BENEFIT PACKAGE FOR NJ FAMILYCARE D ENROLLEES Sample Clauses

BENEFIT PACKAGE FOR NJ FAMILYCARE D ENROLLEES. A. Services Included in the Contractor's Benefits Package for NJ FamilyCare D enrollees. The following services shall be provided and case managed by the Contractor:
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BENEFIT PACKAGE FOR NJ FAMILYCARE D ENROLLEES. A. Services Included in the Contractor's Benefits Package for NJ FamilyCare D enrollees. The following services shall be provided and case managed by the Contractor: 1. Primary Care a. All physicians services, primary and specialty b. In accordance with state certification/licensure requirements, standards, and practices, primary care providers shall also include access to certified nurse midwives, certified nurse practitioners, clinical nurse specialists, and physician assistants c. Services rendered at independent clinics that provide ambulatory services d. Federally Qualified Health Center primary care services 2. Emergency room services 3. Family Planning Services, including medical history and physical examinations (including pelvic and breast), diagnostic and laboratory tests, drugs and biologicals, medical supplies and devices, counseling, continuing medical supervision, continuity of care and genetic counseling Services provided primarily for the diagnosis and treatment of infertility, including sterilization reversals, and related office (medical and clinic) visits, drugs, laboratory services, radiological and diagnostic services and surgical procedures are not covered by the NJ FamilyCare program. Obtaining family planning services from providers outside the Contractor’s provider network is not available to NJ FamilyCare D enrollees. 4. Home Health Care Services -- Limited to skilled nursing which is provided or supervised by a registered nurse, and home health aide when the purpose of the treatment is skilled care; and medical social services which are necessary for the treatment of the beneficiary's medical condition 5. Hospice Services. Hospice care must cover both palliative and curative care. 6. Inpatient Hospital Services, including general hospitals, special hospitals, and rehabilitation hospitals. The Contractor shall not be responsible when the primary admitting diagnosis is mental health or substance abuse related. 7. Outpatient Hospital Services, including outpatient surgery but excluding mental health visits. 8. Laboratory Services -- All laboratory testing sites providing services under this contract must have either a Clinical Laboratory Improvement Act (CLIA) certificate of waiver or a certificate of registration along with a CLIA identification number. Those providers with certificates of waiver shall provide only the types of tests permitted under the terms of their waiver. Laboratories with certificates of registration may perfo...
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