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General Coverage Scope of Coverage Level of Coverage Inpatient Mental Health and Alcohol and Substance Abuse Services Services to be provided in a facility operated by OMH under sec. 7.17 of the Mental Hygiene Law, or a facility issued an operating certificate pursuant to Article 23 or Article 31 of the Mental Hygiene Law or a general hospital as defined in Article 28 of the Public Health Law. No limitations for inpatient mental health services, inpatient detoxification and inpatient rehabilitation. Inpatient Rehabilitation Acute care services provided by an Article 28 General Hospital Services supplies and equipment related to physical medicine and occupational therapy and short-term rehabilitation. Professional Services for Diagnosis and Treatment of Illness and Injury Provides services on ambulatory basis by a covered provider for medically necessary diagnosis and treatment of sickness and injury and other conditions. Includes all services related to visits. Professional services are provided on outpatient basis and inpatient basis. No limitations. Includes wound dressing and casts to immobilize fractures for the immediate treatment of the medical condition. Injections and medications provided at the time of the office visit or therapy will be covered. Includes audiometric testing where deemed medically necessary. Hospice Services and Expenses Coordinated hospice program of home and inpatient services which provide non-curative medical and support services for persons certified by a physician to be terminally ill with a life expectancy of six months or less. Hospice services include palliative and supportive care provided to a patient to meet the special needs arising out of physical, psychological, spiritual, social and economic stress which are experienced during the final stages of illness and during dying and bereavement. Hospice organizations must be certified under Article 40 of the NYS Public Health Law. All services must be provided by qualified employees and volunteers of the hospice or by qualified staff through contractual arrangements to the extent permitted by federal and state requirements. All services must be provided according to a written plan of care which reflects the changing needs of the patient/family. Family members are eligible for up to five visits for bereavement counseling. Outpatient Surgery Procedure performed within the provider’s office will be covered as well as “ambulatory surgery procedures” which may be performed in a hospital-based ambulatory surgery service or a freestanding ambulatory surgery center. The utilization review process must ensure that the ambulatory surgery is appropriately provided. Diagnostic and Laboratory Tests Prescribed ambulatory clinical laboratory tests and diagnostic x-rays. No limitations.