Early Intervention Services. (EIS) For children from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% YES 0% The level of coverage is the same as network provider. YES The level of coverage is the same as network provider. Education Asthma Management 0% YES 40% YES Experimental/ Investigational Services Coverage varies based on type of service. Hearing Hearing Exam 0% YES 40% YES Diagnostic Testing 0% YES 40% YES Hearing Aids A maximum benefit of $1,500 per ear per hearing aid for a member under 19; A maximum benefit of $700 per ear per hearing aid for a member 19 and older. 0% YES The level of coverage is the same as network provider. Service Service Type, Provider, or Place of Service Benefit Limit Network provider For a covered heath care service you pay: Non-network provider For a covered health care service you pay the difference between the charge amount and the allowance plus: Your copayment Does the deductible apply? Your copayment Does the deductible apply? Hemophilia Services Outpatient Prescription drug coverage benefit level is based on type of service and site of service. See Summary of Pharmacy Benefits for details. Coverage varies based on type of hemophilia service. 0% YES 40% YES Home Health Care In your home Intermittent skilled services when billed by a home health care agency. Prescription drug coverage benefit level is based on type of service and site of service. See Summary of Pharmacy Benefits for details. 0% YES 40% YES Hospice Care Inpatient/in your home When provided by an approved hospice care program. Prescription drug coverage benefit level is based on type of service and site of service. See Summary of Pharmacy Benefits for details. 0% YES 40% YES Hospital Emergency Room Services Hospital Emergency Room See Section 8.0 – definition of Emergency. 0% YES The level of coverage is the same as network provider. Service Service Type, Provider, or Place of Service Benefit Limit Network provider For a covered heath care service you pay: Non-network provider For a covered health care service you pay the difference between the charge amount and the allowance plus: Your copayment Does the deductible apply? Your copayment Does the deductible apply? Human Leukocyte Antigen Testing Human Leukocyte Antigen Testing 0% YES 40% YES Infertility Inpatient/ outpatient/in a doctor’s office Three (3) in-vitro cycles will be covered per benefit year with a total of eight (8) in-vitro cycles covered in a m...
Early Intervention Services. Services provided by licensed occupational therapists, physical therapists, speech-language pathologists or clinical social workers working with children from birth to 36 months of age with an identified developmental disability or delay as described in the federal Individuals with Disabilities Education Act.
Early Intervention Services. The Plan provides Benefits for the services of licensed and credentialed occupational therapists, physical therapists, speech-language pathologists, and clinical social workers working with Members from birth to 36 months of age with an identified Developmental Disability and/or delay. Speech, occupational and physical therapy services provided as part of Early Intervention Services do not apply to visit limits under those services. Early Intervention Services are limited to 30 visits per Member per Calendar Year.
Early Intervention Services. 7) Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services, including well-child care and screenings according to the EPSDT Periodicity Schedule;
Early Intervention Services. Early intervention services (EIS) Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% The level of coverage is the same as network provider.
Early Intervention Services. (EIS) Up to the maximum benefit of $5,000 per child, from birth to 36 months, per calendar year. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% NO NO The amount you pay is the same as network provider. Education Asthma Management 0% NO NO 40% YES YES
Early Intervention Services a comprehensive program for children between the ages of birth and three years whose developmental patterns are atypical, or are at serious risk to become atypical through the influence of certain biological or environmental factors. Early Intervention Services include a set of integrated community- based developmental services which use a family centered approach to facilitate developmental progress. Early Intervention Program regulations are found at 130 CMR 440.000. Effective Date of Enrollment – as of 12:01 a.m. on the first day, as determined by EOHHS, on which the Contractor is responsible for providing MCO Covered Services to an Enrollee and as reflected in the HIPAA 834 Outbound Enrollment File. Effective Date of Disenrollment – up to 11:59 p.m. on the last day, as determined by EOHHS, on which the Contractor is responsible for providing MCO Covered Services to an Enrollee and as reflected in the HIPAA 834 Outbound Enrollment File. Eligibility Verification System (EVS) [formerly known as the Recipient Eligibility Verification System (REVS)] – the online and telephonic system Providers must access to verify eligibility, managed care enrollment, and available third party liability information about Members. Emergency Aid to the Elderly, Disabled, and Children (EAEDC) – a cash assistance program administered by the Massachusetts Department of Transitional Assistance. Individuals receiving EAEDC cash assistance are eligible for MassHealth Basic coverage upon Managed Care enrollment in accordance with the requirements of 130 CMR 508.000. Families receiving EAEDC are eligible for MassHealth Standard coverage. Emergency Medical Condition – a medical condition, whether physical or mental, manifesting itself by symptoms of sufficient severity, including severe pain, that, in the absence of prompt medical attention, could reasonably be expected by a prudent layperson who possesses an average knowledge of health and medicine to result in placing the health of an Enrollee or another person or, in the case of a pregnant individual, the health of the individual or their unborn child, in serious jeopardy, serious impairment to bodily function, or serious dysfunction of any body organ or part; or, with respect to a pregnant individual, as further defined in Section 1867(e)(1)(B) of the Social Xxxxxxxx Xxx, 00 X.X.X. § 0000xx(x)(0)(X). Emergency Services – covered inpatient and outpatient services, including Behavioral Health Services, which are furnished to an Enr...
Early Intervention Services. Contractor shall develop and implement systems to identify children who may be eligible to receive services from the Early Start program and refer them to the local Early Start program. These children would include those with a condition known to lead to developmental delay, those in whom a significant developmental delay is suspected, or whose early health history places them at risk for delay. Contractor shall collaborate with the local Regional Center or local Early Start program in determining the Medically Necessary diagnostic and preventive services and treatment plans for Members participating in the Early Start program. Contractor shall provide case management and care coordination to the Member to ensure the provision of all Medically Necessary covered diagnostic, preventive and treatment services identified in the individual family service plan developed by the Early Start program, with Primary Care Provider participation.
Early Intervention Services. Devel- opmental services that:
Early Intervention Services. Medically Necessary early intervention services provided to children younger than three years of age and delivered by certified early intervention specialists in accordance with applicable certification requirements and as defined in the early intervention operational standards established by the Massachusetts Department of Public Health. Such services must be provided by certified early intervention specialists who are working in early intervention programs approved by the Massachusetts Department of Public Health.
