Direct Access Services. The Contractor shall make Covered Services available and accessible to Members as specified in this Contract. The Contractor shall routinely evaluate Out-of- Network utilization and shall contact high volume providers to determine if they are qualified and interested in enrolling in the Contractor’s network. If so, the Contractor shall enroll the provider as soon as the necessary procedures have been completed. When a Member wishes to receive a direct access service or receives a direct access service from an Out-of-Network Provider, the Contractor shall contact the provider to determine if it is qualified and interested in enrolling in the network. If so, the Contractor shall enroll the provider as soon as the necessary enrollment procedures have been completed. The Contractor shall ensure direct access and may not restrict the choice of a qualified provider by a Member for the following services within the Contractor’s Network: A. Primary care vision services, including the fitting of eye-glasses, provided by ophthalmologists, optometrists and opticians; B. Primary care dental and oral surgery services and evaluations by orthodontists and prosthodontists; C. Voluntary family planning in accordance with federal and state laws and judicial opinion; D. Maternity care for Members under eighteen (18) years of age; E. Immunizations to Members under twenty-one (21) years of age; F. Sexually transmitted disease screening, evaluation and treatment; G. Tuberculosis screening, evaluation and treatment; H. Testing for Human Immunodeficiency Virus (HIV), HIV-related conditions, and other communicable diseases as defined by 902 KAR 2:020; I. Chiropractic services; J. For members with special health care needs determined through an assessment to need a course of treatment or regular care monitoring, allow members to directly access a specialist as appropriate for the Member’s condition and identified needs; and K. Women’s health specialists. The Contractor shall ensure direct access and may not restrict the Member’s access to services in accordance with 42 CFR 438 and applicable state statutes and regulations.
Appears in 2 contracts
Samples: Medicaid Managed Care Contract, Medicaid Managed Care Contract
Direct Access Services. The Contractor shall make Covered Services available and accessible to Members as specified in this Contract. The Contractor shall routinely evaluate Out-of- of-Network utilization and shall contact high volume providers to determine if they are qualified and interested in enrolling in the Contractor’s network. If so, the Contractor shall enroll the provider as soon as the necessary procedures have been completed. When a Member wishes to receive a direct access service or receives a direct access service from an Out-of-Network Provider, the Contractor shall contact the provider to determine if it is qualified and interested in enrolling in the network. If so, the Contractor shall enroll the provider as soon as the necessary enrollment procedures have been completed. The Contractor shall ensure direct access and may not restrict the choice of a qualified provider by a Member for the following services within the Contractor’s Network:
A. Primary care vision services, including the fitting of eye-glasses, provided by ophthalmologists, optometrists and opticians;
B. Primary care dental and oral surgery services and evaluations by orthodontists and prosthodontists;
C. Voluntary family planning in accordance with federal and state laws and judicial opinion;
D. Maternity care for Members under eighteen (18) years of age;
E. Immunizations to Members under twenty-one (21) years of age;
F. Sexually transmitted disease screening, evaluation and treatment;
G. Tuberculosis screening, evaluation and treatment;
H. Testing for Human Immunodeficiency Virus (HIV), HIV-related conditions, and other communicable diseases as defined by 902 KAR 2:020;
I. Chiropractic services;
J. For members with special health care needs determined through an assessment to need a course of treatment or regular care monitoring, allow members to directly access a specialist as appropriate for the Member’s condition and identified needs; and
K. J. Women’s health specialists. The Contractor shall ensure direct access and may not restrict the Member’s access to services in accordance with 42 CFR 438 and applicable state statutes and regulations.
Appears in 2 contracts
Samples: Medicaid Managed Care Contract, Medicaid Managed Care Contract
Direct Access Services. The Contractor shall make Covered Services available and accessible to Members as specified in this Contract. Appendix I. The Contractor shall routinely evaluate Out-of- of-Network utilization and shall contact high volume providers to determine if they are qualified and interested in enrolling in the Contractor’s network. If so, the Contractor shall enroll the provider as soon as the necessary procedures have been completed. When a Member wishes to receive a direct access service or receives a direct access service from an Out-of-Network Provider, the Contractor shall contact the provider to determine if it is qualified and interested in enrolling in the network. If so, the Contractor shall enroll the provider as soon as the necessary enrollment procedures have been completed. The Contractor shall ensure direct access and may not restrict the choice of a qualified provider by a Member for the following services within the Contractor’s Network:
A. Primary care vision services, including the fitting of eye-glasses, provided by ophthalmologists, optometrists and opticians;
B. Primary care dental and oral surgery services and evaluations by orthodontists and prosthodontists;
C. Voluntary family planning in accordance with federal and state laws and judicial opinion;
D. Maternity care for Members under eighteen (18) years of age;
E. Immunizations X. Xxxxxxxxxxxxx to Members under twenty-one (21) years of age;
F. Sexually transmitted disease screening, evaluation and treatment;
G. Tuberculosis screening, evaluation and treatment;
H. Testing for Human Immunodeficiency Virus (HIV), HIV-related conditions, and other communicable diseases as defined by 902 KAR 2:020;
I. Chiropractic services;
J. For members with special health care needs determined through an assessment to need a course of treatment or regular care monitoring, allow members to directly access a specialist as appropriate for the Member’s condition and identified needs; and
K. J. Women’s health specialists. The Contractor shall ensure direct access and may not restrict the Member’s access to services in accordance with 42 CFR 438 and applicable state statutes and regulations.
Appears in 1 contract
Samples: Managed Care Contract (Wellcare Health Plans, Inc.)
