Hysterectomies. The CONTRACTOR shall:
Hysterectomies. 2.7.8.3.1 Hysterectomy shall mean a medical procedure or operation for the purpose of removing the uterus. The CONTRACTOR shall cover hysterectomies only if the following requirements are met:
Hysterectomies. The Contractor shall cover the cost of hysterectomies when they are non-elective and medically necessary as provided in 42 CFR 441.255 (2005, as amended). Plan provided, non-elective, medically necessary hysterectomies shall meet the requirements as outlined in MCO Policy and Procedure Guide. Expenditures for the medical services as previously described have been factored into the capitated rate described in § 2.1 of this Contract and the Contractor will not receive any additional payments.
Hysterectomies. The CONTRACTOR shall: Cover the cost of hysterectomies when they are non-elective and medically necessary as provided in 42 CFR §441.255 (2010, as amended). Ensure non-elective, medically necessary hysterectomies shall meet the requirements as outlined in the Managed Care Policy and Procedure Manual.
Hysterectomies. The CONTRACTOR shall: Cover the cost of hysterectomies when they are non-elective and medically necessary as provided in 42 CFR §441.255 (2010, as amended). Ensure non-elective, medically necessary hysterectomies shall meet the requirements as outlined in the Managed Care Policy and Procedure Guide and applicable Department manuals and guides. Independent Laboratory and X-Ray Services The CONTRACTOR is required to pay for medically necessary laboratory and X-ray services. Detailed service provisions are found within the Managed Care Policy and Procedure Guide and applicable Department manuals and guides. The CONTRACTOR shall: Requires that all laboratory testing sites providing services under the contract have either a Clinical Laboratory Improvement Amendments (CLIA) certificate or waiver of a certificate of registration along with a CLIA identification number. [42 CFR 493.1; 42 CFR 493.3] Inpatient Hospital Services Inpatient hospital services are services—provided under the direction of a Physician—furnished to a patient who is admitted to an acute care medical facility for a period of time, as defined in the Department’s Hospital Provider Manual. These services may include, but are not limited to a full range of necessary diagnostic and therapeutic care—including surgical, dental, medical, general nursing, radiological and rehabilitative services in emergency or Non-Emergency conditions. Additional inpatient hospital services would include room and board, miscellaneous hospital services, medical supplies, and equipment. Please refer to the Medicaid Managed Care Policy and Procedure Guide for additional details about services and payment responsibilities based on Enrollment status. The CONTRACTOR shall: Upon the Member’s Day of admission to a hospital, cover the facility charges associated with the entire stay (admission through discharge). Institutional Long-Term Care (LTC) Facilities/Nursing Facilities (NFs) For the purposes of this contract, these are services provided in a facility that is licensed as a nursing facility or hospital that provides swing bed or Administrative Days. The CONTRACTOR shall: Ensure admission Procedures of the Member adhere to the Medicaid requirements of participation for nursing facilities, including level of care certification, preadmission screening and resident review (PASARR), resident assessment, notification of patient’s rights, and other responsibilities. Obtain a level of care certification (DHHS Form 185) from Com...
Hysterectomies. Coverage will be provided for vaginal hysterectomies and abdominal hysterectomies. Coverage includes a minimum stay in the Hospital of:
Hysterectomies. 2.7.7.3.1 The CONTRACTOR shall cover hysterectomies only if the following requirements are met:
Hysterectomies. The CCN shall cover the cost of medically necessary hysterectomies as provided in 42 CFR §441.255 (2005, as amended). CCN provided non-elective, medically necessary hysterectomies shall meet the requirements as outlined in the CCN-P Policy and Procedure Guide. Expenditures for the medical services as previously described have been factored into the prepaid PMPM rate described in § 2.1 of this Provider Agreement and the CCN will not receive any additional payments.
