Services Not Subject to Prior Approval. 2.11.3.1. The Contractor will assure coverage of Emergency Medical Conditions and Urgent Care services. The Contractor must not require prior approval for the following services:
Services Not Subject to Prior Approval. 2.8.2.1. The ICDS Plan will assure coverage of Emergency Medical Conditions and Urgent Care services. The ICDS Plan must not require prior approval for the following services:
Services Not Subject to Prior Approval. The Contractor will assure coverage of Emergency Conditions and Urgent Care services. The Contractor must not require prior approval for the following services: Any services for Emergency Conditions as defined in 42 C.F.R 422.113(b)(1) and 438.114(a) (which includes emergency Behavioral Health care); Urgent Care sought outside of the Service Area; Urgent Care under unusual or extraordinary circumstances provided in the Service Area when the contracted medical provider is unavailable or inaccessible; Family planning services; Out‑of‑area renal dialysis services; Prescription drugs as required in Appendix F; Inpatient Substance Use Disorder Services (American Society of Addition Medicine (ASAM) Level 4) as defined in Appendix B, Exhibit 2. Medical necessity shall be determined by the treating clinician in consultation with the Enrollee; Acute Treatment Services for Substance Use Disorders (ASAM Level 3.7) (ATS), as defined in Appendix B, Exhibit 2. Contractor shall require providers delivering ATS to provide Contractor, within forty‑eight (48) hours of an Enrollee’s admission, with notification of admission of an Enrollee and an initial treatment plan for such Enrollee. Contractor may establish the manner and method of such notification but may not require the provider to submit any information other than the name of the Enrollee, information regarding the Enrollee’s coverage with the Contractor, and the provider’s initial treatment plan. Contractor may not use failure to provide such notice as the basis for denying claims for services provided. Medical necessity shall be determined by the treating clinician in consultation with the Enrollee; Clinical Support Services for Substance Use Disorders (ASAM Level 3.5) (CSS), as defined in Appendix B, Exhibit 2. The Contractor shall require providers delivering CSS to provide the Contractor, within 48 hours of an Enrollee’s admission, with notification of admission of an Enrollee and an initial treatment plan for such Enrollee. The Contractor may establish the manner and method of such notification but may not require the provider to submit any information other than the name of the Enrollee, information regarding the Enrollee’s coverage with the Contractor, and the provider’s initial treatment plan. Contractor may not use failure to provide such notice as the basis for denying claims for services provided. Medical necessity shall be determined by the treating clinician in consultation with the Enrollee; Outpatient...
Services Not Subject to Prior Approval. 2.8.2.1. The ICO will assure coverage of Emergency Medical Conditions and Urgent Care Services. The ICO must not require prior approval for the following services:
