Page 19

SERVICE SCOPE OF BENEFIT (ANNUAL) Including but not limited to: members' needs and personal support systems. Medical case management includes the provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIVIAIDS treatments. Key activities include 1) Initial assessment of service needs; 2) Development of a comprehensive, individualized service plan; 3) Coordination of services required to implement the plan; 4) Monitoring the care; 5) Periodic re-evaluation and adaptation of the plan as necessary over the time beneficiary is enrolled in services. It includes beneficiary-specific advocacy and/or review of utilization of services. This includes all types of case management including face-to- face, phone contact, and any other form of communication. Treatment for Gender Dysphoria Comprehensive benefit package. Early Intervention Covered for RIte Care members as included within the Individual Family Service Plan (IFSP), consistent with R.I. Gen. Laws §§ 27-18-64, 27- 19-55, 27-20-50, and 27-41-68. Subject to stop loss greater than five thousand dollars ($5,000.00). Rehabilitation Services Physical, occupational and speech therapy services may be provided with physician orders by Rhode Island Department of Health-licensed outpatient rehabilitation centers. These services supplement home health and outpatient hospital clinical rehabilitation services when the individual requires specialized rehabilitation services not available from a home health or outpatient hospital provider. See also EPSDT.