Common use of Health Services Limited by Prior Authorization Clause in Contracts

Health Services Limited by Prior Authorization. The following services are currently limited by Prior Authorization of the Department for Members. Other than the Prior Authorization of organ transplants, the Contractor may establish its own policies and procedures relating to Prior Authorization.  Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Special Services The Contractor is responsible for providing and coordinating Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT), and EPSDT Special Services, through the primary care provider (PCP), for any Member under the age of twenty-one (21) years. EPSDT Special Services must be covered by the Contractor and include any Medically Necessary health care, diagnostic, preventive, rehabilitative or therapeutic service that is Medically Necessary for a Member under the age of twenty-one (21) years to correct or ameliorate defects, physical and mental illness, or other conditions whether the needed service is covered by the Kentucky Medicaid State Plan in accordance with Section 1905 (a) of the Social Security Act.  Transplantation of Organs and Tissue (Must be in compliance with State Plan and 907 KAR 1:350.)  Other Prior Authorized Medicaid Services Other Medicaid services limited by Prior Authorization are identified in the individual program coverage areas in Section VI.

Health Services Limited by Prior Authorization. The following services are currently limited by Prior Authorization of the Department for Members. Other than the Prior Authorization of organ transplants, the Contractor may establish its own policies and procedures relating to Prior Authorization.  • Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Special Services The Contractor is responsible for providing and coordinating Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT), and EPSDT Special Services, through the primary care provider (PCP), for any Member under the age of twenty-one (21) years. EPSDT Special Services must be covered by the Contractor and include any Medically Necessary health care, diagnostic, preventive, rehabilitative or therapeutic service that is Medically Necessary for a Member under the age of twenty-one (21) years to correct or ameliorate defects, physical and mental illness, or other conditions whether the needed service is covered by the Kentucky Medicaid State Plan in accordance with Section 1905 (a) of the Social Security Act.  • Transplantation of Organs and Tissue (Must be in compliance with State Plan and 907 KAR 1:350.)  • Other Prior Authorized Medicaid Services Other Medicaid services limited by Prior Authorization are identified in the individual program coverage areas in Section VI.

Health Services Limited by Prior Authorization. The following services are currently limited by Prior Authorization of the Department for Members. Other than the Prior Authorization of organ transplants, the Contractor may establish its own policies and procedures relating to Prior Authorization.  • Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Special Services The Contractor is responsible for providing and coordinating Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT), and EPSDT Special Services, through the primary care provider (PCP), for any Member under the age of twenty-one (21) years. EPSDT Special Services must be covered by the Contractor and include any Medically Necessary health care, diagnostic, preventive, rehabilitative or therapeutic service that is Medically Necessary for a Member under the age of twenty-one (21) years to correct or ameliorate defects, physical and mental illness, or other conditions whether the needed service is covered by the Kentucky Medicaid State Plan in accordance with Section 1905 (a) of the Social Security Act.  • Transplantation of Organs and Tissue (Must be in compliance with State Plan and Currently found at 907 KAR 1:350.)  1:350 • Other Prior Authorized Medicaid Services Other Medicaid services limited by Prior Authorization are identified in the individual program coverage areas in Section VI.