Common use of Medicaid Non-capitated Services Clause in Contracts

Medicaid Non-capitated Services. The following Texas Medicaid programs and services have been excluded from HMO Covered Services. Medicaid Members are eligible to receive these Non-capitated Services on a Fee-for-Service basis from Texas Medicaid providers. HMOs should refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. 1. Texas Health Steps dental (including orthodontia); 2. Early Childhood Intervention (ECI) case management/service coordination; 3. DSHS targeted case management; 4. DSHS mental health rehabilitation; 5. DSHS case management for Children and Pregnant Women; 6. Texas School Health and Related Services (SHARS); 7. Department of Assistive and Rehabilitative Services Blind Children’s Vocational Discovery and Development Program; 8. Tuberculosis services provided by DSHS-approved providers (directly observed therapy and contact investigation); 9. Vendor Drug Program (out-of-office drugs);

Medicaid Non-capitated Services. The following Texas Medicaid programs and services have been excluded from HMO Covered Services. Medicaid Members are eligible to receive these Non-capitated Services on a Fee-for-Service basis from Texas Medicaid providers. HMOs should refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. 1. Texas Health Steps dental (including orthodontia); 2. Texas Health Steps environmental lead investigation (XXX) 3. Early Childhood Intervention (ECI) case management/service coordination; 34. DSHS targeted case management; 45. DSHS mental health rehabilitation; 56. DSHS case management for Children and Pregnant Women; 67. Texas School Health and Related Services (SHARS); 78. Department of Assistive and Rehabilitative Services Blind Children’s Vocational Discovery and Development Program; 89. Tuberculosis services provided by DSHS-approved providers (directly observed therapy and contact investigation); 910. Vendor Drug Program (out-of-office drugs);

Medicaid Non-capitated Services. The following Texas Medicaid programs and services programs, services, or benefits have been excluded from HMO MCO Covered Services. Medicaid Members are eligible to receive these Non-capitated Services on a Fee-for-Service basis from Texas Medicaid providersbasis, or through a Dental MCO (for most dental services). HMOs MCOs should refer to relevant chapters in the Texas Medicaid Provider Procedures Manual and the Texas Medicaid Bulletins for more information. 1. Texas Health Steps dental (including orthodontia); 2. Texas Health Steps environmental lead investigation (XXX); 3. Early Childhood Intervention (ECI) case management/service coordination; 3. DSHS targeted case management; 4. DSHS mental health rehabilitationEarly Childhood Intervention Specialized Skills Training; 5. DSHS case management Case Management for Children and Pregnant Women; 6. Texas School Health and Related Services (SHARS); 7. Department of Assistive and Rehabilitative Services Blind Children’s 's Vocational Discovery and Development Program; 8. Tuberculosis tuberculosis services provided by DSHS-approved providers (directly observed therapy and contact investigation); 9. Vendor Drug Program (out-of-office drugs);

Medicaid Non-capitated Services. The following Texas Medicaid programs and services have been excluded from HMO MCO Covered Services. Medicaid Members are eligible to receive these Non-capitated Services on a Fee-for-Service basis from Texas Medicaid providers. HMOs MCOs should refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. 1. Texas Health Steps dental (including orthodontia); 2. Early Childhood Intervention (ECI) case management/service coordination; 3. DSHS targeted case management;Targeted Case Management – coordinated by LMHAs 4. DSHS mental health rehabilitation; 5. DSHS case management Case Management for Children and Pregnant WomenWomen (CPW); 6. Texas School Health and Related Services (SHARS); 7. Department of Assistive and Rehabilitative Services Blind Children’s Vocational Discovery and Development Program; 8. Tuberculosis tuberculosis services provided by DSHS-approved providers (directly observed therapy and contact investigation); 9. Vendor Drug Program (out-of-office drugs);

Medicaid Non-capitated Services. The following Texas Medicaid programs and services have been excluded from HMO Covered Services. Medicaid Members are eligible to receive these Non-capitated Services on a Fee-for-Service basis from Texas Medicaid providers. HMOs should refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. 1. Texas Health Steps THSteps dental (including orthodontia); 2. Early Childhood Intervention (ECI) case management/service coordination; 3. DSHS targeted case management; 4. DSHS mental health rehabilitation; 5. DSHS case management for Children and Pregnant Women; 6. Texas School Health and Related Services (SHARS); 7. Department of Assistive and Rehabilitative Services Blind Children’s Vocational Discovery and Development Program; 8. Tuberculosis services provided by DSHS-approved providers (directly observed therapy and contact investigation); 9. Vendor Drug Program (out-of-office drugs);

Medicaid Non-capitated Services. The following Texas Medicaid programs and services have been excluded from HMO Covered Services. Medicaid Members are eligible to receive these Non-capitated Services on a Fee-for-Service basis from Texas Medicaid providers. HMOs should refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. 1. Texas Health Steps THSteps dental (including orthodontia); 2. Early Childhood Intervention (ECI) case management/service coordination; 3. DSHS targeted case management; 4. DSHS mental health rehabilitation; 5. DSHS case management for Children and Pregnant Women; 6. Texas School Health and Related Services (SHARS); 7. Department of Assistive and Rehabilitative Services Blind Children’s Vocational Discovery and Development Program; 8. Tuberculosis services provided by DSHS-approved providers (directly observed therapy and contact investigation); 9. Vendor Drug Program (out-of-office drugs);

Medicaid Non-capitated Services. The following Texas Medicaid programs and services have been excluded from HMO Covered Services. Medicaid Members are eligible to receive these Non-capitated Services on a Fee-for-for- Service basis from Texas Medicaid providers. HMOs should refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. 1. Texas Health Steps THSteps dental (including orthodontia); 2. Early Childhood Intervention (ECI) case management/service coordination; 3. DSHS targeted case management; 4. DSHS mental health rehabilitation; 5. DSHS case management for Children and Pregnant Women; 6. Texas School Health and Related Services (SHARS); 7. Department of Assistive and Rehabilitative Services Blind Children’s Vocational Discovery and Development Program; 8. Tuberculosis services provided by DSHS-approved providers (directly observed therapy and contact investigation); 9. Vendor Drug Program (out-of-office drugs);