Specialty care/other providers
CA | FL | IA | NE "XX. Referral Providers
Refer members for services from non-plan providers only where the providers are Medi-Cal providers in good standing. Contractor will pay any co-payments required of members by an authorized referral provider of covered services, if co-payments are required by the Department and are requested by the provider in accordance with State law and regulations." California Contract, page 40."4. Excluded Services. It is agreed that the MediPass provider does not manage the physician components of opthalmological, mental health, or family planning services. These services, as well as other Medicaid services not specifically indicated as covered under MediPass, may be obtained by MediPass patients from a Medicaid provider of their choice. Recipients in Hillsborough, Hardee, Highlands, Manatee, and Polk counties will receive their Medicaid mental health services through Florida Health Partnership, Inc. (FHP). PCPs will not be required to authorize mental health services. However, MediPass patients must be referred to FHP for their mental health care.
4. Authorization and Referrals: It is agreed that the MediPass provider will...
d. Make referrals to the appropriate area Medicaid office for dental and/or transportation services.e. Authorize appropriate follow-up consultation and/or treatment for the duration of an illness subsequent to making a referral to a specialist for consultation and/or treatment of a specific condition. This shall include services rendered by the specialist and referrals made by the specialist for related services.
f. MediPass enrollees may receive up to 10 visits per calendar year of reimbursable services by Medicaid participating Chiropractors without prior authorization by the primary care provider. Any further visits shall require authorization by the primary care provider.
g. MediPass enrollees may receive up to 4 visits per calendar year of reimbursable services by Medicaid participating Podiatrists without prior authorization by the primary care provider. Any further visits shall require authorization by the primary care provider...
9. Disease Management Initiatives. It is agreed that the MediPass provider will cooperate to the greatest extent possible with disease management companies that have contracted with the Agency to provide disease management services to MediPass recipients." Florida Contract, pages 5, 7-9.
"The patient manager agrees to:
B. Pre-authorize payment when referring the patient to another provider or as medically necessary and in the manner prescribed by the Department in provider manual, for the following services: ...home health, physician (except ophthalmology), clinic (including ...Genetic Consultations Centers ... Ambulatory Surgical Centers) ...physical therapy, audiology...podiatry..." Iowa Agreement, pages 1-2."ARTICLE VII...
7.5 Designated Specialty Care Physicians: An appropriate specialist shall be allowed to function in an extended capacity with the PCP for clients with chronic conditions requiring specialty care." Nebraska Contract, page 73.