organic disorders, nicotine and caffeine use problems, pervasive developmental, TIC and neurological disorders, conduct and impulse control disorders, antisocial personality disorder, paraphilias, insomnia and other sleep related disorders (some of these may be covered under the medical part of the plan) Wellmark excludes bereavement counseling or services, family counseling, impulse control The benefits and pricing make provision for disorders, certain developmental and learning inpatient days and outpatient visits. Intent was disorders, certain disorders of early childhood, not to exclude service locations. communication disorders, nicotine dependence, Coverage for full continuum of treatment sensitivity, shyness and social withdrawal services disorder, sexual identification or gender disorders. All of the health plans provide inpatient and outpatient services subject to above limits. John Cost is dependent on what method the quality Deere covers partial hospital/day treatment assurance committee would recommend to programs that may be independent or determine adequate access. Wellmark reimburses for mental health day programs based out of the hospital setting Adequate provider panels billing using a UB92. For community mental A cost estimate is not necessary for this. health centers to be able to provide day programming, they can only bill services using an HCFA-1500; therefore, level of reimbursement Admission, discharge, continued stay, and for would be different. CMHC’s placement criteria are specific to children and adolescents and that the Iowa Juvenile Placement Criteria for substance abuse be used. Each plan has its own criteria to determine medical necessity for mental health and substance abuse. 5. Nutrition Services. Cost estimate for nutrition services: Medically necessary nutrition services Iowa Health Solutions covers medically $16- $17 per half hour, with an estimated should be covered by a license dietitian with necessary nutritional services. In certain cases frequency of 200/1000/year = .27 per member a allow coverage for medically necessary formulas. per month to .28 per member per month physician’s referral. Provide for nutrition services beyond basic Each case is reviewed individually by the
Coverage for full continuum of treatment services Adequate provider panels Admission, discharge, continued stay, and placement criteria are specific to children and adolescents and that the Iowa Juvenile Placement Criteria for substance abuse be used. organic disorders, nicotine and caffeine use problems, pervasive developmental, TIC and neurological disorders, conduct and impulse control disorders, antisocial personality disorder, paraphilias, insomnia and other sleep related disorders (some of these may be covered under the medical part of the plan) Wellmark excludes bereavement counseling or services, family counseling, impulse control disorders, certain developmental and learning disorders, certain disorders of early childhood, communication disorders, nicotine dependence, sensitivity, shyness and social withdrawal disorder, sexual identification or gender disorders. All of the health plans provide inpatient and outpatient services subject to above limits. John Deere covers partial hospital/day treatment programs that may be independent or Wellmark reimburses for mental health day programs based out of the hospital setting billing using a UB92. For community mental health centers to be able to provide day programming, they can only bill services using an HCFA-1500; therefore, level of reimbursement for CMHC’s would be different. Each plan has its own criteria to determine medical necessity for mental health and substance abuse. The benefits and pricing make provision for inpatient days and outpatient visits. Intent was not to exclude service locations. Cost is dependent on what method the quality assurance committee would recommend to determine adequate access. A cost estimate is not necessary for this. 5. Nutrition Services. Medically necessary nutrition services should be covered by a license dietitian with a physician’s referral. Provide for nutrition services beyond basic Iowa Health Solutions covers medically necessary nutritional services. In certain cases allow coverage for medically necessary formulas. Each case is reviewed individually by the Cost estimate for nutrition services: $16- $17 per half hour, with an estimated frequency of 200/1000/year = .27 per member per month to .28 per member per month
HAWKI_2003AnnualReport.docx