What services are included in the managed care benefit package for SSI and SSI-related Medicaid enrollees?
The benefit package for SSI enrollees is a “health only” package and includes: • All medically necessary physical health care, including primary care physician visits associated with a behavioral health diagnosis; • All laboratory services, emergency room visits and transportation, including those associated with behavioral health services or diagnoses; • Inpatient hospital admissions when the stay covers medical services or a combination of medical and behavioral health services but the DRG or rate code is not classified as behavioral health; • Drugs obtained and administered by a medical practitioner or facility, except for Risperdal Consta (J2794) which is reimbursed under Medicaid fee-for-service for all managed care enrollees; and • Chemical dependence detoxification services, including medically managed detoxification and medically supervised inpatient and outpatient withdrawal. The benefit package for SSI enrollees does not include the following behavioral health services, which
