Healthfirst Medicaid and Personal Wellness Plan
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- Maximilian Arnold
- 5 years ago
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1 The Healthfirst Personal Wellness Plan (PWP) is a Health and Recovery Plan, or HARP, approved by New York State. It includes the same benefits package as Medicaid, PLUS access to community support programs, behavioral health treatment, and other impactful health services that can help you live life to the fullest. As a Healthfirst PWP member, you ll also be assigned a Health Home Care Manager who ll work with your healthcare providers and pay special attention to your needs. Medical Services Services Medicaid HARP Adult Day Health Care Adult Protective Services Advance Imaging Services AIDS Adult Day Health Care Audiology, Hearing Aids Services & Products Bariatric Surgery BRCA Genetic Testing Breast Cancer Surgery Cardiac Rehabilitation, as medically necessary, as medically necessary Cataract Surgery, as medically necessary, as medically necessary Chiropractic Services Cognitive skills development testing Consumer Directed Personal Assistance Services (CDPAS) Cosmetic Surgery, if medically necessary, if medically necessary Court-Ordered Services, pursuant to court order, pursuant to court order Crisis Intervention Services. Mobile Crisis, Intensive Crisis Respite and Short Term Day Treatment Dental and Orthodontic Services Durable Medical Equipment (DME). Mobile Crisis, Intensive Crisis Respite and Short Term Page 1 of 5
2 Medical Services (Cont.) Services Medicaid HARP Emergency Services Emergency Transportation Not, by LogistiCare & MAS Not, by LogistiCare & MAS EPSDT Services/Child Teen Health Program (C/THP) Experimental and/or Investigational Treatment on a case-by-case basis on a case-by-case basis Eye Care and Low Vision Services Family Planning and Reproductive Health Services Maternity and Pregnancy Care Foot Care Services HIV and STI Screening, Counseling and Prevention Home Delivered Meals Home Health Services Hospice Inpatient Hospital Services Inpatient Stay Pending Alternate Level of Medical Care Laboratory Services HIV phenotypic, virtual phenotypic and genotypic drug resistance tests and viral tropism testing Maternal Depression Screening Medical Social Services only for those Enrollees transitioning from the LTHHCP and who received Medical Social Services while in the LTHHCP Midwifery Services Nurse Practitioner Services Observation Services Personal Care Services. When only Level I services provided, limited to 8 hours per week. Physician Services Podiatry Services if diabetic if diabetic to transitioned LTHHCP in Medical Social Services. When only Level I services provided, limited to 8 hours per week. Page 2 of 5
3 Medical Services (Cont.) Services Medicaid HARP Post-Stabilization Care Services Prescription and Non-Prescription (OTC) Drugs, Medical Supplies,. Long Acting Injectable. Long Acting Injectable and Enteral Formula Preventive Health Services Private Duty Nursing Services Prosthetic/Orthotic Services/ Orthopedic Footwear Psychotropic Medications, orthopedic footwear and compression stockings Risperidone microspheres Paliperidone palmitate Olanzapine Aripiprazole Haldol (haloperidol) Invega Sustenna Paliperidone Prolixin Zyprexa Relprevv (Non-Formulary) Invega Trinza (Non-Formulary) Abilify Maintena Risperdal Consta Radiology Services Rehabilitation Services. Outpatient physical, occupational and speech therapy limited to 20 visits each per calendar year. Limits do not apply to Enrollees under age 21, Enrollees who are developmentally disabled, and Enrollees with traumatic brain injury. Renal Dialysis Residential Health Care Facility (Nursing Home) Services (RHCF) Second Medical/ Surgical Opinion Smoking Cessation Products Bupropion Chantix Nicotine Replacement Therapy Tuberculosis Directly Observed Therapy Urgent Care, orthopedic footwear and compression stockings Risperidone microspheres Paliperidone palmitate Olanzapine Aripiprazole Haldol (haloperidol) Invega Sustenna Paliperidone Prolixin Zyprexa Relprevv (Non-Formulary) Invega Trinza (Non-Formulary) Abilify Maintena Risperdal Consta. Outpatient physical, occupational and speech therapy limited to 20 visits each per calendar year. Limits do not apply to Enrollees under age 21, Enrollees who are developmentally disabled, and Enrollees with traumatic brain injury. Page 3 of 5
4 Behavioral Health Services Services Medicaid HARP Assertive Community Treatment (ACT). Referrals required. Referrals required Buprenorphine Management: Naloxone, Suboxone Care Coordination for the HARP Program and HARP-Eligible Enrollees in the HIV SNP Program Community Psychiatric Support and Treatment (CPST) Services in Community Residences Comprehensive Psychiatric Emergency Programs (CPEPs) Continuing Day Treatment (CDT) Education Support Services Family Support and Training Habilitation Services Intensive Crisis Respite Intensive Psychiatric Rehabilitation Treatment (IPRT) Intensive Supported Employment (ISE) LDSS Mandated SUD Services, pursuant to Welfare Reform/LDSS mandate, pursuant to Welfare Reform/LDSS mandate Mental Health Services Non-Emergency Transportation by Logisticare by Logisticare Ongoing Supported Employment Partial Hospitalization Peer Supports-Empowerment Services Personal Emergency Response System (PERS) Personalized Recovery Oriented Services (PROS) i. Community Rehabilitation in 3 phases: in 3 phases: and Support (CRS) Pre-Admission Pre-Admission Admission Admission ii. Intensive Rehabilitation (IR) Active Rehabilitation Active Rehabilitation iii. Ongoing Rehabilitation and Support (ORS) iv. Clinical Treatment Page 4 of 5
5 Behavioral Health Services (Cont.) Services Medicaid HARP Pre-vocational Services Not Psychosocial Rehabilitation (PSR) Not Short-term Crisis Respite SUD Inpatient Detoxification Services Substance Use Management: Vivitrol Naltrexone SUD Inpatient Rehabilitation and Treatment Services SUD Medically Supervised Outpatient Withdrawal SUD Outpatient (Includes outpatient clinic; outpatient rehabilitation; and opioid treatment) SUD Residential Addiction Treatment Services Transitional Employment Page 5 of 5 Plans are offered by affiliates of Healthfirst, Inc. Plans contain exclusions and limitations HF Management Services, LLC INAHARP17_45(gr)
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Medicaid Managed Care The matrix below lists the available for adults (age 21 and older) enrolled in the West Virginia Mountain Health Trust and s. Ambulance Ambulatory surgical center services Some services
FREQUENTLY ASKED QUESTIONS (FAQS) FOR PROVIDER INDUSTRY
FREQUENTLY ASKED QUESTIONS (FAQS) FOR PROVIDER INDUSTRY 1. What changes are proposed for the Medicaid Program in the State Fiscal Year 2012 budget? Will clients be notified if these changes are not approved