Non-Covered Health Services with Care Coordination a. Contractor shall coordinate services for each Member who requires health services not covered under the CCO Payment.
b. Contractor shall assist its Members in gaining access to certain Substance Use Disorder and mental health services that are not Covered Services and that are provided under separate contract with OHA, including but are not limited to the following:
(1) Medical Transportation pursuant to rules (OAR 410-136-3000 et seq.) promulgated by OHA and published in its Medical Transportation Services Guide;
(2) Standard therapeutic class 7 & 11 Prescription drugs, Depakote, Lamictal and their generic equivalents dispensed through a licensed pharmacy. These medications are paid through OHA’s Fee for Service system;
(3) Therapeutic Xxxxxx Care reimbursed under HCPCS Code S5146 for Members under 21 years of age;
(4) Therapeutic group home reimbursed for Members under 21 years of age;
(5) Behavioral rehabilitative services that are financed through Medicaid and regulated by DHS Child Welfare and OYA;
(6) Investigation of Members for Civil Commitment;
(7) Long Term Psychiatric Care (LTPC) for Members 18 years of age and older;
(8) Preadmission Screening and Resident Review (PASRR) for Members seeking admission to a LTPC;
(9) Long Term Psychiatric Care (LTPC) for Members age 17 and under, including:
(a) Secure Children's Inpatient program (SCIP),
(b) Secure Adolescent Inpatient Program (SAIP), or
(c) Stabilization and transition services (STS);
(10) Personal care in adult xxxxxx homes for Members 18 years of age and older;
(11) Residential mental health services for Members 18 years of age and older provided in licensed community treatment programs;
(12) Abuse investigations and protective services as described in OAR 407-045-0000 through 407-045-0370 and ORS 430.735 through 430.765; and
(13) Personal Care Services as described in OAR 411-034-0000 through 411-034-0090 and OAR 309-040-0300 through 309-040-0330.
7. Non-Covered Health Services without Care Coordination
a. Physician assisted suicide under the Oregon Death with Dignity Act, ORS 127.800-127.897;
b. Hospice services for Members who reside in a skilled Nursing Facility;
c. Long term care services excluded from Contractor reimbursement pursuant to ORS 414.631;
d. School-based services that are Covered Services provided in accordance with Individuals with Disabilities Education Act (IDEA) requirements that are reimbursed with the educational services program;
e. Administrative examinations reque...
Non-Covered Health Services with Care Coordination. Contractor must provide information in its Member Handbook about the availability of support from Contractor to access and coordinate care for Non-Covered Health Services with Care Coordination described in this Sec. 9 and how to request such support from Contractor. Additionally, Contractor is responsible for ensuring its Members have access to NEMT services for the services described in this Sec. 9.
a. Except as provided in Sec. 10 below of this Ex. B, Part 2, Contractor shall coordinate services for each Member who requires health services not covered under this Contract. Such services not covered include, but are not limited to, the following:
(1) Out-of-Hospital birth (OOHB), also known as Planned Community Birth (PCB), services including prenatal and postpartum care for individuals meeting criteria defined in OAR 000-000-0000. Specifically, OHA will be responsible for providing and paying for Care Coordination related to maternity care and primary OOHB services for those Members approved for OOHBs as well as for those Members in provisionally approved status. Further, OHA will be responsible for providing and paying for newborn initial assessment and newborn bloodspot screening test, including the screening kit obtained through Oregon State Public Health Laboratory. OHA will also be responsible for, with the assistance of Contractor, providing Care Coordination for the services ancillary to OOHBs including, but not limited to, pharmacy, ultrasounds, labs, prenatal vitamins, and all other Covered Services related to typical maternity care. However, Contractor shall be responsible for payment of the foregoing typical ancillary maternity care services in accordance with OAR 410-141-3826 9 and continue to be responsible for providing Care Coordination and payment of Covered Services other than those related to maternity care. OHA shall provide Contractor with a list of Members approved and not approved for OOHB services on a regular basis;
Non-Covered Health Services with Care Coordination. Contractor must provide information in its Member Handbook about the availability of support from Contractor to access and coordinate care for Non-Covered Health Services with Care Coordination described in this Sec. 9 and how to request such support from Contractor. Additionally, Contractor is responsible for ensuring its Members have access to NEMT services for the services described in this Sec. 9.
a. Except as provided in Sec. 10 below of this Ex. B, Part 2, Contractor shall coordinate services for each Member who requires health services not covered under this Contract. Such services not covered include, but are not limited to, the following:
(1) Out-of-Hospital birth (OOHB), also known as Planned Community Birth (PCB), services including prenatal and postpartum care for individuals meeting criteria defined in OAR 000-000-0000. Specifically, OHA will be responsible for providing and paying for Care Coordination related to maternity care and primary OOHB services for those Members approved for OOHBs as well as for those Members in provisionally approved status. Further, OHA will be responsible for providing and paying for newborn initial assessment and newborn bloodspot screening test, including the screening kit obtained through Oregon State Public Health Laboratory. OHA will also be responsible for, with the assistance of Contractor, providing Care Coordination for the services ancillary to
Non-Covered Health Services with Care Coordination. Contractor must provide information in its Member Handbook about the availability of support from Contractor to access and coordinate care for Non-Covered Health Services with Care Coordination described in this Sec. 9 and how to request such support from Contractor. Additionally, Contractor is responsible for ensuring its Members have access to NEMT services for the services described in this Sec. 9.
a. Except as provided in Sec. 10 below of this Ex. B, Part 2, Contractor shall coordinate services for each Member who requires health services not covered under this Contract. Such services not covered include, but are not limited to, the following:
(1) Out-of-Hospital birth (OOHB), also known as Planned Community Birth (PCB), services including prenatal and postpartum care for individuals meeting criteria defined in OAR
Non-Covered Health Services with Care Coordination a. Contractor shall coordinate services for each Member who requires health services not covered under the CCO Payment.
b. Contractor shall assist its Members in gaining access to certain Substance Use Disorder and mental health services that are not Covered Services and that are provided under separate contract with OHA, including but are not limited to the following:
