Provided to a patient before or after the date the patient is eligible for the program Provided outside the United States Not claimed (billed) by the provider within 90 days from the date of service or 90 days from the date of eligibility, if the patient was eligible in one or more of the three months before the application month Elective surgeries Provided by a immediate relative or household member patient’s Payable by or available under any health, accident or other insurance coverage, by any private or other governmental benefit system, by any legally liable third party or under other contract Provided by military medical facilities, or Veterans provided by military medical facilities, or Veterans Administration facilities, or United States public health service hospitals Related to any condition covered under the worker’s compensation laws. SPECIFIC EXCLUSIONS The following specific services or supplies are excluded: Separate payments for services and supplies to an institution that receives a vendor payment or has a reimbursement formula that includes the services and supplies as a part of institutional care. Whole blood or packed red cells available at no cost to the patient Take home items and drugs or non-prescribed drugs Treatment of flatfoot conditions, subluxations of the foot, and routine foot care and hygiene, including cutting or removal of corns, warts, calluses, and nail trimming Prosthetic and orthopedic devices Social and educational counseling with the exception of diabetic teaching/counseling provided at Medical Center Hospital Custodial care Autopsies Recreational therapy Separate fees for completing or filing a claim under the program Services or supplies that are not reasonable and necessary for diagnosis and/or treatment Dentures Prescriptions for and the cost of supportive devices and special shoes Eyeglasses and examinations for the prescription and fitting of eyeglasses Hearing aids Medical transportation unless ECHDA approved for emergency medical services as an optional service Chiropractors LIMITED SERVICES Exclude the following services and supplies unless the specified conditions are met:
Provided to a patient before or after the date the patient is eligible for the program Provided outside the United States Not claimed (billed) by the provider within 90 days from the date of service or 90 days from the date of eligibility, if the patient was eligible in one or more of the three months before the application month Elective surgeries Provided by a patient’s immediate relative or household member Payable by or available under any health, accident or other insurance coverage, by any private or other governmental benefit system, by any legally liable third party or under other contract Provided by military medical facilities, or Veterans provided by military medical facilities, or Veterans Administration facilities, or United States public health service hospitals Related to any condition covered under the worker’s compensation laws. SPECIFIC EXCLUSIONS The following specific services or supplies are excluded: Separate payments for services and supplies to an institution that receives a vendor payment or has a reimbursement formula that includes the services and supplies as a part of institutional care. Whole blood or packed red cells available at no cost to the patient Take home items and drugs or non-prescribed drugs Treatment of flatfoot conditions, subluxations of the foot, and routine foot care and hygiene, including cutting or removal of corns, warts, calluses, and nail trimming Prosthetic and orthopedic devices Social and educational counseling with the exception of diabetic teaching/counseling provided at Medical Center Hospital Custodial care Autopsies Recreational therapy Separate fees for completing or filing a claim under the program Services or supplies that are not reasonable and necessary for diagnosis and/or treatment Dentures Prescriptions for and the cost of supportive devices and special shoes Eyeglasses and examinations for the prescription and fitting of eyeglasses Hearing aids Medical transportation unless ECHDA approved for emergency medical services as an optional service Chiropractors LIMITED SERVICES Exclude the following services and supplies unless the specified conditions are met:
FY-2016-ECHDA-POLICY.docx