Common use of Services Not Subject to Prior Approval Clause in Contracts

Services Not Subject to Prior Approval. 2.9.3.1 The Contractor will assure coverage of Emergency Medical Conditions and Urgent Care services. The Contractor must not require prior approval for the following services: 2.9.3.1.1 Any services for Emergency Medical Conditions as defined in 42 C.F.R 422.113(b)(1) and 438.114(a), which includes emergency behavioral health care; 2.9.3.1.2 Urgent Care sought outside of the Service Area; 2.9.3.1.3 Urgent Care under unusual or extraordinary circumstances provided in the Service Area when the contracted Provider is unavailable or inaccessible; 2.9.3.1.4 Family planning services; and 2.9.3.1.5 Out-of-area renal dialysis services.

Services Not Subject to Prior Approval. 2.9.3.1 The Contractor will assure coverage of Emergency Medical Conditions and Urgent Care services. The Contractor must not require prior approval Prior Approval for the following services: 2.9.3.1.1 2.9.3.1 Any services for Emergency Medical Conditions as defined in 42 C.F.R §§ 422.113(b)(1) and 438.114(a), which includes emergency behavioral health care; 2.9.3.1.2 2.9.3.2 Urgent Care sought outside of the Service Area; 2.9.3.1.3 2.9.3.3 Urgent Care under unusual or extraordinary circumstances provided in the Service Area when the contracted Provider is unavailable or inaccessible; 2.9.3.1.4 2.9.3.4 Family planning services; and 2.9.3.1.5 2.9.3.5 Out-of-area renal dialysis services.