Covered Services

Funded Services

The table below identifies covered services by fund source.

	T-XIX Funded Services for T-XIX Members		SAPT Funded Services for SAPT-eligible Members
	State Plan	Waiver
Level I - Outpatient
Individual Counseling	X		X
Group Counseling	X		X
Level II - Intensive Outpatient
Treatment/Partial Hospitalization
Intensive Outpatient	X		X
Level III - Residential/Inpatient
Treatment
3.1 Reintegration		X	X
3.5 Intermediate		X	X
3.7 Social Detoxification			X
Level IV - Medically Managed
Intensive Inpatient Treatment
Acute Detoxification	X
Inpatient Treatment	X
Auxiliary Services
Assessment/Referral	X		X
Case Management	X
Person-Centered Case Management (PCCM)			X
Support Services			X
Dependent Children			X

Coverage and Payment for Emergency Services of T-XIX

ValueOptions^® of Kansas is responsible for coverage and payment of emergency services and post-stabilization services as required in 42 CFR 438.114.

1. A Member who has an emergency medical condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or stabilize the Member.
2. The attending emergency physician, or the provider actually treating the Member, is responsible for determining when the Member is sufficiently stabilized from an emergency medical condition for transfer or discharge from an emergency room, and that determination is binding on the ValueOptions^® of Kansas.
3. ValueOptions^® of Kansas shall not deny payment for treatment obtained when an Member had an emergency medical condition, including cases in which the absence of immediate medical attention would not have had the outcomes specified in 42 CFR 438.114(a) of the definition of emergency medical condition.
4. ValueOptions^® of Kansas shall not deny payment for treatment obtained when a ValueOptions^® of Kansas clinical care manager instructs the Member to seek emergency services.
5. ValueOptions^® of Kansas shall not limit what constitutes an emergency medical condition on the basis of lists of diagnoses or symptoms. However, the diagnoses and/or symptoms must be related to a covered substance abuse condition as defined in your provider agreement.
6. Emergency services for covered conditions shall be reimbursed for Member regardless of whether authorized in advance or whether the provider of the service is a part of the service network.
7. For emergency services provided to a Member by a network or non-network provider when substance abuse diagnoses are the primary condition, ValueOptions^® of Kansas shall not refuse to cover emergency services based on the emergency room provider, hospital, or fiscal agent not notifying ValueOptions^® of Kansas of the Member's screening and treatment within ten calendar days of presentation for emergency services.
8. For emergency services provided for substance abuse reasons by a network or non-network provider, ValueOptions^® of Kansas shall:
   1. provide a minimum triage fee to the hospital regardless of whether the facility notifies ValueOptions^®; the triage fee shall be no less than is paid through the fee-for-service T-XIX program;
   2. reimburse the facility for emergency services provided, contingent upon the facility’s compliance with notification policies; and
   3. reimburse non-network providers an emergency room fee which is no less than the minimum payment which would be made to a network provider.

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