Physician services
AL | CA | FL | IN | MT | NE | NY | NC | WV "PATIENT 1ST REFERRED SERVICES
The following services DO REQUIRE a referral from the Patient's Primary Medical Provider...
Service...
Physicians." Alabama PMP, Attachment 4, unnumbered pages."MANDATORY CAPITATED SERVICES...
PHYSICIAN SERVICES
Norplant...
Immunizations/Injections...
Psychiatry...
Cardiovascular...
Vascular Testing...
Pulmonary...
Allergy...
Neurology...
Chemotherapy Injections...
Special Dermatological...
Physical Medicine...
Special Services...
Neonatal ICU...
Other...
Blood & Products...PHYSICIAN VISITS
Office...
Out-Patient Consult.
Confirm Consult...
Critical Care...
Skilled Nursing Facility...
Boarding Home..." California Contract, Attachment A, pages AI- AIV."Services to be managed
1. General Services. It is agreed that the MediPass provider will provide patient management for the following services for each patient: ...
--Physician Services..." Florida Agreement, page 4."1. Role of the Primary Medical Provider
The provider agrees to function in the role of Primary Medical Provider (PMP), as an authorized provider for the Hoosier Healthwise Program's Primary Care Case Management provider network. In this role, the PMP will provide, or will arrange for the provision of, routine comprehensive preventive services, medically necessary primary care treatment and urgent care services, in keeping with the universally accepted standards as defined by Article II, Paragraph 1, of this Addendum. In particular, the PMP will provide or authorize the following services:physician services" Indiana Contract, page 1.
MT"E. 'Exempt Services' are those Medicaid services which do not need to be provided or authorized by the enrollee's primary care provider. Exempt services include the following: ...
The following subcategories of PASSPORT-managed services do not require authorization:
anesthesiology..." Montana Agreement, pages 2-3."1.1.34 The Term 'NHC Benefits Package', also commonly referred to as the Basic Benefits Package, shall include the following medical/surgical services, representing a minimum benefits package, as defined in this contract and 471Nebraska Administrative Code (NAC), that shall be arranged for by the Contractor to clients enrolled in the NHC: ...
(f) Physician services, including nurse practitioner services, certified nurse midwife services, and physician assistant services, anesthesia services, and physician assistant services including a Certified Registered Nurse Anesthetist, excluding anesthesia for MH/SA (See 471 NAC 18000 and 29000)..." Nebraska Contract, pages 5-7."COVERED SERVICES:
Covered services constitute services provided directly by the Contractor or Participating Provider and included in the capitation rate paid to the Contractor.Primary care medical services include assessment, diagnosis, and treatment (including the development and implementation of an individual treatment plan) of conditions not requiring a specialist.Physician Services: Services provided in an office, home, hospital, or clinic. Physician services include the full range of primary care and preventive medical services. The Contractor shall provide health screening examinations and immunizations for Enrollees under this Agreement in accordance with the same standards set forth in the Child/Teen Health Plan ('C/THP') requirements specified in 42 CFR, Part 441, sub-part B, and 18 NYCRR.
Routine obstetrical/gynecological services, which include: a physical examination in accordance with the guidelines of the American College of Obstetricians and Gynecologists, pap smear, breast exams, and pelvic exams." New York Contract, Appendix L, page 1.
"Introduction
Adult Medicaid recipients receive preventive health care through Adult Health Screenings. An Adult Health Screening is a package of preventive services that can be performed once per year on Medicaid recipients that are 21 years of age or older.Definition
Adult Health Screening is a service that provides preventive health care for adults through annual health assessments with the exception that it will prevent serious illness through early detection and treatment.Adult Health Screenings are delivered through local health department clinics, rural health centers, Federally Qualified Health Centers, Carolina ACCESS Primary Care Providers serving adults and other physicians in private practices..." North Carolina Agreement, Adult Health Screening, page 1.
"IV. IT IS AGREED THAT THE PAAS PHYSICIAN OR CLINIC WILL:
A. Provide patient care management for the following services: physician services..." West Virginia PAAS, page 3.