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1.4 RHP Benefit Package A. The IHCC groups participating in RHP under this section receive the full scope of services covered under the Medicaid State Plan and the State’s Section 1115 waiver. Covered services may be provided through the managed care plan or through the fee-for-service delivery system if the service is “out-of-plan” – that is, not included in the managed care plan but covered under Medicaid. Fee-for- service benefits may be furnished either by the managed care provider or by any participating provider. 1. Access to Benefits – Each RHP member selects a primary care provider (PCP) who performs necessary medical care and coordinates referrals to specialty care. The PCP orders treatment determined to be medically necessary in accordance with the health plan’s policies. Prior authorization rules may apply, as required by the Medicaid agency. 2. Delivery of Benefits – In-plan services are paid for on a capitated basis. 3. Medical Necessity – The standard of "medical necessity" is used as the basis for determining whether access to a Medicaid covered service is required and appropriate. Medically necessary services must be provided in the most cost-efficient and appropriate setting and must not be provided solely for the convenience of the member or service provider. 4. Medicaid Benefits – The coverage provided through RHP is categorized as follows: RHP Benefits (a) In-Plan (b) Out-of-Plan Inpatient Hospital Care Dental Services Outpatient Hospital Services Court-ordered Mental Health and Substance Abuse Services Ordered to a Non-Network Facility or Provider Physician Services Non-Emergency Transportation Services (The health plan is required to coordinate with EOHHS’ non-emergency transportation broker.) Family Planning Services Nursing home Services in Excess of 30 Consecutive Days