Covered Items and Services. 2.4.1 Covered Items and Services must be available to all Participants twenty-four (24) hours a day, seven (7) days a week. All services must be provided, in accordance with the IDT policy.
Covered Items and Services. The set of items and services required to be offered by the FIDA Plans, as defined in Appendix A.
Covered Items and Services. 2.4.1. Covered Items and Services must be available to all Participants twenty-four
Covered Items and Services. Medical Necessity. The FIDA Plan shall provide services to Participants as follows: The FIDA Plan shall authorize, arrange, coordinate, and provide to Participants all Medically Necessary Covered Items and Services as specified in Section 2.4, in accordance with the requirements of the Contract and the IDT Policy. The FIDA Plan must provide all Covered Items and Services that are Medically Necessary, including but not limited to, those Covered Items and Services that: Prevent, diagnose, correct, or cure conditions in the Participant that cause acute suffering, endanger life, result in illness or infirmity, interfere with such Participant's capacity for normal activity, or threaten some significant handicap. Notwithstanding this definition, the FIDA Plan will provide coverage in accordance with the more favorable of the current Medicare and NYSDOH coverage rules, as outlined in NYSDOH and Federal rules and coverage guidelines. All care must be provided in accordance and compliance with the ADA, as specified by the Xxxxxxxx decision. The FIDA Plan must cover all Items and Services outlined in the Contract and in the State and Federal guidance, including any guidance that may be issued during the Demonstration and may not impose more stringent coverage rules or Medical Necessity criteria for any Covered Items or Services. The FIDA Plan and IDT shall not arbitrarily deny or reduce the amount, duration, or scope of a required Covered Item or Service solely because of diagnosis, type of illness, or condition of the Participant. The FIDA Plan and IDT shall not deny authorization for a Covered Item or Service that the Participant or the Provider demonstrates is Medically Necessary. The FIDA Plan or the IDT may place appropriate limits on a Covered Item or Service, as relates to a given Participant. Any limits must be made on the basis of Medical Necessity, or for the purpose of Utilization Management, provided that the furnished services can reasonably be expected to achieve their purpose. The FIDA Plan’s Medical Necessity guidelines must, at a minimum, be: Developed with input from practicing Physicians in the Demonstration Plan’s Service Area; Developed in accordance with standards adopted by national accreditation organizations; Developed in accordance with the definition of Medical Necessity in this Appendix; Updated at least annually or as new treatments, applications and technologies are adopted as generally accepted professional medical practice; Evidence-b...
Covered Items and Services. Payment by the Medicare Program currently includes payment for nursing services, certain therapies, use of a bed and the room in which the bed is located, linens, bedding, diapers and other incontinence supplies, routine laundry service, regular meals and snacks, certain equipment, social services, activities, and routine personal hygiene items which are required to meet your needs. Certain items and services are not covered in the Medicare daily rate. Extra charges for those non-covered items and services are set forth in Appendix A to this Admission Agreement. Certain other items and services are not included in our daily Medicaid rate (such as certain therapies, pharmacy services and dental services) but are covered by Medicaid and are billed directly to Medicaid by the provider. Future change in federal law may change the items and services which are included in payment by the Medicare Program to us.
