Regional Generic Provider Agreement - Ohio Department of Job and ...
Regional Generic Provider Agreement - Ohio Department of Job and ...
Regional Generic Provider Agreement - Ohio Department of Job and ...
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Appendix G<br />
Covered Families <strong>and</strong> Children (CFC) population<br />
Page 3<br />
• Sex change surgery <strong>and</strong> related services<br />
• Sexual or marriage counseling<br />
• Acupuncture <strong>and</strong> bi<strong>of</strong>eedback services<br />
• Services to find cause <strong>of</strong> death (autopsy)<br />
• Comfort items in the hospital (e.g., TV or phone)<br />
• Paternity testing<br />
MCPs are also not required to pay for non-emergency services or supplies<br />
received without members following the directions in their MCP member<br />
h<strong>and</strong>book, unless otherwise directed by ODJFS.<br />
*These services could be deemed medically necessary if medical<br />
complications/conditions in addition to the obesity or physical<br />
imperfection are present.<br />
b. Limitations & Clarifications<br />
i. Member Cost-Sharing<br />
As specified in OAC rules 5101:3-26-05(D) <strong>and</strong> 5101:3-26-12,<br />
MCPs are permitted to impose the applicable member co-payment<br />
amount(s) for dental services, vision services, non-emergency<br />
emergency department services, or prescription drugs, other than<br />
generic drugs. MCPs must notify ODJFS if they intend to impose a<br />
co-payment. ODJFS must approve the notice to be sent to the<br />
MCP’s members <strong>and</strong> the timing <strong>of</strong> when the co-payments will<br />
begin to be imposed. If ODJFS determines that an MCP’s decision<br />
to impose a particular co-payment on their members would<br />
constitute a significant change for those members, ODJFS may<br />
require the effective date <strong>of</strong> the co-payment to coincide with the<br />
“Open Enrollment” month.<br />
Notwithst<strong>and</strong>ing the preceding paragraph, MCPs must provide an<br />
ODJFS-approved notice to all their members 90 days in advance <strong>of</strong><br />
the date that the MCP will impose the co-payment. With the<br />
exception <strong>of</strong> member co-payments the MCP has elected to<br />
implement in accordance with OAC rules 5101:3-26-05(D) <strong>and</strong><br />
5101:3-26-12, the MCP’s payment constitutes payment in full for<br />
any covered services <strong>and</strong> their subcontractors must not charge<br />
members or ODJFS any additional co-payment, cost sharing,<br />
down-payment, or similar charge, refundable or otherwise.