Medicaid (MMA)

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

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

CCP Expanded Benefits

Service Description Coverage/Limitations Prior Authorization

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;does not require prior authorization.

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;does not require plan OK..

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 for the first one 28 days after birth.

Up to 28 days old. 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

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

Behavioral Health Services

 

Intensive Outpatient Treatment

 

Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education.

 

 

 

 

 

Unlimited at an in-network facility for 21+ years old.

Plan OK Needed. Please contact Carisk for Authorization at 1-800-294-8642.

 

 

Pain Management Services

 

 

 

Acupuncture

 

 

 

 

 

 

Chiropractic Services

 

 

 

 

 

 

 

 

 

Massage Therapy

 

 

 

 

 

 

Treatments for long-lasting pain that does not get better after other services have been provided

 

Treatments for long-lasting pain that does not get better after other services have been provided

 

 

 

 

Treatments for long-lasting pain that does not get better after other services have been provided

 

 

 

 

 

 

 

20 units per year. Must be diagnosed with chronic pain or cancer for 21+ years old

 

 

13 additional visits per year. Must be diagnosed with chronic pain or cancer for 21+ years old

 

 

 

 

 

8 units (2 hours) per Month. Must be diagnosed with chronic pain or cancer for 21+ years old

 

 

 

 

 

 

 

 

Plan OK Needed

 

 

 

 

 

Plan OK Needed

 

 

 

 

 

 

 

 

Plan OK Needed

Click here to download the AHCA MMA Program Overview (PDF).