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Molina Healthcare of Florida

Member Services: Toll free (866) 472-4585 or TTY/TDD (800) 955-877

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Our goal is to provide you with the best care possible. All covered services below must be received by providers that are part of the Molina Healthcare Health Plan and prior approval may be required. You may want to know services that are with regular Medicaid. You can call your local Medicaid office. !
Benefits Covered Molina Medicaid Prior Auth. Require d (Y/N) Community Plus Plan Prior Auth. Required(Y/ N)

Adult Well Care

Adult well care visits are covered one per fiscal year (June July). These services may be provided by your PCP. An annual well woman (pap smear) is in addition to the annual adult well care visit.

Covered for both Reform and NonReform members

Medically necessary covered services to treat a particular injury, illness or disease. Medicare primarily covers these services.

Ambulance use is covered when: Ambulance You must go to the hospital in an emergency. You may need to be taken from one hospital to another. This will need to be approved by Molina Healthcare. Used in a 911 situation. Ambulance is covered for Reform members, but not a covered benefit for Non-Reform members.

These services are primarily covered by Medicare.

Childrens Health

Screenings and routine office visits. Immunizations are covered per the immunization schedule of the United States. For this list, see the Preventive Health Guidelines. Chiropractic services are covered. Prior approval is needed for more than 10 visits.

Covered for both Reform and NonReform members

N/A

N/A

Chiropractic

Covered for both Reform and NonReform members

Y- for more than 10 visits

Chiropractic services are covered under Medicare. Dental services include: Annual examination X-rays Fluoride treatment (every 6

Adult services include the following: Dental Services Routine preventive services Diagnostic and restorative services Radiology services

Covered for both Reform and NonReform members

YRefer to Denta Quest

Y- Refer to DentaQue st at (888)6969541

Full and partial denture services Emergency dental for pain and infection

at (888) 6969541

months)

Children under the age of 21 are covered for the following: Diagnostic services Preventive treatment Restorative treatment Endodontic treatment Periodontal treatment Surgical procedures and/or extractions Orthodontic treatment Complete and partial dentures Emergency services Dermatology services are covered without a referral to a doctor that is part of Molina Healthcare. Medically necessary equipment, supplies and services to treat diabetes. Self and education services are covered per the American Diabetes Association standards. Covered for both Reform and NonReform members These services are primarily covered by Medicare

Dermatology

Diabetes Supplies and Education

Covered for both Reform and NonReform members

These services are primarily covered by Medicare

Dialysis Free

Covered for both

These services are

Standing

Dialysis services are covered and include: Routine laboratory tests Supplies Preventive care Diagnostic care

Reform and NonReform members

Nnotific ation only

primarily covered by Medicare

Durable Medical Equipment (DME)

Durable Medical Equipment (DME) is covered for children and adults. Adults have limited benefits. Examples of DME equipment are: Wheelchairs, nebulizers, oxygen and C-PAP. Emergencies are covered at any hospital. They are available 24 hours a day, 7 days a week. You do not need approval. Call 911 or go to the nearest emergency room.

Covered for both Reform and NonReform members

These services are primarily covered by Medicare

Emergency Services

Covered for both Reform and NonReform members

Same language N

The States Enhanced Benefit Rewards Program offers you rewards for improving your health. Enhanced When a reform plan beneficiary Benefit Rewards participates in an approved Program healthy behavior, they earn credits that can be used to buy over-thecounter health-related items at Medicaid pharmacies. Some

The Enhanced Benefit Rewards Program only applies to Reform members.

N/A N

N/A

approved healthy behaviors are: Immunizations for children Dental checkups for children Taking your prescriptions as directed Weight loss programs

You can earn up to $125 of credits per state fiscal year (July June). All reform beneficiaries are eligible. For questions, call the Enhanced Benefit Call Center at (866) 421-8474 or email enhancedbenefit@ahca.myflorida. com.

Family Planning Services

Family planning services include: Education and counseling, initial examination, diagnostic procedures and routine laboratory studies, contraceptive drugs and supplies and follow-up care. You may receive these services at: Your PCP Rural health centers County health departments

Covered for both Reform and NonReform members

N/A N

N/A

Federal qualified health centers Includes exam and evaluation every three years. Limit of one hearing aid per ear every three years, including repairs. Home Health Care Services include: Occupational therapy Physical therapy Speech therapy Home Health Aide Skilled Nursing **If ordered by a doctor and medically necessary***

Hearing Services

Hearing services include: Evaluation and diagnostic testing, hearing aids and repair.

Covered for both Reform and NonReform members

Home Health Care Services include: Wound care Nutritional infusion Personal care per doctor request These services are performed by a registered nurse or licensed nurse.

Home Health Care Services

Covered for both Reform and NonReform members

Immunizations

Immunizations are covered for children under the age of 21.

Covered for both Reform and NonReform members

N/A

N/A

Medically needed and approved hospital care when you are in a hospital. Services covered include: Inpatient Hospital Services Room and board Nursing care ! Medical supplies ! Diagnostic services ! Therapeutic services ! Drugs
! !

NonReform: Limited to 45 days per fiscal year (July-June) including behavioral health. Reform: Limited to 45 days per fiscal year (July June) except for emergency admission. Children under 21 and pregnant adults have inpatient coverage for Y These services are primarily covered by Medicare Y

365 days.

If you want to speak to us in your own language, you may ask for an interpreter. You may call Member Services at (866) 472-4585. Interpreter Services If you are vision and/or hearing impaired, call our TTY phone number at (800) 955-8771. These services are free of charge.

Covered for both Reform and NonReform members

Same language

Laboratory

Molina has contracted with Quest Diagnostics for all your outpatient lab work. Your doctor will send lab work to Quest Diagnostics. If you need to go for lab tests you may visit www.QuestDiagnostics.com/patie nt to find a location or make an appointment. You can also call Molina Healthcares Member Services at (866) 472-4585 for a list of locations.

Covered for both Reform and NonReform members

These services are primarily covered by Medicare

Maternity Services Prenatal and Postpartum

Nurse Advice Line

Molina Healthcare covers pre- and post-partum maternity care with an OB-GYN that is part of the Molina Healthcare Health Plan. Vaginal deliveries are covered for no less than 48 hours of inpatient stay. Csection deliveries are covered at least 96 hours of inpatient stay. This service is available 24 hours a day, 7 days a week to help answer medical questions you may have. The number is (888) 275-8750 Medically necessary preventive and diagnostic services provided in an outpatient hospital setting. Some outpatient services may have a dollar limit of $1500 per fiscal year (July June). Some outpatient services require prior authorization. Molina will pay up to $25 maximum per household per month for specific over-thecounter items purchased at a Molina contracted pharmacy Podiatry routine care is covered. Routine services include: Cutting and removal of

Covered for both Reform and NonReform members

N/A

N/A

Covered for both Reform and NonReform members

Same language

Outpatient Hospital Services

Covered for both Reform and NonReform members

Outpatient hospital services include all diagnostic procedures or services provided in a hospital outpatient setting. Medicare primarily covers these services

Over-theCounter Pharmacy

Covered for both Reform and NonReform members Covered for both Reform and NonReform members

Same language

Podiatry

Medicare primarily covers services other than routine foot care

corns and calluses Trimming of nails Routine hygienic care of the foot

Prescription Drugs

Medically necessary drugs prescribed by a physician and provided at a licensed pharmacy that is part of the Molina Plan

Covered for both Reform and NonReform members

Yrefer to the Molina Y- refer to Drug Medically necessary the Molina List drugs prescribed by a Drug List Formul physician and Formulary ary or provided at a licensed or contact contac pharmacy that is part Member tMemb of the Molina Plan. Services er Medicare primarily (888) 472Servic covers these services 4585 es (888) 4724585

Prosthetics & Orthotics

Prosthetic & orthotic devices are covered. They need to be medically necessary and approved. Orthotic devices help correct weak or abnormal body parts. These devices aid in limiting or reducing motion in a diseased or injured

Covered for both Reform and NonReform members

These services are primarily covered by Medicare

part of the body. Prosthetics are artificial devices that replace all or part of a permanent body part. Sterilization is a covered benefit. Please contact your doctor for any needed prior approvals. Covered for both Reform and NonReform members

Sterilization

N/A Physical, occupational, and speech therapies provide members with treatment to restore, improve or maintain impaired functions aimed at increasing or maintaining the enrollees ability to perform tasks required for independent functioning when determined through a multidisciplinary assessment to improve a members capability to live safely in the home setting. In addition, respiratory therapy is

N/A

Therapy ServicesPhysical, Respiratory, Occupational and Speech Therapies

Occupational, physical, respiratory and speech therapies are covered under the age of 21. Adults are covered for physical and respiratory services in an outpatient hospital setting. An initial evaluation plus 6 visits.

Covered for both Reform and NonReform members

YAfter initial evalua tion plus 6 visits.

treatment of conditions that interfere with respiratory functions or other deficiencies of the cardiopulmonary system. The following transplants are covered: Bone marrow Cornea Heart Kidney Liver Lung Pancreas

**The following transplants are covered for NonReform members: Bone Marrow Cornea Kidney Pancreas Y These services are primarily covered by Medicare Y

Transplants

Transplants must be medically necessary and approved. Evaluations are covered for all transplants. Pre and post care is covered for all transplants including those that are not covered by Molina Healthcare. Donor services are not covered. **The above covered transplants only apply to Reform members**

Transportation

If you need a ride to your doctor appointments, you may call Logisticare at (866) 528-0454 or for TTY (866) 288-3133 to schedule a ride. These services need prior approval. A wheelchair van is available if needed. You may also call your PCP or Member Services at (866) 4724585 to assist you.

Transportation is not available for Non-Reform members through Molina, please contact Medicaid.

Y- non emerg Emergency medical ent transportation is ground covered. Medicare and air primarily covers these ambul services ance

Vision

Unlimited eye exams and eyeglasses, if medically necessary. Contact lenses are also covered, if medically necessary.

Refer to March Vision Care at (888) 4934070

Vision services cover eye exams and pair of eyeglasses per year including repair. These services need to be medically necessary. Adult companion services include: Non- medical care Supervision Socialization **does not include hands on nursing care. This service provides social and health

Refer to March Vision Care at (888) 4934070

Adult Companion Services

N/A

N/A

N/A

Adult Day Health Center

N/A

N/A

N/A

Assisted Living Services

N/A

N/A

N/A

Chore Services

N/A

N/A

N/A

Consumable Medical Supplies

N/A

N/A

N/A

activities in an organized day program at a center. Assisted living services include: Personal Care Housekeeping Medication Oversight Social programs to assist the member in an assisted living facility These services assist with heavy household chores to maintain your home as a clean and safe living environment Disposable supplies necessary to appropriately care for the needs of the member include: Disposable diapers Gloves Gauze Tape This service does not include items covered

Environmental Accessibility Adaptation Services

N/A

N/A

N/A

Escort Services

N/A

N/A

N/A

Family Training Services Financial Assessment

N/A N/A

N/A N/A

N/A N/A

under the Medicaid home health services such as: Detergents Bleach Paper Towels Prescription Drugs These are changes to the members home to ensure safety and help the member function with greater independence in the home. This excludes adaptations or improvements to the home that are of general use and are not of direct medical or remedial benefit to the member. This service assists members who require an individual to accompany them to a medical appointment. These services help train family members who provide care for you Provides our members with

Y Y

/Risk Reduction

Home Delivered Meals

N/A

N/A

N/A

Homemaker Services

N/A

N/A

N/A

Nursing Facility Services

N/A

N/A

N/A

Nutritional Assessment/Ris k Reduction Personal Care

N/A

N/A

N/A

N/A

N/A

N/A

guidance regarding financial activities such as bill paying. This service is provided for our members who have difficulty preparing food and nutritional supplements for members who have a medical need. Household activities such as meal preparations and chores. Available service for members who require such services. Medicare covers skilled nursing home services. The Florida Department of Children and Families will determine a patients financial responsibility. Provides our members with guidance and education about nutrition to you and your family. These services are

Services

Personal Emergency Response System

N/A

N/A

N/A

Community Mental Health Services

N/A

N/A

in-home assistance with: Bathing Dressing Eating Personal Hygiene This is a service provided by an electronic device that helps a member at high risk to get help at home in an emergency. It is limited to members who live alone or who are alone for significant parts of the day and who would otherwise require extensive supervision. Outpatient treatment of mental health and substance abuse or inpatient treatment when the condition may present a danger to the person or to others. Services must be under the care of a psychiatrist. Medicare primarily covers these

services. ! Note: For a full and detailed list of benefit information, please refer to your Member Handbook or call Member Services.

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