Common use of Services Not Covered Clause in Contracts

Services Not Covered. a. Behavioral Health Services Contractors will not be responsible for coverage of behavioral health services. Behavioral health services are defined as any inpatient or residential treatment for mental disorders; any outpatient hospital mental health treatment (revenue codes 90X and 91X or procedure codes 908XX); any procedure using procedure code 908XX; other mental health services using HCPCS codes for programs described in Medicaid Policy Sections 15 or 21; and any service outlined in the approved waivers for IDDD or SED (MYPAC). The Contractor will be responsible for coverage of all drugs, including psychotropic drugs, for Members as many of these medicines are prescribed by primary care physicians. b. Non-emergency Transportation Services Contractors will not be responsible for coverage of non-emergency transportation services. The Division has an existing contract with a provider for these services. However, the Contractor will be required to coordinate with the non-emergency transportation provider for provision of these services to Members. c. Inpatient Hospital Services Contractors will not be responsible for coverage of inpatient hospital services. However, the Contractor will be responsible for coverage of services billed by physicians and other providers during a hospital stay (including, but not limited to, physician surgeries, inpatient physician visits, etc).