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Birth, Baby, and Beyond
CCP will assist you in getting the following services. We will work closely with your doctor to ensure the services you need are provided on time and by the best doctors.
Service | Description | Coverage/Limitations | Prior Authorization |
---|---|---|---|
Allergy Services
|
Services to treat conditions such as sneezing or rashes that are not caused by an illness
|
We cover blood or skin allergy testing and up to 156 doses per year of allergy shots
Copayment:$2.00 per office visit
|
No Plan OK Needed
|
Ambulance Transportation Services
|
Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities
|
Covered as medically necessary.
|
No Plan OK Needed
|
Ambulatory Surgical Center Services
|
Surgery and other procedures that are performed in a facility that is not the hospital (outpatient)
|
Covered as medically necessary.
|
Plan OK Needed.
|
Anesthesia Services
|
Services to keep you from feeling pain during surgery or other medical procedures
|
Covered as medically necessary.
|
No Plan OK Needed
|
Assistive Care Services
|
Services provided to adults (ages 18 and older) help with activities of daily living and taking medication
|
We cover 365/366 days of services per year,
|
No Prior Authorization is required when services are rendered in an Assisted Living Facility, Adult family care home, or Residential treatment facility.
|
Behavioral Health Assessment Services
|
Services used to detect or diagnose mental illnesses and behavioral health disorders
|
We cover:
- One initial assessment per year
- One reassessment per year
- Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day)
- Copayment: $2.00 per visit
|
Please contact Carisk for information at 1-800-294-8642
|
Behavioral Health Overlay Services
|
Behavioral health services provided to children (ages 0 – 18) enrolled in a DCF program
|
We cover 365/366 days of services per year, including therapy, support services, and aftercare planning
|
Please contact Carisk for information at 1-800-294-8642
|
Cardiovascular Services
|
Services that treat the heart and circulatory (blood vessels) system
|
We cover the following as prescribed by your doctor:
- Cardiac testing
- Cardiac surgical procedures
- Cardiac devices
- Copayment: $2.00 per office visit
|
Plan OK Needed for certain invasive services.
|
Child Health Services Targeted Case Management
|
Services provided to children (ages 0 - 3) to help them get health care and other services
|
Your child must be enrolled in the DOH Early Steps program
|
No Plan OK Needed
|
Chiropractic Services
|
Diagnosis and manipulative treatment of misalignments of the joints, especially the spinal column, which may cause other disorders by affecting the nerves, muscles, and organs
|
We cover:
- One new patient visit
- 24 established patient visits per year
- X-rays
- Copayment: $1.00 per visit
|
Plan OK Needed after 24 visits per year, up to a maximum of 37 visits.
|
Clinic Services
|
Health care services provided in a county health department, federally qualified health center, or a rural health clinic
|
Copayment: $3.00 per visit to a federally qualified health center or rural health clinic visit
|
No Plan OK Needed
|
Detoxification Services
|
Services provided to people who are withdrawing from drugs or alcohol
|
As medically necessary.
|
Plan OK Needed. Please contact Carisk for Authorization at 1-800-294-8642
|
Dialysis Services
|
Medical care, tests, and other treatments for the kidneys. This service also includes dialysis supplies and other supplies that help treat the kidneys
|
We cover the following as prescribed by your treating doctor:
- Hemodialysis treatments
Peritoneal dialysis treatments
|
Plan OK Needed
|
Durable Medical Equipment and Medical Supplies Services
|
Medical equipment is used to manage and treat a condition, illness, or injury. Durable medical equipment is used over and over again and includes things like wheelchairs, braces, crutches, and other items. Medical supplies are items meant for one-time use and then thrown away
|
Some service and age limits apply. Call 1-866-899-4828 for more information.
-
|
Prior Authorization is required for some Durable Medical Equipment and Medical Supplies
|
Early Intervention Services
|
Services to children ages 0 - 3 who have developmental delays and other conditions
|
We cover:
- One initial evaluation per lifetime, completed by a team
- Up to 3 screenings per year
- Up to 3 follow-up evaluations per year
Up to 2 training or support sessions per week
|
No Plan OK Needed
|
Emergency Transportation Services
|
Transportation provided by ambulances or air ambulances (helicopter or airplane) to get you to a hospital because of an emergency
|
Covered as medically necessary.
-
|
No Plan OK Needed
|
Evaluation and Management Services
|
Services for doctor’s visits to stay healthy and prevent or treat illness
|
We cover:
- One adult health screening (check-up) per year
- Child health check-ups are provided based on age and developmental needs
- One visit per month for people living in nursing facilities
- Up to two office visits per month for adults to treat illnesses or conditions
Copayment: $2.00 per office visit
|
No Plan OK Needed
|
Family Therapy Services
|
Services for families to have therapy sessions with a mental health professional
|
We cover:
- Up to 26 hours per year
- Copayment: $2.00 per visit
|
Please contact Carisk for information at 1-800-294-8642
|
Gastrointestinal Services
|
Services to treat conditions, illnesses, or diseases of the stomach or digestion system
|
We cover:
- Covered as medically necessary
- Copayment: $2.00 per office visit
|
Plan OK Needed for invasive procedures.
|
Genitourinary Services
|
Services to treat conditions, illnesses, or diseases of the genitals or urinary system
|
We cover:
- Covered as medically necessary
Copayment: $2.00 per office visit
|
Plan OK Needed for invasive procedures.
|
Group Therapy Services
|
Services for a group of people to have therapy sessions with a mental health professional
|
We cover:
- Up to 39 hours per year
- Copayment: $2.00 per visit
|
Please contact Carisk for information at 1-800-294-8642
|
Hearing Services
|
Hearing tests, treatments, and supplies that help diagnose or treat problems with your hearing. This includes hearing aids and repairs
|
We cover hearing tests and the following as prescribed by your doctor:
- Cochlear implants
- One new hearing aid per ear, once every 3 years
- Repairs
|
Plan OK Needed for Cochlear implants.
|
Home Health Services
|
Nursing services and medical assistance provided in your home to help you manage or recover from a medical condition, illness or injury
|
We cover:
- Up to 4 visits per day for pregnant recipients and recipients ages 0-20
- Up to 3 visits per day for all other recipients
- Copayment: $2.00 per provider, per day
|
Plan OK Needed
|
Hospice Services
|
Medical care, treatment, and emotional support services for people with terminal illnesses or who are at the end of their lives to help keep them comfortable and pain free. Support services are also available for family members or caregivers
|
- Covered as medically necessary
- Copayment: See information on Patient Responsibility for copayment information
|
Plan OK Needed
|
Individual Therapy Services
|
Services for people to have one-to-one therapy sessions with a mental health professional
|
We cover:
- Up to 26 hours per year
- Copayment: $2.00 per visit
|
Please contact Carisk for information at 1-800-294-8642
|
Inpatient Hospital Services
|
Medical care that you get while you are in the hospital. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you
|
We cover the following inpatient hospital services based on age and situation:
- Up to 365/366 days for recipients ages 0-20
- Up to 45 days for all other recipients (extra days are covered for emergencies)
|
Plan OK Needed
|
Integumentary Services
|
Services to diagnose or treat skin conditions, illnesses or diseases
|
- Covered as medically necessary
- Copayment: $2.00 per office visit
|
Plan OK Needed for invasive procedures.
|
Laboratory Services
|
Services that test blood, urine, saliva or other items from the body for conditions, illnesses or diseases
|
- Covered as medically necessary
Copayment: $1.00 per lab visit, $2.00 per office visit
|
Plan OK Needed for genetic testing.
|
Medical Foster Care Services
|
Services that help children with health problems who live in foster care homes
|
- Must be in the custody of the Department of Children and Families
|
No Plan OK Needed
|
Medication Assisted Treatment Services
|
Services used to help people who are struggling with drug addiction
|
- Covered as medically necessary
- Copayment: $2.00 per visit
|
Please contact Carisk for Authorization 1-800-294-8642
|
Medication Management Services
|
Services to help people understand and make the best choices for taking medication
|
- Covered as medically necessary
- Copayment: $2.00 per visit
|
No Plan OK Needed
|
Mental Health Targeted Case Management
|
Services to help get medical and behavioral health care for people with mental illnesses
|
Covered as medically necessary
|
Please contact Carisk for information at 1-800-294-8642
|
Neurology Services
|
Services to diagnose or treat conditions, illnesses or diseases of the brain, spinal cord or nervous system
|
- Covered as medically necessary
- Copayment: $2.00 per office visit
|
Plan OK Needed for some procedures.
|
Non-Emergency Transportation Services
|
Transportation to and from all of your medical appointments. This could be on the bus, a van that can transport disabled people, a taxi, or other kinds of vehicles
|
We cover the following services for recipients who have no transportation:
- Out-of-state travel
- Transfers between hospitals or facilities
- Escorts when medically necessary
- Copayment: $1.00 per each one-way trip ($2.00 to go to your doctor’s office and back home)
-
|
No Plan OK Needed.
|
Nursing Facility Services
|
Medical care or nursing care that you get while living full-time in a nursing facility. This can be a short-term rehabilitation stay or long-term
|
- We cover 365/366 days of services in nursing facilities as medically necessary
- Copayment: See information on Patient Responsibility for copayment information
|
Plan OK Needed
|
Occupational Therapy Services
|
Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself, and using items around the house
|
We cover for children ages 0-20 and for adults under the $1,500 outpatient services cap:
- One initial evaluation per year
- Up to 210 minutes of treatment per week
- One initial wheelchair evaluation per 5 years
We cover for people of all ages:
Follow-up wheelchair evaluations, one at delivery and one 6-months later
|
Plan OK Needed
|
Oral Surgery Services
|
Services that provide teeth extractions (removals) and to treat other conditions, illnesses or diseases of the mouth and oral cavity
|
- Covered as medically necessary
- Copayment: $2.00 per office visit
|
Plan OK Needed for some procedures.
|
Orthopedic Services
|
Services to diagnose or treat conditions, illnesses or diseases of the bones or joints
|
- Covered as medically necessary
Copayment: $2.00 per office visit
|
Plan OK Needed for Invasive procedures and advanced imaging services (such as MRI or CAT scan)
|
Outpatient Hospital Services
|
Medical care that you get while you are in the hospital but are not staying overnight. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you
|
- Emergency services are covered as medically necessary
- Non-emergency services cannot cost more than $1,500 per year for recipients ages 21 and over
- Copayment: $15.00 or less for non-emergency services at an emergency room and $3.00 for all others
|
Plan OK Needed for some invasive procedures and overnight hospital observation.
|
Pain Management Services
|
Treatments for long-lasting pain that does not get better after other services have been provided
|
- Covered as medically necessary. Some service limits may apply
Copayment: $2.00 per visit
|
Plan OK Needed for Invasive procedures.
|
Physical Therapy Services
|
Physical therapy includes exercises, stretching and other treatments to help your body get stronger and feel better after an injury, illness or because of a medical condition
|
We cover for children ages 0-20 and for adults under the $1,500 outpatient services cap:
- One initial evaluation per year
- Up to 210 minutes of treatment per week
- One initial wheelchair evaluation per 5 years
We cover for people of all ages:
Follow-up wheelchair evaluations, one at delivery and one 6-months later
|
Plan OK Needed except for initial evaluation and re-evaluations.
|
Podiatry Services
|
Medical care and other treatments for the feet
|
We cover:
- Up to 24 office visits per year
- Foot and nail care
- X-rays and other imaging for the foot, ankle and lower leg
- Surgery on the foot, ankle or lower leg
- Copayment: $2.00 per office visit
|
Plan OK Needed for Invasive surgery.
|
Prescribed Drug Services
|
This service is for drugs that are prescribed to you by a doctor or other healthcare provider
|
We cover:
- Up to a 34-day supply of drugs, per prescription
Refills, as prescribed
|
Some medications require Prior Authorization. All covered medications are $0 copay.
|
Private Duty Nursing Services
|
Nursing services provided in the home to people ages 0 to 20 who need constant care
|
We cover:
- Up to 24 hours per day
|
Plan OK Needed
|
Partial Hospitalization
|
Mental health services that are performed in a facility in a regular hospital
|
We cover:
As medically necessary .
|
Plan OK Needed. Please contact Carisk for Authorization at 1-800-294-8642
|
Psychological Testing Services
|
Tests used to detect or diagnose problems with memory, IQ or other areas
|
We cover:
- 10 hours of psychological testing per year
- Copayment: $2.00 per visit
|
Please contact Carisk for information at 1-800-294-8642
|
Psychosocial Rehabilitation Services
|
Services to assist people to re-enter everyday life. They include help with basic activities such as cooking, managing money and performing household chores
|
We cover:
- Up to 480 hours per year
Copayment: $2.00 per visit
|
Please contact Carisk for information at 1-800-294-8642
|
Radiology and Nuclear Medicine Services
|
Services that include imaging such as x-rays, MRIs or CAT scans. They also include portable x-rays
|
- Covered as medically necessary
- Copayment: $1.00 per portable x-ray visit; $2.00 per office visit
|
Plan OK Needed for advanced imaging such as MRI or CAT scans. No Plan OK Needed for x-rays.
|
Regional Perinatal Intensive Care Center Services
|
Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions
|
- Covered as medically necessary
|
No Plan OK Needed
|
Reproductive Services
|
Services for women who are pregnant or want to become pregnant. They also include family planning services that provide birth control drugs and supplies to help you plan the size of your family
|
- We cover family planning services. You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. You do not need prior approval for these services. These services are free. These services are voluntary and confidential, even if you are under 18 years old.
|
No Plan OK Needed
|
Respiratory Services
|
Services that treat conditions, illnesses or diseases of the lungs or respiratory system
|
We cover:
- Respiratory testing
- Respiratory surgical procedures
- Respiratory device management
- Copayment: $2.00 per office visit
|
Plan OK Needed for some invasive procedures and devices.
|
Respiratory Therapy Services
|
Services for recipients ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease
|
We cover:
- One initial evaluation per year
- One therapy re-evaluation per 6 months
Up to 210 minutes of therapy treatments per week (maximum of 60 minutes per day)
|
Plan OK Needed except for initial evaluation and re-evaluations.
|
Specialized Therapeutic Services
|
Services provided to children ages 0-20 with mental illnesses or substance use disorders
|
We cover the following :
- Assessments
- Foster care services
- Group home services
|
Please contact Carisk for Authorization at 1-800-294-8642
|
Speech-Language Pathology Services
|
Services that include tests and treatments help you talk or swallow better
|
We cover the following services for children ages 0-20:
- Communication devices and services
- Up to 210 minutes of treatment per week
- One initial evaluation per year
We cover the following services for adults:
- One communication evaluation per 5 years
|
Plan OK Needed except for initial evaluation and re-evaluations.
|
Statewide Inpatient Psychiatric Program Services
|
Services for children with severe mental illnesses that need treatment in the hospital
|
- Covered as medically necessary for children ages 0-20
|
Please contact Carisk for Authorization at 1-800-294-8642
|
Therapeutic Behavioral On-Site Services
|
Services provided by a team to prevent children ages 0-20 with mental illnesses or behavioral health issues from being placed in a hospital or other facility
|
We cover:
- Up to 9 hours per month
Copayment: $2.00 per visit
|
Please contact Carisk for information at 1-800-294-8642
|
Transplant Services
|
Services that include all surgery and pre and post-surgical care
|
Covered as medically necessary
|
Plan OK Needed
|
Visual Aid Services
|
Visual Aids are items such as glasses, contact lenses and prosthetic (fake) eyes
|
We cover the following services when prescribed by your doctor:
- Two pairs of eyeglasses for children ages 0-20
- Contact lenses
- Prosthetic eyes
|
Please contact 20/20 for Authorization at 1-877-296-0799
|
Visual Care Services
|
Services that test and treat conditions, illnesses, and diseases of the eyes
|
- Covered as medically necessary
- Copayment: $2.00 per office visit
|
Please contact 20/20 for Authorization at 1-877-296-0799
|
Addictions Receiving Facility Services
|
Services used to help people who are struggling with drug or alcohol addiction
|
As medically necessary and recommended by us
|
Plan OK Needed
|
Ambulatory Detoxification Services
|
Services provided to people who are withdrawing from drugs or alcohol
|
As medically necessary and recommended by us
|
Plan OK Needed
|
Crisis Stabilization Unit Services
|
Emergency mental health services that are performed in a facility that is not a regular hospital
|
As medically necessary and recommended by us
|
No
|
Service | Description | Coverage/Limitations | Prior Authorization |
---|---|---|---|
Equine Therapy |
Equine therapy includes interactions between the member and horses to help improve behaviors and emotions. |
Up to 10 therapy treatment sessions per year for 21+ years old. One evaluation/re-evaluation per year. |
Plan OK Needed |
Occupational Therapy |
Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself, and using items around the house |
Up to 7 therapy treatments unit per week for 21+ years old. One evaluation/re-evaluation per year |
Plan OK Needed |
Physical Therapy |
Physical therapy includes exercises, stretching and other treatments to help your body get stronger and feel better after an injury, illness or because of a medical condition. |
Up to 7 therapy treatments unit per week for 21+ years old. One evaluation/re-evaluation per year |
Plan OK Needed |
Hearing Services |
Hearing tests, treatments, and supplies that help diagnose or treat problems with your hearing. This includes hearing aids and repairs. |
Please contact member services for more information 1-866-899-4828 Service is for 21+ years old |
No Plan OK Needed |
Vision Services |
Visual Aids are items such as glasses and contact lenses. |
Contact lenses - 6-month supply for 21+ years old Frames – 1 per year for 21+ years old. Also includes one eye exam per year. |
Please contact 20/20 Vision at 1-877-296-0799 |
Prenatal Services |
Services that ensure that you and your baby are healthy during and after your pregnancy. |
Please contact member services for more information 1-866-899-4828. Plan OK needed for hospital grade breast pump rental. |
Please contact member services for more information 1-866-899-4828 |
Respiratory Therapy |
Services to help you breathe better while being treated for a respiratory condition, illness or disease |
One (1) per day for 21+ years old. One evaluation/re-evaluation per year and one treatment per day; does not require plan OK. |
Plan OK Needed |
Speech Therapy |
Services that include tests and treatments to help you talk or swallow better. |
Up to 7 therapy treatments units per week. One evaluation/re-evaluation per year, one evaluation of oral & pharyngeal swallowing function per year, one AAC initial evaluation per year, one AAC re-evaluation per year, and up to 4 30-minute sessions for AAC fitting, adjustment, & training visits per year; does not require plan OK. |
Plan OK Needed |
Primary Care Services |
Routine or sick visits to your Primary Care Physician (PCP) for adults 21+ years old |
Unlimited Visits |
No Plan OK Needed |
Newborn Circumcision |
Available upon request during the initial hospitalization visit and in physician offices within 12 weeks after birth. A limit of (1) per lifetime. |
Available within the first (12) weeks of birth. One (1) per lifetime. |
No Plan OK Needed |
CVS Discount Program |
All enrollees will receive a CVS discount card providing 20% off purchases including Over the Counter medications. |
20% discount off certain OTC items. |
No Plan OK Needed |
Doula Services |
A non-medical person who stays with and assists you before, during, or after childbirth. |
Unlimited per pregnancy |
No Plan OK Needed |
Medically Related Home Care Services/Homemaker |
Homemaker service for medical needs |
2 carpet cleanings/year for enrollees with asthma. |
Plan OK Needed |
Home Delivered Meals – Post Facility Discharge (Hospital or Nursing Facility) |
Meal delivery after your inpatient hospital stay |
Ten (10) meals annually. |
No Plan OK Needed |
Home Delivered Meals – Disaster Preparedness/Relief |
Meal delivery before or after a natural disaster |
One (1) annually. |
No Plan OK Needed |
Home Visit by a Clinical Social Worker |
Services of a clinical social worker in home health or hospice setting. |
48 visits per year for 21+ years old. |
Plan OK Needed |
Meals and Lodging – Non-emergency Transportation Day-Trips |
For non-emergency care when you have to travel a long distance. |
$150 per stay. |
No Plan OK Needed |
Nutritional Counseling |
Provides you with information on the right type of foods to eat and based on your health needs. |
Unlimited. |
Plan OK Needed |
Swimming Lessons |
Drowning Prevention Lessons |
Members up to age 11 are covered for up to $200 per year. This is limited to 1000 enrollees per year. |
Plan OK Needed |
Vaccine – TdaP |
Preventive Service |
One (1) vaccine per pregnancy. |
No Plan OK Needed |
Vaccine – Influenza |
Preventive Service |
Unlimited. |
No Plan OK Needed |
Vaccine – Shingles |
Preventive Service |
One (1) per year. |
No Plan OK Needed |
Vaccine – Pneumonia |
Preventive Service |
Unlimited. |
No Plan OK Needed |
Waived Copayments |
All services, including behavioral health. |
Ages 21+ years old. |
No Plan OK Needed |
Medication Assisted Treatment |
Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program |
Ages 21+ years old. |
Plan OK Needed |
Vaccine – Hepatitis A |
Preventive Service |
Ages 21+ years old. |
No Plan OK Needed |
Housing Assistance |
Supported Housing, per month |
Ages 21+ years old. |
Plan OK Needed |
Non-emergency Transportation - Non-Medical Purposes |
Transportation: ancillary: parking fees, tolls, other |
Ages 21+ years old. |
Plan OK Needed |
Therapy - Art |
Activity therapy, such as music, dance, art, or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) |
Ages 21+ years old. |
Plan OK Needed |
Therapy - Pet |
Activity therapy, such as music, dance, art, or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) |
Ages 21+ years old. |
Plan OK Needed |
Hospital Bed |
Durable Medical Equipment |
Ages 21+ years old. |
Plan OK Needed |
Glucose Monitoring |
Durable Medical Equipment |
Ages 21+ years old. |
Plan OK Needed |
Breast Pump |
Durable Medical Equipment |
Ages 21+ years old. |
Plan OK Needed |
Assessment Services |
Evaluation & Assessments |
Ages 21+ years old. |
Plan OK Needed |
Behavioral Health Day Services/Day Treatment |
Behavior Health Day Treatment |
Ages 21+ years old. |
Plan OK Needed |
Behavioral Health Screening Services |
Behavioral Health Screening Services |
Ages 21+ years old. |
Plan OK Needed |
Behavioral Health Medical Services (Verbal Interaction) |
Behavioral Health Medical Services (Verbal Interaction), Mental Health /Behavioral Health Medical Services (Verbal Interaction), Substance Abuse |
Ages 21+ years old. |
Plan OK Needed |
Behavioral Health Medical Services (Medication Management) |
Medication Management |
Ages 21+ years old. |
Plan OK Needed |
Behavioral Health Medical Services (Drug Screening) |
Behavioral Health Medical Services (Alcohol and Other Drug Screening Specimen Collection) |
Ages 21+ years old. |
Plan OK Needed |
Psychosocial Rehabilitation |
Psychosocial rehabilitation services |
Ages 21+ years old. |
Plan OK Needed |
Substance Abuse Treatment or Detoxification Services (Outpatient) |
Ambulatory setting substance abuse treatment or detoxification services |
Ages 21+ years old. |
Plan OK Needed |
Therapy (Individual/Family) |
Individual and Family Therapy / Brief Individual Psychotherapy / Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) |
Ages 21+ years old. |
Plan OK Needed |
Behavioral Health On-Site Services |
Therapeutic Behavioral On-Site Services, Behavior Management |
Ages 21+ years old. |
Plan OK Needed |
Targeted Case Management |
Targeted Case Management |
Ages 21+ years old. |
Plan OK Needed |