Hospital Services — Outpatient a. Outpatient Hospital services consist of preventive, diagnostic, therapeutic or palliative care under the direction of a physician or dentist at a licensed acute care Hospital. Outpatient Hospital services include Medically Necessary emergency room services, dressings, splints, oxygen and physician ordered services and supplies for the clinical treatment of a specific diagnosis or treatment.
a. The Health Plan shall provide outpatient Hospital services and Emergency Services and Care as Medically Necessary and appropriate and without any specified dollar limitations.
b. The Health Plan shall have a procedure for the authorization of dental care and associated ancillary medical services provided in an outpatient Hospital setting if that care meets the following requirements:
(1) Is provided under the direction of a dentist at a licensed Hospital; and
(2) Is Medically Necessary; or
(3) The Health Plan shall pay for any Medically Necessary duration of stay in a noncontracted facility which results from a medical emergency, until such time as the Health Plan can safely transport the Enrollee to a participating facility.
Hospital Services — Outpatient. Outpatient hospital services consist of medically necessary preventive, diagnostic, therapeutic or palliative care under the direction of a physician or dentist at a licensed acute care hospital. Outpatient hospital services include medically necessary emergency room services, dressings, splints, oxygen and physician-ordered services and supplies for the clinical treatment of a specific diagnosis or treatment.
a. The Health Plan shall provide emergency services and care without any specified dollar limitations.
b. The Health Plan shall have a procedure for the authorization of dental care and associated ancillary medical services provided in an outpatient hospital setting if that care meets the following requirements:
(1) Is provided under the direction of a dentist at a licensed hospital; and
(2) Although not usually considered medically necessary, is considered medically necessary to the extent that the outpatient hospital services must be provided in a hospital due to the enrollee’s disability, behavioral health condition or abnormal behavior due to emotional instability or a developmental disability.
Hospital Services — Outpatient. Outpatient hospital services consist of preventive, diagnostic, therapeutic or palliative care under the direction of a physician or dentist at a licensed acute care Hospital. Outpatient hospital services include Medically Necessary emergency room services, dressings, splints, oxygen and physician ordered services and supplies for the clinical treatment of a specific diagnosis or treatment.
a. The Health Plan shall provide Emergency Services and Care as Medically Necessary.
b. The Health Plan shall have a procedure for the authorization of dental care and associated ancillary medical services provided in an outpatient hospital setting if that care meets the following requirements:
(1) Is provided under the direction of a dentist at a licensed Hospital; and
(2) Is Medically Necessary; or
(3) The Health Plan shall pay for any Medically Necessary duration of stay in a noncontracted facility which results from a medical emergency until such time as the Plan can safely transport the Enrollee to a Plan participating facility.
Hospital Services — Outpatient. Outpatient hospital services consist of medically necessary preventive, diagnostic, therapeutic or palliative care under the direction of a physician or dentist at a licensed WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract acute care hospital. Outpatient hospital services include medically necessary emergency room services, dressings, splints, oxygen and physician-ordered services and supplies for the clinical treatment of a specific diagnosis or treatment.
a. The Health Plan shall provide emergency services and care without any specified dollar limitations.
b. The Health Plan shall have a procedure for the authorization of dental care and associated ancillary medical services provided in an outpatient hospital setting if that care meets the following requirements:
(1) Is provided under the direction of a dentist at a licensed hospital; and
(2) Although not usually considered medically necessary, is considered medically necessary to the extent that the outpatient hospital services must be provided in a hospital due to the enrollee’s disability, behavioral health condition or abnormal behavior due to emotional instability or a developmental disability.
Hospital Services — Outpatient. Outpatient hospital services consist of medically necessary preventive, diagnostic, therapeutic or palliative care under the direction of a physician or dentist at a licensed HealthEase of Florida, Inc. Medicaid HMO Non-Reform Contract acute care hospital. Outpatient hospital services include medically necessary emergency room services, dressings, splints, oxygen and physician-ordered services and supplies for the clinical treatment of a specific diagnosis or treatment.
a. The Health Plan shall provide emergency services and care without any specified dollar limitations.
b. The Health Plan shall have a procedure for the authorization of dental care and associated ancillary medical services provided in an outpatient hospital setting if that care meets the following requirements:
(1) Is provided under the direction of a dentist at a licensed hospital; and
(2) Although not usually considered medically necessary, is considered medically necessary to the extent that the outpatient hospital services must be provided in a hospital due to the enrollee’s disability, behavioral health condition or abnormal behavior due to emotional instability or a developmental disability.
Hospital Services — Outpatient. Outpatient hospital services consist of preventive, diagnostic, therapeutic or palliative care under the direction of a physician or dentist at a licensed acute care Hospital. Outpatient hospital services include Medically Necessary emergency room services, dressings, splints, oxygen and physician ordered services and supplies for the clinical treatment of a specific diagnosis or treatment.
a. The PSN shall provide Emergency Services and Care as Medically Necessary.
b. The PSN shall have a procedure for the authorization of dental care and associated ancillary medical services provided in an outpatient hospital setting if that care meets the following requirements:
(1) Is provided under the direction of a dentist at a licensed Hospital; and
(2) Is Medically Necessary; or
(3) If not usually considered Medically Necessary, is considered Medically Necessary such that the outpatient Hospital services necessitate being provided in a Hospital due to the Enrollee‘s disability, mental health condition or abnormal behavior due to emotional instability or a developmental disability.
