Common use of Special service access requirements Clause in Contracts

Special service access requirements. 5.20.2.1 School-based health centers. 5.20.2.1.1 Contractor shall offer contracts to all the school health centers recognized by the Department of Public Health that are in Contractor’s Contracting Area. Contractor shall not require prior authorization or a Referral as a condition of payment for school- based health center services provided by those school-based health centers with which Contractor has contracts. 5.20.2.1.2 For school-based health centers outside of the Contracting Area, Contractor shall accept claims from non-Network Providers of school-based health center services. Contractor shall make payment to non- Network Providers of such services according to the Department’s applicable Medicaid FFS reimbursement schedule. Contractor may require school-based health centers to follow Contractor’s protocols for communication regarding services rendered in order to further care coordination.

Special service access requirements. 5.20.2.1 School-based health centers. 5.20.2.1.1 Contractor shall offer contracts to all the school health centers recognized by the Department of Public Health that are in Contractor’s Contracting Area. Contractor shall not require prior authorization or a Referral as a condition of payment for school- school-based health center services provided by those school-based health centers with which Contractor has contracts. 5.20.2.1.2 For Illinois school-–based health centers outside of the Contracting Area, Contractor shall accept claims from non-non- Network Providers of school-based health center services. Contractor shall make payment to non- non-Network Providers of such services according to the Department’s applicable Medicaid FFS reimbursement schedule. Contractor may require school-based health centers to follow Contractor’s protocols for communication regarding services rendered in order to further care coordination.