Common use of Hospital Services — Ancillary Services Clause in Contracts

Hospital Services — Ancillary Services. a. The Health Plan shall provide Medically Necessary ancillary medical services at the Hospital without limitation. Ancillary Hospital services include, but are not limited to, radiology, pathology, neurology, neonatology, and anesthesiology. When the Health Plan or the Health Plan's authorized physician authorizes these services (either inpatient or outpatient), the Health Plan must reimburse the provider of the service at the Medicaid line item rate, unless the Health Plan and the Hospital have negotiated another reimbursement rate. Also, the Health Plan must reimburse non-network physicians for emergency ancillary services provided in a Hospital setting. b. If the Health Plan provides dental services as an optional service, the Health Plan shall have a procedure for the authorization of Medically Necessary dental care and associated ancillary services provided in licensed ambulatory surgical center settings if that care is provided under the direction of a dentist as described in the State plan.

Hospital Services — Ancillary Services. a. The Health Plan shall provide Medically Necessary ancillary medical services at the Hospital without limitation. Ancillary Hospital services include, but are not limited to, radiology, pathology, neurology, neonatology, and anesthesiology. When the Health Plan or the Health Plan's authorized physician authorizes these services (either inpatient or outpatient), the Health Plan must reimburse the provider of the service at the Medicaid line item rate, unless the Health Plan and the Hospital have negotiated another reimbursement rate. Also, the Health Plan must reimburse non-network physicians for emergency ancillary services provided in a Hospital hospital setting. b. If the Health Plan provides dental services as an optional service, the The Health Plan shall have a procedure for the authorization of Medically Necessary dental care and associated ancillary services provided in licensed ambulatory surgical center settings if that care is provided under the direction of a dentist as described in the State state plan.

Hospital Services — Ancillary Services. a. The Health Plan shall provide Medically Necessary ancillary medical services at the Hospital without limitation. Ancillary Hospital services include, but are not limited to, radiology, pathology, neurology, neonatology, and anesthesiology. When the Health Plan or the Health Plan's ’s authorized physician authorizes these services (either inpatient or outpatient), the Health Plan must reimburse the provider of the service at the Medicaid line item rate, unless the Health Plan and the Hospital have negotiated another reimbursement rate. Also, the Health Plan must reimburse non-network physicians for emergency ancillary services provided in a Hospital setting. b. If the Health Plan provides dental services as an optional service, the Health Plan shall have a procedure for the authorization of Medically Necessary dental care and associated ancillary services provided in licensed ambulatory surgical center settings if that care is provided under the direction of a dentist as described in the State plan.

Hospital Services — Ancillary Services. a. The Health Plan shall provide Medically Necessary medically necessary ancillary medical services at the Hospital hospital without limitation. Ancillary Hospital hospital services include, but are not limited to, radiology, pathology, neurology, neonatology, and anesthesiology. . (1) When the capitated Health Plan or the Health Plan's its authorized physician authorizes these services (either inpatient or outpatient), the Health Plan must shall reimburse the provider of the service at the Medicaid line item rate, unless the Health Plan and the Hospital hospital have negotiated another reimbursement rate. Also, the . (2) The Health Plan must reimburse shall authorize payment for non-network physicians for emergency ancillary services provided in a Hospital hospital setting. b. If the Health Plan provides covers dental services services, as an optional servicespecified in Attachment I, the Health Plan it shall have a procedure for the authorization of Medically Necessary medically necessary dental care and associated ancillary services provided in licensed ambulatory surgical center settings if that care is provided under the direction of a dentist as described in the State planPlan.