Common use of Benefit Package Clause in Contracts

Benefit Package. A. The following categories of services shall be provided by the Contractor for all Medicaid and NJ FamilyCare A, B, C, D and ABP enrollees, except where indicated. See Section B.4.1 of the Appendices for complete definitions of the covered services. 1. Primary and Specialty Care by physicians and, within the scope of practice and in accordance with State certification/licensure requirements, standards and practices, by Certified Nurse Midwives, Doulas, Certified Nurse Practitioners, Clinical Nurse Specialists, and Physician Assistants 2. Preventive Health Care and Counseling and Health Promotion 3. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program Services For NJ FamilyCare B, C and D enrollees, coverage includes early and periodic screening and diagnostic medical examinations, dental, vision, hearing, and lead screening services. It includes only those treatment services identified through the examination that are available under the Contractor’s benefit package or specified services under the FFS program. NJ FamilyCare members eligible for EPSDT program services shall not be assessed/referred for new MLTSS enrollment unless an MLTSS specific benefit is medically necessary and not available through any other funding source. NJ FamilyCare members aging out of EPSDT benefits may be assessed/referred for MLTSS enrollment up to six months in advance of their 21st birthday. 4. Emergency Medical Care 5. Inpatient Hospital Services including acute care hospitals, rehabilitation hospitals, and specialty care hospitals whether within New Jersey or out of state. 6. Outpatient Hospital Services 7. Laboratory Services.

Benefit Package. A. The following categories of services shall be provided by the Contractor for all Medicaid and NJ FamilyCare A, B, C, D and ABP enrollees, except where indicated. See Section B.4.1 of the Appendices for complete definitions of the covered services. 1. Primary and Specialty Care by physicians and, within the scope of practice and in accordance with State certification/licensure requirements, standards and practices, by Certified Nurse Midwives, Doulas, Certified Nurse Practitioners, Clinical Nurse Specialists, and Physician Assistants 2. Preventive Health Care and Counseling and Health Promotion 3. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program Services For NJ FamilyCare B, C and D enrollees, coverage includes early and periodic screening and diagnostic medical examinations, dental, vision, hearing, and lead screening services. It includes only those treatment services identified through the examination that are available under the Contractor’s benefit package or specified services under the FFS program. NJ FamilyCare members eligible for EPSDT program services shall not be assessed/referred for new MLTSS enrollment unless an MLTSS specific benefit is medically necessary and not available through any other funding source. NJ FamilyCare members aging out of EPSDT benefits may be assessed/referred for MLTSS enrollment up to six months in advance of their 21st birthday. 4. Emergency Medical Care 5. Inpatient Hospital Services including acute care hospitals, rehabilitation hospitals, and specialty care hospitals whether within New Jersey or out of statespecial hospitals. 6. Outpatient Hospital Services 7. Laboratory Services.

Benefit Package. A. The following categories of services shall be provided by the Contractor for all Medicaid and NJ FamilyCare A, B, C, D C and ABP enrollees, except where indicated. See Section B.4.1 of the Appendices for complete definitions of the covered services. 1. Primary and Specialty Care by physicians and, within the scope of practice and in accordance with State certification/licensure requirements, standards and practices, by Certified Nurse Midwives, Doulas, Certified Nurse Practitioners, Clinical Nurse Specialists, and Physician Assistants 2. Preventive Health Care and Counseling and Health Promotion 3. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program Services For NJ FamilyCare B, B and C and D enrollees, coverage includes early and periodic screening and diagnostic medical examinations, dental, vision, hearing, and lead screening services. It includes only those treatment services identified through the examination that are available under the Contractor’s benefit package or specified services under the FFS program. NJ FamilyCare members eligible for EPSDT program services shall not be assessed/referred for new MLTSS enrollment unless an MLTSS specific benefit is medically necessary and not available through any other funding source. NJ FamilyCare members aging out of EPSDT benefits may be assessed/referred for MLTSS enrollment up to six months in advance of their 21st birthday. 4. Emergency Medical Care 5. Inpatient Hospital Services including acute care hospitals, rehabilitation hospitals, and specialty care hospitals whether within New Jersey or out of statespecial hospitals. 6. Outpatient Hospital Services 7. Laboratory Services.