Common use of NON-CAPITATED SERVICES Clause in Contracts

NON-CAPITATED SERVICES. The following Texas Medicaid program services have been excluded from the services included in the calculation of HMO capitation rate: THSteps Dental (including Orthodontia) Early Childhood Intervention Case Management/Service Coordination MHMR Targeted Case Management Mental Health Rehabilitation Pregnant Women and Infants Case Management THSteps Medical Case Management Texas School Health and Related Services Texas Commission for the Blind Case Management Tuberculosis Services Provided by TDH-approved providers (Directly Observed Therapy andContact Investigation) Vendor Drugs (out-of-office drugs) 1999 Renewal Contract Tarrant Service Area 42 August 9, 1999 43 Medical Transportation TDHS Hospice Services Refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. Although HMO is not responsible for paying or reimbursing for these non-capitated services, HMO remains responsible for providing appropriate referrals for Members to obtain or access these services. 6.1.8.1 HMO is responsible for informing providers that all non-capitated services must be submitted to TDH for payment or reimbursement.

NON-CAPITATED SERVICES. The following Texas Medicaid program services have been excluded from the services included in the calculation of HMO capitation rate: THSteps Dental (including Orthodontia) 1999 Renewal Contract Harrxx Xxxvice Area 42 August 9, 1999 Early Childhood Intervention Case Management/Service Coordination MHMR Targeted Case Management Mental Health Rehabilitation Pregnant Women and Infants Case Management THSteps Medical Case Management Texas School Health and Related Services Texas Commission for the Blind Case Management Tuberculosis Services Provided by TDH-approved providers (Directly Observed Therapy andContact and Contact Investigation) Vendor Drugs (out-of-office drugs) 1999 Renewal Contract Tarrant Service Area 42 August 9, 1999 43 Medical Transportation TDHS Hospice Services Refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. Although HMO is not responsible for paying or reimbursing for these non-capitated services, HMO remains responsible for providing appropriate referrals for Members to obtain or access these services. 6.1.8.1 HMO is responsible for informing providers that all non-capitated services must be submitted to TDH for payment or reimbursement.

NON-CAPITATED SERVICES. The following Texas Medicaid program ---------------------- services have been excluded from the services included in the calculation of HMO capitation rate: THSteps Dental (including Orthodontia) Early Childhood Intervention Case Management/Service Coordination MHMR Targeted Case Management Mental Health Rehabilitation Pregnant Women and Infants Case Management THSteps Medical Case Management Texas School Health and Related Services Texas Commission for the Blind Case Management Tuberculosis Services Provided by TDH-approved providers (Directly Observed Therapy andContact and Contact Investigation) Vendor Drugs (out-of-office drugs) 1999 Renewal Contract Tarrant Service Area 42 August 9, 1999 43 Medical Transportation TDHS Hospice Services 1999 Renewal Contract Xxxxxx Service Area August 9, 1999 36 Refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. Although HMO is not responsible for paying or reimbursing for these non-capitated services, HMO remains responsible for providing appropriate referrals for Members to obtain or access these services. 6.1.8.1 HMO is responsible for informing providers that all non-capitated services must be submitted to TDH for payment or reimbursement.

NON-CAPITATED SERVICES. The following Texas Medicaid program services have been excluded from the services included in the calculation of HMO capitation rate: THSteps Dental (including Orthodontia) Early Childhood Intervention Case Management/Service Service/Coordination MHMR Targeted Case Management Mental Health Rehabilitation Pregnant Women and Infants Case Management THSteps Medical Case Management Texas School Health and Related Services Texas Commission for the Blind Case Management Tuberculosis Services Provided by TDH-approved providers (Directly Observed Therapy andContact and Contact Investigation) Vendor Drugs (out-of-office drugs) 1999 Renewal Contract Tarrant Service Area 42 August 9, 1999 43 Medical Transportation TDHS Hospice Services 1999 Renewal Contract Bexar Service Area August 9, 1999 Refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. Although HMO is not responsible for paying or reimbursing for these non-capitated services, HMO remains responsible for providing appropriate referrals for Members to obtain or access these services. 6.1.8.1 HMO is responsible for informing providers that all non-capitated services must be submitted to TDH for payment or reimbursement.