Medicaid Redesign Team Changes Effective October 1, 2013

Date Issued: 10/1/2013

C-Sections

Medicaid managed care and Family Health Plus plans are required to reduce reimbursement to practitioners and hospitals by a minimum of 10% for elective C-section deliveries and elective induction of labor for pregnancies of less than 39 weeks in the absence of a documented medical indication.

Hospice Services

Medicaid managed care plans cover hospice services. Hospice care is a coordinated program of home and inpatient services that provides non-curative medical and support services for members certified by a physician to be terminally ill with a life expectancy of one year or less. Medically necessary curative services are covered for children under age 21 in receipt of hospice services in addition to palliative care. Family members are eligible for up to five visits for bereavement counseling.

Lumbar Discography

This procedure is no longer covered by Medicaid managed care.

Transcutaneous Nerve Stimulation (TENS) for Treatment of Pain

Coverage for Medicaid managed care and Family Health Plus members is limited to pain associated with osteoarthritis of the knee.

Implantable Infusion Pumps for Non-Cancer Pain

Coverage for Medicaid managed care and Family Health Plus members is discontinued, except in cases of intractable cancer pain.

Functional Electrical Stimulators

Coverage for Medicaid managed care and Family Health Plus members is discontinued for spinal cord and head injury, cerebral palsy and upper motor neuron disease.