Self-Referral Services. In accordance with state and federal requirements, some covered benefits are available to members on a self-referral basis. These services shall not require a physician’s referral or other authorization from the Contractor. The Contractor must include self-referral providers in its contracted network. The Contractor may direct members to seek the services of the self-referral providers contracted in the Contractor’s network. However, with the exception of behavioral health and routine dental services, the Contractor cannot require that the members receive such services from network providers. Members may self-refer to any IHCP provider qualified to provide the service(s). When members choose to receive self-referral services from IHCP-enrolled self- referral providers who do not have contractual relationships with the Contractor, the Contractor is responsible for payment to these providers up to the applicable benefit limits and at 98% of Indiana Medicaid fee-for-service (FFS) rates. Chiropractic services may be provided by a licensed chiropractor, enrolled as an IHCP provider, when rendered within the scope of the practice of chiropractic as defined in IC 25-10-1-1 and 846 IAC 1-1. Eye care services, except surgical services may be provided by any provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) or IC 25-24 (optometrist) who has entered into a provider agreement under IC 12-15-11. Podiatric services may be provided by any provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) or IC 25-29 (doctor of podiatric medicine) who has entered into a provider agreement under IC 12-15-11. Psychiatric services may be provided by any provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) who has entered into a provider agreement under IC 12-15-11. Family planning services under federal regulation 42 CFR 431.51(b)(2) requires freedom of choice of providers and access to family planning services and supplies. Family planning services are those services provided to individuals of childbearing age to temporarily or permanently prevent or delay pregnancy. Family planning services also include sexually transmitted disease testing. Abortions and abortifacients are not covered family planning services, except as allowable under the federal Hyde Amendment. Members may self-refer to any IHCP provider qualified to provide the family planning service(s), including providers that are not in ...
Self-Referral Services. In accordance with state and federal requirements, some covered benefits are available to members on a self-referral basis. These services shall not require a physician’s referral or other authorization from the Contractor. The Contractor must include self-referral providers in its contracted network. Note that network is defined as a list of the doctors, other health care providers, and hospitals that the Contractor contracts with to provide medical care to its members. These providers are called “network providers” or “in-network providers.” A provider that isn’t contracted with the Contractor is called an “out-of-network provider.” The Contractor may direct members to seek the services of the self-referral providers contracted in the Contractor’s network. However, with the exception of behavioral health and routine dental services, the Contractor cannot require that the members receive such services from network providers. Members may self-refer to any IHCP provider qualified to provide the service(s). When members choose to receive self-referral services from IHCP- enrolled self-referral providers who do not have contractual relationships with the Contractor, the Contractor is responsible for payment to these providers up to the applicable benefit limits and at a rate not less than 100% of Indiana Medicaid fee-for- service (FFS) rates. ▪ Chiropractic services may be provided by a licensed chiropractor, enrolled as an IHCP provider, when rendered within the scope of the practice of chiropractic as defined in IC 25-10-1-1 and 846 IAC 1-1. ▪ Eye care services, except surgical services may be provided by any IHCP provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) or IC 25-24 (optometrist) who has entered into a provider agreement under IC 12-15-11. ▪ Podiatric services may be provided by any IHCP provider licensed under IC 25-
Self-Referral Services. In accordance with state and federal requirements, the Hoosier Healthwise program includes some benefits and services that are available to members on a self-referral basis. These self-referral services shall not require a referral from the member’s PMP or authorization from the Contractor. The Contractor shall include self-referral providers in its contracted network. The Contractor and its PMPs may direct members to seek the services of the self-referral providers contracted in the Contractor’s network. The Contractor cannot require that the members receive such services from network providers. Hoosier Healthwise members may self-refer to any IHCP provider qualified to provide the service(s). When Hoosier Healthwise members choose to receive self-referral services from IHCP- enrolled self-referral providers who do not have contractual relationships with the Contractor, the Contractor is responsible for payment to these providers up to the applicable benefit limits and at 98% of Indiana Medicaid FFS rates. Members may not self-refer to a provider who is not enrolled in IHCP. The following services are considered self-referral services. The Indiana Administrative Code 405 IAC 5 (Hoosier Healthwise) and provides further detail regarding these benefits. ▪ Chiropractic services may be provided by a licensed chiropractor, enrolled as an Indiana Medicaid provider, when rendered within the scope of the practice of chiropractic as defined in IC 25-10-1-1 and 846 IAC 1-1 who has entered into a provider agreement under IC 12-15-11. ▪ Eye care services, except surgical services may be provided by any provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) or IC 25-24 (optometrist) who has entered into a provider agreement under IC 12-15-11. ▪ Routine Dental services may be provided by any in-network licensed dental provider who has entered into a provider agreement under IC 12-15-11. ▪ Podiatric services may be provided by any provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) or IC 25-29 (doctor of podiatric medicine) who has entered into a provider agreement under IC 12-15-11. ▪ Psychiatric services may be provided by any provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) who has entered into a provider agreement under IC 12- 15-11. ▪ Family planning services under federal regulation 42 CFR 431.51(b)(2) and section 1902(a)(23) of the Social Security Act requires a freedom of choice o...
Self-Referral Services. In accordance with state and federal requirements, the PathWays program includes some benefits and services that are available to members on a self-referral basis. These self- referral services shall not require a referral from the member’s PMP or authorization from the Contractor. The Contractor shall include self-referral providers in its contracted network. Note that network is defined as a list of the doctors, other health care providers, and hospitals that the Contractor contracts with to provide medical care to its members. These providers are called “network providers” or “in-network providers.” A provider that isn’t contracted with the Contractor is called an “out-of-network provider.” The Contractor and its PMPs may direct members to seek the services of the self-referral providers contracted in the Contractor’s network. The Contractor cannot require that the members receive such services from network providers, unless otherwise noted. PathWays members may self-refer to any IHCP provider qualified to provide the service(s). When PathWays members choose to receive self-referral services from IHCP-enrolled self- referral providers who do not have contractual relationships with the Contractor, the Contractor is responsible for payment to these providers up to the applicable benefit limits and at an amount not less than 100% of Indiana Medicaid FFS rates, except for situations described under Section 2.8 of this contract. Members may not self-refer to a provider who is not enrolled in IHCP. The following services are considered self-referral services and 405 IAC 5 provides further detail regarding these benefits. ▪ Chiropractic services may be provided by a licensed chiropractor, enrolled as an Indiana Medicaid provider, when rendered within the scope of the practice of chiropractic as defined in IC 25-10-1-1 and 846 IAC 1-2-1 who has entered into a provider agreement under IC 12-15-11. ▪ Eye care services, except surgical services may be provided by any provider licensed under IC 25-22.5 (Doctor of Medicine or doctor of osteopathy) or IC 25-24 (optometrist) who has entered into a provider agreement under IC 12-15-11. ▪ Routine Dental services may be provided by any in-network licensed dental provider who has entered into a provider agreement under IC 12-15-11. ▪ Podiatric services may be provided by any provider licensed under IC 25-22.5 (Doctor of Medicine or doctor of osteopathy) or IC 25-29 (doctor of podiatric medicine) who has entered into a pro...
Self-Referral Services. For Healthy Families Members, Self-Referral Services include acupuncture, chiropractic and sensitive services. -- A 0207
Self-Referral Services. In accordance with state and federal requirements, the Hoosier Healthwise program includes some benefits and services that are available to members on a self-referral basis. These self-referral services shall not require a referral from the member’s PMP or authorization from the Contractor. The Contractor shall include self-referral providers in its contracted network. The Contractor and its PMPs may direct members to seek the services of the self-referral providers contracted in the Contractor’s network. The Contractor cannot require that the members receive such services from network providers. Hoosier Healthwise members may self-refer to any IHCP provider qualified to provide the service(s). When Hoosier Healthwise members choose to receive self-referral services from IHCP-enrolled self-referral providers who do not have contractual relationships with the Contractor, the Contractor is responsible for payment to these providers up to the applicable benefit limits and at 98% of Indiana Medicaid FFS rates.
