Molinalogo

Both ground and emergency helicopter ambulance transportation are covered. No prior authorization is required.
Excludes non-emergency medical transportation.

Both inpatient and outpatient behavioral health and/or substance abuse services are covered with a prior authorization. Services include:

• Inpatient Psychiatric Hospital
• Inpatient Psychiatric Services
• Mental Health Outpatient Clinic
• Mental Health Rehabilitative Treatment
• Psychologist
• Outpatient Psychiatric
• Residential Treatment Centers (RTC)
• Care Management
• Medication Management

If you need mental health and/or substance abuse services, call the Nurse Advice Line for information at (833) 685-2104, TTY/TDD 711 for the hearing impaired.
You may also self-refer directly to a State Certified community mental health center or treatment center.
For facilities near you, please refer to the provider directory online, visit the member portal at MyMolina.com or call Member Services (833) 685-2102, TTY/TDD 711 for the hearing impaired.
If there is an emergency situation, you do not need a prior authorization. Please refer to Emergency services related to Behavioral Health.

Covered for members under the age of 21, referred through the EPDST program and screened through their PCP

Covered for Children under 21 years of age provided by Nevada Medicaid through Liberty dental.
For adults, 21 years of age and older, coverage is limited to emergency dental examinations and extractions, and in some instances false teeth (full and partial dentures to replace missing teeth). Contact Liberty Dental.

Coverage for items that are medically necessary as determined by the Nevada Medicaid and Nevada Check Up program includes:

• Certain medically needed equipment (e.g. wheelchairs, ventilators, etc.)
• Items that would not generally be useful to a person without an illness or an injury

Durable medical equipment is used to serve a medical purpose, fitted for use in the home, and able to withstand repeated use.

EPSDT is provided to members that are under 21 years old and does not require prior authorization. These services include:

• Screening services including a comprehensive health and developmental history (both physical and mental health)
• Comprehensive, unclothed physical exam
• Immunizations
• Lead screening and testing
• Age-appropriate vaccinations
• Laboratory tests (including blood lead level assessment appropriate to age and risk)
• Health education
• Vision services
• Dental services referrals
• Hearing services

Other necessary health care, diagnostic services, treatment, and other measures described in Section 1905(a) of the Act to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the Medicaid State Plan.

Covered until the attending physician or the Provider treating the Member determines that the Member is sufficiently stabilized for transfer or discharge.

Public Crisis Teams and Providers of Crisis Intervention services render Emergency Services to Members experiencing a Behavioral Health crisis.
These services involve immediate and intensive interventions designed to help stabilize the Member and ensure stabilization, such as:

• Situational risk-of-harm assessments
• Follow-up and debriefing sessions to ensure stabilization and continuity of care
• Identification of referral sources for ongoing community Behavioral Health Services.

Coverage for members includes one eye exam, lenses and frames every 12 months.

Children: (under age 21) 2 eye exams per year and 2 pair of glasses. EPSDT- eligible members are eligible for more services if determined medically necessary.

Covered for any member of childbearing age may receive Family Planning Services from any qualified Provider, including plan or non-plan providers. No referral needed. These services may include:

• Education
• Counseling
• Physical exams
• Birth control devices, implants, medication, and supplies

Other covered services for members 21 years of age or older include:

• Tubal ligations
• Vasectomies

These services that are not included for those members that are:

• Mentally incompetent
• Institutionalized
• Under the aged of 21 years old

Abortions are excluded from coverage, except when certain conditions exist. For example, to save the life of the mother, for rape or incest, or if medically necessary. Your provider will explain these services and ask you to sign

Coverage for members includes Hearing aid(s) and related supplies, as well as Hearing aid testing and repairs.
Replacement of lost or damaged ear mold(s) are covered only for those under 21.

Coverage is provided for Home Health Services that are medically necessary and receive Prior Authorization.

• Personal care services
• Home environment evaluation
• Dietitian services
• Skilled nursing services
• Home health aide services
• Respiratory therapy
• Physical therapy (limit restrictions apply)
• Occupational therapy (limit restrictions apply)
• Speech therapy (limit restrictions apply)

For complete list of limitations, please contact Member Services (833) 685-2102, TTY/TDD 711 for the hearing impaired.
Coverage is not provided for Home Health services in a hospital or office setting.

Coverage is provided for inpatient and outpatient hospital services that are medically necessary with a Prior Authorization.
Coverage is also provided when you get services in a hospital or are admitted to the hospital for Emergency or out-of-area Urgent Care Services. Prior authorization is not required for emergencies.
The following inpatient services are covered in a Participating Provider hospital or rehabilitation facility, when the services are generally and customarily provided by acute care general hospitals or rehabilitation facilities inside our service area:

• Room and board, including a private room if Medically Necessary
• Specialized care and critical care units
• General and special nursing care
• Operating and recover rooms
• Services of Participating Provider physicians, including consultation and treatment by Specialists
• Anesthesia
• Drugs prescribed in accord with the Universal Preferred Drug guidelines
• Radioactive materials used for therapeutic purposes
• Durable medical equipment and medical supplies
• Imaging, laboratory, and special procedures, including MRI, CT, and PET scans, and ultrasound imaging
• Mastectomies (removal of breast) and lymph node dissections
• Blood, blood products and their administration, blood storage (including the services and supplies of a blood bank)
• Physical, occupational, and speech therapy (including treatment in an organized, multidisciplinary rehabilitation program)
• Respiratory therapy
• Medical social services and discharge planning

 

Medically necessary lab tests are covered .

Coverage includes prenatal care, delivery services at a hospital or birthing center, pre-term labor, care for complications, and postpartum care.

Coverage provided in the Molina Healthcare of Nevada network and with a Prior Authorization for providers not in our network.

Coverage for all office visits to providers that are in the Molina Healthcare of Nevada network. Providers not in the Molina Healthcare of Nevada network require Prior Authorization.
For providers near you, please refer to the provider directory online, visit the member portal at MyMolina.com or call Member Services at (833) 685-2102, TTY/TDD 711 for hearing impaired

Coverage is provided with a Prior Authorization.

Molina Healthcare wants to make sure you get medical care as soon as you think you are pregnant. If you think you are pregnant, see you PCP.
Once you are pregnant your PCP will want you to see an OB/GYN. You don’t need a referral or prior authorization to see an OB/GYN.
If you need help finding an OB/GYN, call Member Services at (833) 685-2102, TTY/TDD 711 for hearing impaired; we can help you arrange for your prenatal care.

Covered services include mammograms, well baby and well childcare, regular check-ups and screenings, as well as EPSDT services. These services do not require a prior authorization.

Covered for services ordered by a provider. Certain Radiology and X-Rays require Prior Authorization, such as CT scans, MRIs and MRAs.

Molina covers all RTC charges including admission, bed day rate, and ancillary services.

Covered for medically necessary services with a Prior Authorization for stays no longer than 180 calendar days. Items that are not medically necessary such as a private room are not covered.

Coverage for Speech, Occupational and Physical therapy services with a Prior Authorization.

Covered, with limitations, when Medically Necessary including Corneal, Kidney, Liver and Bone Marrow transplants.
For children up to age 21, any Medically Necessary transplant that is not experimental will be covered.

Non-emergent medical transportation is available through MTM. They arrange rides to covered services for members who have no other way to receive a ride to their routine medical appointments.
If you qualify for this service and need to arrange non-emergency transportation contact MTM at (844) 879-7341 or for hearing impaired contact (TTY/TDD: 711) or call Member Services at (833) 685-2102 (TTY/TDD: 711).
Non-emergent transportation is not available to Nevada Check Up members.
Call to schedule your ride. You must give at least 5 working days notice when scheduling transportation.

Covered for a sudden illness, injury, or condition that is not an emergency but needs to be treated right away or when your doctor is unavailable. Examples may include sprains, vomiting, rashes, and ear infections. Prior Authorization is not required.

Coverage of age-appropriate vaccination in accordance with the most current Advisory Committee on Immunization Practices (ACIP) schedule. No prior authorization is required.