Services Chart Sample Clauses
Services Chart. Pursuant to federal and state requirements, TennCare enrollees under the age of 21 are eligible for all services listed in Section 1905(a) of the Social Security Act. These services, and the entity responsible for providing them to TennCare enrollees under the age of 21, are listed below. Notwithstanding any other provision of this Contract, the CONTRACTOR shall provide all services for which “MCO” is identified as the responsible entity to members under the age of 21. All services, other than TennCare Kids screens and interperiodic screens, must be medically necessary in order to be covered by the CONTRACTOR. The CONTRACTOR shall provide all medically necessary TennCare Kids covered services regardless of whether or not the need for such services was identified by a provider whose services had received prior authorization from the CONTRACTOR or by a contract provider.
(1) Inpatient hospital services (other than services in an institution for mental diseases) MCO
(2) (A) Outpatient hospital services MCO (2)(B) Rural health clinic services (RHCs) MCO MCOs are not required to contract with RHCs if the services are available through other contract providers.
Services Chart. Pursuant to federal and state requirements, TennCare enrollees under the age of 21 are eligible for all services listed in Section 1905(a) of the Social Security Act. These services, and the entity responsible for providing them to TennCare enrollees under the age of 21, are listed below. Notwithstanding any other provision of this Agreement, the CONTRACTOR shall provide all services for which “MCO” is identified as the responsible entity to members under the age of 21. All services, other than TENNderCare screens and interperiodic screens, must be medically necessary in order to be covered by the CONTRACTOR. The CONTRACTOR shall provide all medically necessary TENNderCare covered services regardless of whether or not the need for such services was identified by a provider whose services had received prior authorization from the CONTRACTOR or by a contract provider.
(1) Inpatient hospital services (other than services in an institution for mental diseases) MCO
(2) (A) Outpatient hospital services MCO (2)(B) Rural health clinic services (RHCs) MCO MCOs are not required to contract with RHCs if the services are available through other contract providers. (2)(C) Federally-qualified health center services (FQHCs) MCO MCOs are not required to contract with FQHCs if they can demonstrate adequate provider capacity without them.
(3) Other laboratory and X-ray services MCO
(4) (A) Nursing facility services for individuals age 21 and older Not applicable for TENNderCare (4)(B) EPSDT services MCO for physical health and behavioral health services; DBM for dental services except as described in Section 2.6.1.3; PBM for pharmacy services as described except as in Section 2.6.1.3