Hospital Outpatient. In a hospital outpatient setting, the member pays a copayment. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability.
Hospital Outpatient. In a hospital outpatient setting, the member pays a copayment. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability. Outpatient Rehabilitation (Occupational Therapy, Physical Therapy, Speech Language Pathology) Covered. MCO. Covers Covers physical therapy, occupational Part B. Outpatient evaluation and treatment for occupational, speech language pathology, and physical therapy. physical, therapy, speech Certain conditions and limitations apply. occupational, and pathology, and speech/language cognitive Any applicable cost sharing is covered by therapy. For rehabilitation the Medicaid benefit. Members have $0 FamilyCare B and therapy. cost sharing liability. C beneficiaries, limited to 60 days Covered for per therapy per services calendar year rendered beyond (except for MLTSS Medicare Part B members - refer to benefit limits. Appendix B.9.0). (N.J.A.C. § See also
Hospital Outpatient. In a hospital outpatient setting, the member pays a copayment for medically necessary treatment provided by a doctor. Members also pay a copayment for foot exams related to diabetic peripheral neuropathy rendered in a hospital outpatient setting. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability. Prescription Drugs (including Medicare Part B and Part D) Covered. MCO and FFS Covered for services Part B: All Part B prescription drugs. (coverage differs rendered beyond Part D: Medicare Part D Prescription Drug for each). Categorically Medicare Part B and Part D coverage is a required benefit for all SNPs. See 42 CFR 422.100(f)(3). Needy. MCO coverage benefit limits. Includes Any applicable cost sharing is covered by excludes ABD prescription the Medicaid benefit. Members have $0 population and all drugs (legend cost sharing liability. other dual eligible and non-legend beneficiaries. (N.J.A.C. covered by the Medicaid 10:49-5.2(a)18) FFS covers program including legend and non- physician legend drugs for administered the ABD drugs); population and all prescription other dual eligible vitamins and beneficiaries. (N.J.A.C. mineral products (except prenatal 10:49-5.2(b)15) (N.J.A.C. § vitamins and fluoride) 10:74-3.4(a)2) For the including, but not limited to, Medically Needy, therapeutic only available to vitamins, such as pregnant women high potency A, and needy D, E, Iron, Zinc, children (Groups A and minerals, and B) or aged, including blind, and disabled potassium, niacin beneficiaries and related residing in products. All Medicaid blood clotting participating factors shall be nursing facilities included in the (not available to list of blood any other ABD clotting factors. group). (N.J.A.C. The contractor shall continue to 10:49-5.3(a)6) cover physician administered drugs for all enrollees in accordance with the list of applicable codes provided by DMAHS. Includes drugs which may be excluded from Medicare Part D coverage under section 1927(d)(2) referred to in the Medicare Modernization Act 2003. $0 cost-share for beneficiaries. Physician Services - Primary and Specialty Care Covered. Covered for services rendered beyond Medicare Part B benefit limits. Part B. Covers medically necessary services and certain preventive services in outpatient settings. Physician services covered by Part B in some inpatient settings. Any applicable cost sharing is covered by the Medicaid benefit. Member...
Hospital Outpatient. The member pays a copayment for digital rectal exams in a hospital outpatient setting. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability.
Hospital Outpatient. Projected PMPM and Actual PMPM shall include claims costs for hospital outpatient facilities only for those categories of services subject to CareAdvantage review activities, i.e., ambulatory surgery, home health care, home infusion, and observation room. Hospital outpatient claims costs shall exclude claims costs incurred for mental health, substance abuse and ancillary services not provided in conjunction with those categories of services subject to CareAdvantage review activities, maternity-related services and ITS claims, as well as professional fees. Any other inclusions or exclusions will be prospectively agreed upon by the parties.
Hospital Outpatient. Outpatient hospital services at a network hospital will be subject to an $8.00 copayment. Effective June 1, 2005, the copayment will be $15.00. Mammographies and Cervical Cytology Screening. Coverage for cervical cytology screening once each health insurance contract year will be provided subject to the doctor's office limit and either an $8.00 copayment or deductible and coinsurance. Services for the examination of the Pap smear on a different date or at a different location than the office visit will result in a separate $8.00 copayment or deductible and coinsurance. Effective June 1, 2005, the copayment will be $10.00. Coverage will be provided for mammographies according to the guidelines outlined below subject to the doctor's office visit limit and an $8.00 copayment or deductible and coinsurance. Effective June 1, 2005, the copayment will be $10.00.
Hospital Outpatient. Treatment by a Physician or surgeon in the outpatient department of a hospital will be considered up to the Allowable Expense for such treatment.
Hospital Outpatient. Plan will pay Provider at the then current Indiana Medicaid rates and methodology or its successor, less applicable Copayments.
