Common use of CONTRACTOR Physical Health Benefits Chart Clause in Contracts

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.

CONTRACTOR Physical Health Benefits Chart. SERVICE BENEFIT LIMIT Inpatient Hospital Services 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. facility.‌‌ Outpatient Hospital Services Services‌ As medically necessary. Physician Inpatient Services Services‌‌‌ As medically necessary. Physician Outpatient Services/Community Health Clinic Clinic‌ Services/Other Clinic Services As medically necessary. SERVICE BENEFIT LIMIT TENNderCare Services 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.

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.