Prosthetics and Orthotics Clause Samples

Prosthetics and Orthotics. Psychosocial Rehabilitation Services Radiology Facilities Recovery Services (Behavioral Health) Rehabilitation Option Services Rehabilitation Services Providers Reproductive Health Services Respite (Behavioral Health) (annual limits may apply but may be exceeded based on the Member's health and safety needs) Rural Health Clinics Services School-Based Services Screening, Brief Intervention, Referral to Treatment (SBIRT) Services Speech and Language Therapy Supportive Housing (limitations apply) Swing Bed Hospital Services Telemedicine Services Tobacco Cessation treatment and services (may include counseling, prescription medications, and products) Tot-to-Teen Health Checks Transplant Services Transportation Services (medical) Transitional Care Management services Treatment ▇▇▇▇▇▇ Care I Treatment ▇▇▇▇▇▇ Care II Vision Care Services Agency-Based Community Benefit Services Included Under Turquoise Care Adult Day Health Assisted Living Behavior Support Consultation Community Transition Services Emergency Response Employment Supports Environmental Modifications ($5,000 limit every five years) Home Health Aide Nutritional Counseling Personal Care Services (Consumer Directed and Consumer Delegated) Private Duty Nursing for Adults Respite (annual limits may apply) Skilled Maintenance Therapy Services Self-Directed Community Benefit Services Included Under Turquoise Care Behavior Support Consultation Customized Community Support Emergency Response Employment Supports Environmental Modifications ($5,000 limit every 5 years) Home Health Aide Self-Directed Personal Care (formerly Homemaker) Start-Up Goods (For Member electing SDCB on or after January 1, 2019, one-time limit of $2000) Nutritional Counseling

Prosthetics and Orthotics. Leg, arm, back and neck braces, artificial legs, arms, and eyes, and external breast prostheses after a Mastectomy. These Services include: adjustment, repairs, and replacements required because of breakage, wear, loss, or a change in the patient’s physical condition.

Prosthetics and Orthotics. The following Prosthetic Devices and Orthotics, including but not limited to the following list, are Medicaid benefits for clients of all ages if Medical Necessity has been established and use in the home setting has been determined to be appropriate. Medical Necessity shall be determined based on criteria established by the Department, and in accordance with 10 CCR 2505-10, Section 8.590.2A: • Ankle-foot/knee-ankle-foot Orthotics • Artificial limbs • Augmentative communication devices and communication boards • Colostomy (and other ostomy) bags and necessary accouterments required for attachment, including irrigation and flushing equipment and other items/supplies directly related to ostomy care • Facial prosthetics • Lumbar-sacral orthoses (LSO) • Orthopedic footwear, including shoes, related modifications, inserts and heel/sole replacements when an integral part of a leg or ankle brace • Recumbent ankle positioning splints • Rigid and semi-rigid braces • Specialized eating utensils and other Medically Necessary activities of daily living aids; and • Therapeutic shoes • Thoracic-lumbar-sacral orthoses (TLSO) Covered Services include the rental or purchase of Prosthetic Devices and supplies including repair, maintenance and delivery. Preference will be given to items with demonstrated strength, durability, ease of use and appropriateness for the Client and for conditions under which the devices will be operated. Coverage in a particular case is subject to the requirement that the devices be Medically Necessary for treatment of an illness, injury, condition, secondary disability, or for maintenance of health. Prosthetic Devices may be recommended by an appropriate licensed practitioner, but must be prescribed by a doctor of medicine or a doctor of osteopathy. All of the following are benefits of the program when provided by a rural health clinic that has been certified in accordance with 10 CCR 2505-10 8.740 insofar as these services provided are otherwise reimbursable under the Program.

Prosthetics and Orthotics.  Covered.  (SSA §1905(a)13)  (State Plan, Covered for services rendered beyond Medicare Part B Covered. Part B. Includes arm, leg, back, and neck braces; artificial eyes; artificial limbs and replacements; certain breast prostheses Addendum to Attachment 3.1-A, Page 12(c), TN 95- 41) benefit limits. Includes (but is not limited to) coverage for certified shoe repair, hearing aids, and dentures. following mastectomy; and prosthetic devices for replacing internal body parts or functions. Excludes dentures, hearing aids and exams for fitting hearing aids. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability. Renal Dialysis  Covered.  Covered for services rendered beyond Medicare Part B benefit limits. Part B. Covered for members with End- Stage Renal Disease (ESRD). Certain restrictions and options apply to coverage under SNP. See 42 CFR 422.50(a)(2)(ii); 42 CFR 422.52(c). Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability. Routine Annual Physical Exams  Covered.  Covered for services rendered beyond Medicare Part B benefit limits. Covered. Part B. Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability.