Intervention. HMO must require, through contract provisions, that all medically necessary health and behavioral health care services contained in the Member's IFSP are provided to the Member in amount, duration and scope established by the IFSP. Medical necessity for health and behavioral health care services is determined by the interdisciplinary team as approved by the Member's PCP. HMO cannot modify the plan of care or alter the amount, duration and scope of services required by the Member's IFSP. HMO cannot create unnecessary barriers for the Member to obtain IFSP services, including requiring prior authorization for the ECI assessment and insufficient authorization periods for prior authorized services.
Appears in 5 contracts
Samples: Contract for Services (Amerigroup Corp), Contract for Services (Amerigroup Corp), Contract for Services (Centene Corp)
Intervention. HMO must require, through contract provisions, that all medically necessary health and behavioral health care services contained in the Member's IFSP are provided to the Member in amount, duration and scope established by the IFSP. Medical necessity for health and behavioral health care services is determined by the interdisciplinary team as approved by the Member's PCP. HMO cannot modify the plan of care or alter the amount, duration and scope of services required by the Member's IFSP. HMO cannot create unnecessary barriers for the Member to obtain IFSP services, including requiring prior authorization for the ECI assessment and insufficient authorization periods for prior authorized services.
Appears in 2 contracts
Samples: Contract for Services (Amerigroup Corp), Star+plus Contract (Amerigroup Corp)
Intervention. HMO must require, through contract provisions, that all medically necessary health and behavioral health care services contained in the Member's IFSP are provided to the Member in amount, duration and scope established by the IFSP. Medical necessity for health and behavioral health care services is determined by the interdisciplinary team as approved by the Member's PCP. HMO cannot modify the plan of care or alter the amount, duration and scope of services required by the Member's IFSP. HMO cannot create unnecessary barriers for the Member to obtain IFSP services, including requiring prior authorization for the ECI assessment and insufficient authorization periods for prior authorized services.. El Paso Service Area HMO Contract
Appears in 1 contract
Samples: Contract for Services (Centene Corp)
