty network, please see the Presbyterian Pharmacy website at xxxxx://xxx.xxx.xxx/tools-resources/member/Pages/pharmacy.aspx or the drug list at xxxx://xxxx.xxx.xxx/idc/groups/public/%40phs/%40php/documents/phsconten t/pel_00052739.pdf. o You may call our Presbyterian Customer Service Center for more information at (000) 000-0000 or 0-000-000-0000, 0000 Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call our TTY 711. This benefit has one or more exclusions as specified in the Exclusions Section. Inpatient means you have been admitted by a health care Practitioner/Provider to a Hospital for the purposes of receiving Hospital services. Eligible Inpatient Hospital services are acute care services provided when you are a registered bed patient and there is a room and board charge. Admissions are considered Inpatient based on Medical Necessity, regardless of the length of time spent in the Hospital. Hospital admissions (Inpatient, non-emergent) require Prior Authorization. Inpatient Hospital benefits also include Acute medical detoxification. Hyperbaric Oxygen Therapy is a covered benefit only if the therapy is proposed for a condition recognized as one of the accepted indications as defined by the Hyperbaric Oxygen Therapy Committee of The Undersea and Hyperbaric Medical Society (UHMS). Hyperbaric Oxygen Therapy is Excluded for any other condition. Hyperbaric Oxygen Therapy requires Prior Authorization when provided by an In- network Practitioner/Provider in order to be Covered.

Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of age in accordance with state mandated benefits as follows: • Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Child or well-baby screening and/or • Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. This benefit has one or more exclusions as specified in the Exclusions Section. Home Health Care Services are Health Care Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. Home Health Care Services shall include Medically Necessary skilled intermittent Health Care Services provided by a registered nurse or a licensed practical nurse; physical, occupational, and/or respiratory therapist and/or speech pathologist. Intermittent Home Health aide services are only Covered when part of an approved plan of care which includes skilled services. Such services may include collection of specimens to be submitted to an approved laboratory facility for analysis. Medical equipment, Prescription Drugs and Medications, laboratory services and supplies deemed Medically Necessary by a Practitioner/Provider for the provision of health services in the home, except Durable Medical Equipment, will be Covered. The following Home Health Care Services will be Covered when we approve a Prior Authorization request: • Home health care or home intravenous services as an alternative to Hospitalization, as determined by your Practitioner/Provider • Total parenteral and enteral nutrition as the sole source of nutrition • Medical Drugs: (Medications obtained through the medical benefit): A Medical Drug is any drug administered by a Health Care Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. o For a complete list of Medical Drugs to determine which require Prior Authorization and what drugs are mandated to our In-network Specialty network, please see the Presbyterian Pharmacy website at xxxxx://xxx.xxx.xxx/tools-resources/member/Pages/pharmacy.aspx or the drug list at xxxx://xxxx.xxx.xxx/idc/groups/public/%40phs/%40php/documents/phsconten t/pel_00052739.pdf. o You may call our Presbyterian Customer Service Center for more information at (000) 000-0000 or 0-000-000-0000, 0000 Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call our TTY 711. This benefit has one or more exclusions as specified in the Exclusions Section. Inpatient means you have been admitted by a health care Practitioner/Provider to a Hospital for the purposes of receiving Hospital services. Eligible Inpatient Hospital services are acute care services provided when you are a registered bed patient and there is a room and board charge. Admissions are considered Inpatient based on Medical Necessity, regardless of the length of time spent in the Hospital. Hospital admissions (Inpatient, non-emergent) require Prior Authorization. Inpatient Hospital benefits also include Acute medical detoxification. Hyperbaric Oxygen Therapy is a covered benefit only if the therapy is proposed for a condition recognized as one of the accepted indications as defined by the Hyperbaric Oxygen Therapy Committee of The Undersea and Hyperbaric Medical Society (UHMS). Hyperbaric Oxygen Therapy is Excluded for any other condition. Hyperbaric Oxygen Therapy requires Prior Authorization when provided by an In- network Practitioner/Provider in order to be Covered.

Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of age in accordance with state mandated benefits as follows: • Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Child or well-baby screening and/or • Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. This benefit has one or more exclusions as specified in the Exclusions Section. Home Health Care Services are Health Care Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. Home Health Care Services shall include Medically Necessary skilled intermittent Health Care Services provided by a registered nurse or a licensed practical nurse; physical, occupational, and/or respiratory therapist and/or speech pathologist. Intermittent Home Health aide services are only Covered when part of an approved plan of care which includes skilled services. Such services may include collection of specimens to be submitted to an approved laboratory facility for analysis. Medical equipment, Prescription Drugs and Medications, laboratory services and supplies deemed Medically Necessary by a Practitioner/Provider for the provision of health services in the home, except Durable Medical Equipment, will be Covered. The following Home Health Care Services will be Covered when we approve a Prior Authorization request: • Home health care or home intravenous services as an alternative to Hospitalization, as determined by your Practitioner/Provider • Total parenteral and enteral nutrition as the sole source of nutrition • Medical Drugs: (Medications obtained through the medical benefit): A Medical Drug is any drug administered by a Health Care Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. o For a complete list of Medical Drugs to determine which require Prior Authorization and what drugs are mandated to our In-network Specialty network, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/%40phs/%40php/documents/phsconten t/pel_00052739.pdf. pel_00052739.pdf.‌‌ o You may call our Presbyterian Customer Service Center for more information at (000) 000-0000 or 0-000-000-0000, Monday through Friday, from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. This benefit has one or more exclusions as specified in the Exclusions Section.

Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of age in accordance with state mandated benefits as follows: • Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Child or well-baby screening and/or • Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. This benefit has one or more exclusions as specified in the Exclusions Section. Home Health Care Services are Health Care Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. Home Health Care Services shall include Medically Necessary skilled intermittent Health Care Services provided by a registered nurse or a licensed practical nurse; physical, occupational, and/or respiratory therapist and/or speech pathologist. Intermittent Home Health aide services are only Covered when part of an approved plan of care which includes skilled services. Such services may include collection of specimens to be submitted to an approved laboratory facility for analysis. Medical equipment, Prescription Drugs and Medications, laboratory services and supplies deemed Medically Necessary by a Practitioner/Provider for the provision of health services in the home, except Durable Medical Equipment, will be Covered. The following Home Health Care Services will be Covered when we approve a Prior Authorization request: • Home health care or home intravenous services as an alternative to Hospitalization, as determined by your Practitioner/Provider • Total parenteral and enteral nutrition as the sole source of nutrition • Medical Drugs: (Medications obtained through the medical benefit): A Medical Drug is any drug administered by a Health Care Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. network.‌ o For a complete list of Medical Drugs to determine which require Prior Authorization and what drugs are mandated to our In-network Specialty network, please see the Presbyterian Pharmacy website at xxxx://xxxx.xxx.xxx/idc/groups/public/%40phs/%40php/documents/phsconten t/pel_00052739.pdf. o You may call our Presbyterian Customer Service Center for more information at (000) 000-0000 or 0-000-000-0000, 0000 Monday through Friday, Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. This benefit has one or more exclusions as specified in the Exclusions Section.