CONTRACTOR Behavioral Health Benefits Chart. SERVICE BENEFIT LIMIT 24-hour Psychiatric Residential Treatment Medicaid/Standard Eligible, Age 21 and older: As medically necessary. Medicaid/Standard Eligible, Under age 21: Covered as medically necessary. Inpatient, Residential & Outpatient Substance Abuse Benefits1 Medicaid/Standard Eligible, Age 21 and older: Limited to ten (10) days detox, $30,000 in medically necessary lifetime benefits unless otherwise described in the 2008 Mental Health Parity Act as determined by TENNCARE. Medicaid/Standard Eligible, Under age 21: Covered as medically necessary.
CONTRACTOR Behavioral Health Benefits Chart. SERVICE BENEFIT LIMIT 24-hour Psychiatric Residential Treatment Medicaid/Standard Eligible, Age 21 and older: As medically necessary. Medicaid/Standard Eligible, Under age 21: Covered as medically necessary.
CONTRACTOR Behavioral Health Benefits Chart. SERVICE BENEFIT LIMIT
CONTRACTOR Behavioral Health Benefits Chart. SERVICE BENEFIT LIMIT 24-hour Psychiatric Residential Treatment Medicaid/Standard Eligible, Age 21 and older: As medically necessary. Medicaid/Standard Eligible, Under age 21: Covered as medically necessary.
2.6.1.4.1 The CMS Managed Care Rules specify that an MCO may cover, in addition to services covered under the state plan, any services necessary for compliance with the requirements for parity in mental health and substance use disorder benefits in 42 CFR part 438, subpart K. In accordance with this requirement, this Contract identifies the types and amount, duration and scope of services consistent with the analysis of parity compliance conducted by TENNCARE.
2.6.1.4.1.1 In accordance with 42 CFR 438.905(a), the CONTRACTOR must comply with 42 CFR Subpart K—Parity in Mental Health and Substance Use Disorder Benefits requirements for all enrollees of a MCO in states that cover both medical/surgical benefits and mental health or substance use disorder benefits under the state plan.
2.6.1.4.1.2 TENNCARE does not impose an annual dollar limit on any medical/surgical benefits or includes an aggregate lifetime or annual dollar limit that applies to medical/surgical benefits provided to enrollees through a contract with the state, therefore, the CONTRACTOR shall not impose an aggregate lifetime or annual dollar limit on mental health or substance use disorder benefits, in accordance with 42 CFR 438.905(b), 42 CFR 438.905(c), and 42 CFR 438.905(e).
2.6.1.4.1.3 In accordance with 42 CFR 438.910(b)(1), the CONTRACTOR shall not apply any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to enrollees (whether or not the benefits are furnished by the same managed care contractor).
2.6.1.4.1.4 In accordance with 42 CFR 438.910(b)(2) and as specified in the benefit charts of Section A.2.6.1.3
CONTRACTOR Behavioral Health Benefits Chart. SERVICE BENEFIT LIMIT Psychiatric Inpatient Hospital Services (including physician services) As medically necessary. Psychiatric- Rehabilitation Services As medically necessary. Behavioral Health Crisis Services As necessary. Lab and X-ray Services As medically necessary. Non-emergency Medical Transportation (including Non- Emergency Ambulance Transportation) Same as for physical health (see Section 2.6.1.3 above).
CONTRACTOR Behavioral Health Benefits Chart. SERVICE BENEFIT LIMIT SERVICE BENEFIT LIMIT 24-hour Psychiatric Residential Treatment Medicaid/Standard Eligible, Age 21 and older: As medically necessary. Medicaid/Standard Eligible, Under age 21: Covered as medically necessary. Inpatient, Residential & Outpatient Substance Abuse Benefits1 Medicaid/Standard Eligible, Age 21 and older: Limited to ten (10) days detox, $30,000 in medically necessary lifetime benefits. Medicaid/Standard Eligible, Under age 21: Covered as medically necessary. 1When medically appropriate, services in a licensed substance abuse residential treatment facility may be substituted for inpatient substance abuse services. Methadone clinic services are not covered for adults.
