And sometimes that's all you need. Unlimited units for verbal interaction, medication management and drug screening, Behavioral Health Psychosocial Rehabilitation, Services to help people re-enter everyday life (cooking, managing money and performing household chores), Computerized Cognitive Behavioral Analysis. No prior authorization required for the first three days of involuntary behavioral health inpatient admission. And remember, while there are plenty of benefits to breastfeeding, if you need to supplement or switch to formula, your baby will still grow and thrive. If you need a ride to any of these services, we can help you. Therapy services, behavior management, and therapeutic support are coordinated through individualized treatment teams to help members with complex needs from requiring placement in a more intensive, restrictive behavioral health setting. 1 Flu/Pandemic Prevention kit; 3 ply face masks 10 piece; oral digital thermometer; hand sanitizer. X-rays and other imaging for the foot, ankle and lower leg. Must be diagnosed with asthma to qualify. The hospital grade breast pump will be covered upon the mother's discharge from the hospital HUSKY Health will not reimburse for a pump while the mother is inpatient. Telehealth Services Transportation Services Member Resources Accessing Care Advance Directive Care Management Complaints, Grievances and Appeals Disease Management Emergency Situations EPSDT Program Fraud, Waste and Abuse Get the Most from Your Coverage Interoperability and Patient Access Key Contacts Member Handbook For children up to 21 there are no limits if medically necessary. Up to three screenings per calendar year. Up to 365/366 days for members ages 0-20. Lets go over some of the basics of breastfeeding. Call Member Services to ask about getting expanded benefits. It may help with brain development and learning. These services are voluntary and confidential, even if you are under 18 years old. Breast pumps will only be covered once per 3 years, and if the item is used for multiple pregnancies during the reasonable useful lifetime, only the kits will be covered. The Florida Dept. Hospital-grade breast pumps are used by mothers of NICU babies or when medical issues may hinder mom & baby's ability to successfully breastfeed. You will need Adobe Reader to open PDFs on this site. Supervision, social programs and activities provided at an adult day care center during the day. Medical care and other treatments for the feet. These tables list the services covered by our Plan. All services limited to one every two calendar years, except for hearing aid monaural in ear, which is one per calendar year. Medical care, treatment and emotional support services for people with terminal illnesses or who are at the end of their lives to help keep them comfortable and pain free. You can hire family members, neighbors or friends. Services can include housekeeping; help with bathing, dressing and eating; medication assistance; and social programs. We cover the following medically necessary services when prescribed by your doctor: Services that test and treat conditions, illnesses and diseases of the eyes. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or services. Or find a chapter of La Leche League, a group led by moms who offer support and encouragement to women looking to breastfeed. Your health insurance plan must cover the cost of a breast pump. Services used to help people who are struggling with drug addiction. Services to keep you from feeling pain during surgery or other medical procedures. Ordering a breast pump for your baby can be completely free, and Acelleron does all the work involved in making that happen. Apple Health covers deliveries provided by a licensed midwife, nurse midwife or physician. As medically necessary, some service and age limits apply. After 4 to 6 Weeks: Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. After the first three days, prior authorization required. These are 24-hour services if you live in an adult family care home. Order Your Insurance-Covered Breast Pump Today! One initial evaluation per lifetime, completed by a team. Eligible for the first 1,000 members who have received their flu vaccine. All at the touch of a button! Medical equipment is used to manage and treat a condition, illness, or injury. A review of all the prescription and over- the-counter medications you are taking. Priority Health has also partnered with Ovia for participants to have access to a free pregnancy tracker and Byram for covered breast pumps. Call us. Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions. This means you get to choose your service provider and how and when you get your service. If you need a ride to any of these services, we can help you. Participants may be directed to call Member Services at 1-800-859-9889. Medical equipment is used over and over again, and includes things like wheelchairs, braces, walkers and other items. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. SMI Specialty Plan members are eligible to receive $35 per household worth of OTC items each month. There may be some services that we do not cover, but might still be covered by Medicaid. A health and wellness program for birth, baby and beyond. They include help with basic activities such as cooking, managing money and performing household chores. Breastfeeding may benefit society - The OWH . Apple Health covers one manual breast pump per lifetime. These regular checkups allow doctors to find and treat health problems early, if needed. Specialized Therapeutic Foster Care Services. Doulas are trained non-medical companions that support pregnant people. There may be some services that we do not cover, but might still be covered by Medicaid. Talk to your care manager about getting expanded benefits. Because of the Affordable Care Act (ACA), health insurance providers are required to provide coverage for breastfeeding support, counseling, and equipment. Up to two office visits per month for adults to treat illnesses or conditions. Meals delivered to your home after discharge from hospital or nursing facility. Durable Medical Equipment/ It does not include major changes like new carpeting, roof repairs, plumbing systems, etc. Apple Health covers planned home births and births in birthing centers or hospitals. They include help with basic activities such as cooking, managing money and performing household chores. Sunshine Health is a managed care plan with a Florida Medicaid contract. Up to 480 hours per calendar year, as medically necessary. Comprehensive Behavioral Health Assessments. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Therapeutic counseling for primary caregivers who reside with LTC members in a private home. Follow-up wheelchair evaluations, one at delivery and one six months later. Breast milk can be stored at room temperature for 10 hours, in the refrigerator for up to eight days, and in a freezer for three months. One evaluation/re- evaluation per calendar year. The death of an infant in the US has been linked to a contaminated breast-feeding pump that was washed in a household sink. One frame every two years and two lenses every 365 days for adults ages 21 and older. Covered as medically necessary. Testing services by a mental health professional with special training in infants and young children. This means they are optional services you can choose over more traditional services based on your individual needs. Transportation to and from all of your medical appointments. These are medical-grade garments designed by healthcare professionals that provide lots of health benefits for moms. One therapy re- evaluation per six months. Prior authorization is required for voluntary admissions. Emergency substance abuse services that are performed in a facility that is not a regular hospital. We're here to help! Durable medical equipment is used over and over again, and includes things like wheelchairs, braces, crutches and other items. Unlimited hypoallergenic bedding and one (1) HEPA filter vacuum cleaner for members diagnosed with asthma. Provided to members with behavioral health conditions in an outpatient setting. SMI Specialty Plan members are eligible to receive $35 per household worth of OTC items each month. This includes having a case manager and making a plan of care that lists all the services you need and receive. You'll want to buy or rent a breast pump if a partner or loved one is going to help at feeding time. One evaluation/re- evaluation per calendar year. All other types of breast pumps require a prior authorization from your provider. Other moms may have additional ideas or offer the support you need. For more information contact the Managed Care Plan. Behavioral Health Day Services/Day Treatment, Day treatment and adult day care services, Behavioral Health Medical Services (Medication Management, Drug Screening). This service helps you with general household activities, like meal preparation and routine home chores. If you need a ride to any of these services, we can help you. Substance Abuse Intensive Outpatient Program*. Remember, services must bemedically necessary in order for us to pay for them. Provided to members with behavioral health conditions and involves activities with trained animals. Services that help children with health problems who live in foster care homes. Sunshine Health is a managed care plan with a Florida Medicaid contract. The American Academy of Pediatrics recommends that babies be given exclusively breast milk for their first six months of life or even longer. To find out about these benefits, call the state Medicaid Help Line at 1-877-254-1055. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. The table below lists the medical services that are covered by Sunshine Health. Some service limits may apply. Services to treat conditions such as sneezing or rashes that are not caused by an illness. Up to 24 office visits per calendar year. This could be on the bus, a van that can transport people with disabilities, a taxi, or other kinds of vehicles. Transfers between hospitals or facilities. Visual aids are items such as glasses, contact lenses and prosthetic (fake) eyes. Covered as medically necessary for children ages 0-20. Up to a 34-day supply of drugs, per prescription. A breast pump is covered for the period of time that a newborn is detained in the hospital after the mother is discharged. Up to 24 hours per day, as medically necessary. Download the free version of Adobe Reader. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Personal toiletries and household items such as detergent, bleach and paper towels are covered as medically necessary. Prenatal care is an important way to keep you and your baby healthy during your pregnancy. Download the free version of Adobe Reader. Your child must be enrolled in the DOH Early Steps program. One therapy re- evaluation per six months. Emergency services are covered as medically necessary. Telehealth Services Transportation Services Member Resources Accessing Care Advance Directive Care Management Complaints, Grievances and Appeals Disease Management Emergency Situations EPSDT Program Fraud, Waste and Abuse Get the Most from Your Coverage Interoperability and Patient Access Key Contacts Member Handbook Family supplementation is allowed to pay the difference in cost between a shared and private room directly to the facility. Surgery and other procedures that are performed in a facility that is not the hospital (outpatient). This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Prior authorization may be required for some equipment or services. Up to two training or support sessions per week. Breast pump supplies, including the following: 2.1 Breast . It's a good idea to try it if you can, because breast milk has all the nutrition a baby needs during the first six months. Up to 365/366 days for members ages 0-20. Contact lens types: spherical, PMMA, toric or prism ballast, gas permeable, extended wear, hydrophilic, spherical, toric or prism ballast; and hydrophilic extended wear, other types. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions. If patients request more information, please direct them to Member Services at 1-800-682-9090 (TTY 711). Nursing services provided in the home to members ages 0 to 20 who need constant care. Unlimited units for group therapy and unlimited units for brief group medical therapy. Services to treat conditions, illnesses, or diseases of the stomach or digestion system. Treatments for long-lasting pain that does not get better after other services have been provided. Infant Mental Health Pre- and Post- Testing Services*. Substance abuse treatment of detoxification services provided in an outpatient setting. Limited to members who live alone or who are alone for significant parts of the day who would otherwise require extensive supervision. Must be in the custody of the Department of Children and Families. 5. Family Training and Counseling for Child Development*.