Practitioner Services. Charges for the services of the following Duly Licensed practitioners will be eligible. Unless specifically stated in the benefit booklet (as posted on the Board's intranet site), no benefits will be payable for tests, completion of reports or consultations with any person other than a Covered Person. A Physician's written authorization is only required for practitioner services where specified below. Physiotherapist or Certified Athletic Therapist (The services of a physiotherapist who has an agreement with the provincial health insurance plan will not be covered) Clinical Psychologist or Marriage and Family Therapist, up to a maximum of $500 per Covered Person in a calendar year Massage Therapist, up to a maximum of $500 per Covered Person in a calendar year Speech Pathologist, up to a maximum of $350 per Covered Person in a calendar year Chiropractor*, Osteopath, Podiatrist*, Chiropodist or Naturopath, up to a maximum of $500 per Covered Person per practitioner in a calendar year. This limit will include coverage for one x-ray taken by each practitioner each calendar year for each Covered Person.
Practitioner Services. The Health Plan shall provide medically necessary practitioner services in accordance with the Practitioner Services Coverage and Limitations Handbook, and including the limitations and requirements specified below.
a. Primary Care Services
(1) The Health Plan shall process claims for and, if capitated or are approved by the Agency to subcapitate for certain covered services, pay certain physicians who provide Florida Medicaid-covered eligible primary care services in accordance with sections 1902(a)(13), 1902(jj), 1932(f), and 1905(dd) of the Social Security Act, as amended by the Affordable Care Act and 42 CFR sections 438, 441 and 447, for dates of service on or after January 1, 2013, through December 31, 2014. This provision also applies to any payments made through subcapitation arrangements. For Health Plans with subcapitation arrangements, the Agency recommends that the Health Plan implement a physician payment increase methodology similar to the Agency’s payment methodology approved by federal CMS. For purposes of sub-item 23., the term capitated Health Plan includes FFS PSNs approved to subcapitate for services.
(2) The capitated Health Plan shall ensure the physician payment specified in this section applies to such primary care services provided by physicians with a specialty designation of family medicine, general internal medicine, or pediatric medicine or related subspecialists. Physicians affected include the following:
(a) A physician as defined in 42 CFR 440.50; or provider under the personal supervision of a physician who self-attests to a specialty designation of family medicine, general internal medicine or pediatric medicine; or a subspecialty recognized by the American Board of Medical Specialties (ABMS), the American Board of Physician Specialties (ABPS) or the American Osteopathic Association (AOA); and
(b) A physician who self-attests that he/she is board certified with such a specialty or subspecialty and/or has furnished evaluation and management services and vaccine administration services under the codes listed below that equal at least sixty percent (60%) of the Medicaid codes he or she has billed during the most recently completed calendar year or, for newly eligible physicians, the prior month.
(3) The Health Plan shall ensure that increased payments specified in this provision are not provided to physicians delivering primary care services at FQHCs, RHCs or CHDs.
(4) The capitated Health Plan shall make increased physician ...
Practitioner Services. OLPG, by and through HSC-S Faculty, shall provide the following health care professional services: (1) professional medical services to and for patients at Hospitals, including medically indigent and uninsured patients, as defined by Louisiana law (“Professional Services”); and (2) on call coverage services to the Hospitals (“On Call Coverage”). Collectively, Professional Services and On Call Coverage shall be referred to as “Practitioner Services.”
Practitioner Services. Charges for the services of the following Duly Licensed practitioners will be eligible. specifically stated, no benefits will be payable for tests, completion of reports or consultations with any person other than a Covered Person. A Physician’s written authorization is only required for practitioner services where specified below. Physiotherapist or Certified Athletic Therapist, up to a combined maximum of per Covered Person in a calendar year. (The services of a physiotherapist who has an agreement with provincial health insurance plan will not be covered.) Clinical Psychologist or Marriage and Family Therapist, up to a combined maximum of per Covered Person in a calendar year. Massage Therapist, up to a maximum of per Covered Person in a calendar year. (These services must be authorized in writing by the Covered Person’s attending Physician.) Speech Pathologist, up to a maximum of per Covered Person in a calendar year. Chiropractor*, Osteopath*, Podiatrist*, Chiropodist or Naturopath, up to a maximum of per Covered Person per practitioner in a calendar year. Benefits are also payable for x-rays taken by a chiropractor, osteopath or podiatrist, up to a maximum of per Covered Person per practitioner in a calendar year. for the these practitioners will be made any annual allowance under the health insuranceplan has been exhausted. Charges for: Drugs, and injected allergy sera which: are listed in Manulife Financial Formulary Three, are purchased on the prescription of a Physician or Dentist, and are dispensed by a Duly Licensed pharmacist, Physician, Dentist or Hospital. This includes extemporaneous preparations provided at least one of the ingredients is Drugs and medicines considered to be life sustaining (as determined by Manulife ’Financial) when purchased on the prescription of a physician or dentist and dispensed by a Duly Licensed pharmacist, physician, dentist or hospital. This includes extemporaneous preparations provided at least one of the ingredients is drugs, up to a of per Covered Person per calendar year. Insulin, needles, syringes and chemical testing agents for the management of Injected vitamins. Sclerotherapy drugs for varicose vein treatment. cessation aids, up to a three month supply per calendar year (204 tablets is the equivalent of a three month supply) and limited to two three month per Covered Person’s lifetime. For a Covered Person years of and older, charges for the following expenses which are no longer payable under a Governme...
Practitioner Services. Practitioner I description of the orthopedic shoe and modification(s) is required. Boots, sandals or sport-specific footwear are not eligible. 80% to a benefit maximum of $300 per participant per Practitioner I Services are provided to a combined benefit maximum per participant per benefit year. The services of an occupational therapist must be prescribed by a physician or nurse practitioner. Practitioner II Practitioner II Services are provided to a combined benefit maximum per participant per benefit year. The services of a massage therapist or nutritional counsellor must be prescribed by a physician or nurse practitioner.
