June 21, 2017
The following has been reviewed and approved by DMAS – we are working with DMAS to be sure that the material distributed is as clear as possible!
Plans are required to cover at least those items and services currently covered by Medicaid; they may choose to cover additional services/items. For individuals enrolled in one of the DD Waivers, the Waiver service is the first choice, in other words, if the service is an option in the DD Waiver in which the individual is enrolled, the service should be included in the individual’s ISP and authorized for payment under that DD Waiver not as a CCC Plus service.
Of special note, the basic health benefit “prescription drugs and over-the-counter medications (when prescribed by doctors)” should not be read to broadly, the DMAS formulary still applies; under this benefit, the Health Plan only must cover what is in the formulary.