CONTRACTOR Physical Health Benefits Chart Sample Clauses

CONTRACTOR Physical Health Benefits Chart. SERVICE BENEFIT LIMIT Inpatient Hospital Services Medicaid/Standard Eligible, Age 21 and older: As medically necessary. Inpatient rehabilitation hospital facility services are not covered for adults unless determined by the CONTRACTOR to be a cost effective alternative (see Section A.2.6.5). Medicaid/Standard Eligible, Under age 21: As medically necessary, including rehabilitation hospital facility. Outpatient Hospital Services As medically necessary. Physician Inpatient Services As medically necessary. Physician Outpatient Services/Community Health Clinic Services/Other Clinic Services As medically necessary. TennCare Kids Services Medicaid/Standard Eligible, Age 21 and older: Not covered. Medicaid/Standard Eligible, Under age 21: Covered as medically necessary, except that the screenings do not have to be medically necessary. Children may also receive screenings in-between regular checkups if a parent or caregiver believes there is a problem. Screening, interperiodic screening, diagnostic and follow-up treatment services as medically necessary in accordance with federal and state requirements. See Section A.2.7.6. Preventive Care Services As described in Section A.2.7.5. Lab and X-ray Services As medically necessary. Hospice Care As medically necessary. Shall be provided by a Medicare-certified hospice. SERVICE BENEFIT LIMIT Dental Services Dental Services shall be provided by the Dental Benefits Manager or in some cases, through an HCBS waiver program for persons with intellectual disabilities (i.e., mental retardation). However, the facility, medical and anesthesia services related to the dental service that are not provided by a dentist or in a dentist’s office shall be covered services provided by the CONTRACTOR when the dental service is covered by the DBM or though an HCBS waiver program for persons with intellectual disabilities (i.e., mental retardation). Vision Services Medicaid/Standard Eligible, Age 21 and older: Medical eye care, meaning evaluation and management of abnormal conditions, diseases, and disorders of the eye (not including evaluation and treatment of refractive state), shall be covered as medically necessary. Routine periodic assessment, evaluation, or screening of normal eyes and examinations for the purpose of prescribing fitting or changing eyeglass and/or contact lenses are not covered. One pair of cataract glasses or lenses is covered for adults following cataract surgery. Medicaid/Standard Eligible, Under age 21: Preventive...
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CONTRACTOR Physical Health Benefits Chart. SERVICE BENEFIT LIMIT Inpatient Hospital Services Medicaid/Standard Eligible, Age 21 and older: As medically necessary. Inpatient rehabilitation hospital facility services are not covered for adults unless determined by the CONTRACTOR to be a cost effective alternative (see Section 2.6.5). Medicaid/Standard Eligible, Under age 21: As medically necessary, including rehabilitation hospital facility. Outpatient Hospital Services As medically necessary. Physician Inpatient Services As medically necessary. Physician Outpatient Services/Community Health Clinic Services/Other Clinic Services As medically necessary. SERVICE BENEFIT LIMIT TENNderCare Services Medicaid/Standard Eligible, Age 21 and older: Not covered. Medicaid/Standard Eligible, Under age 21: Covered as medically necessary, except that the screenings do not have to be medically necessary. Children may also receive screenings in-between regular checkups if a parent or caregiver believes there is a problem. Screening, interperiodic screening, diagnostic and follow-up treatment services as medically necessary in accordance with federal and state requirements. See Section 2.7.6.
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Related to CONTRACTOR Physical Health Benefits Chart

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