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21.4 Covered Services 21.4.1 Covered Services Introduction The benefit and coverage information provided here is subject to change. The most current Medicaid coverage information is included in the ForwardHealth Online Handbook. A covered service is any medical service that Medicaid will pay for an eligible member, if billed. DMS enrolls qualified health care providers and reimburses them for providing Medicaid-covered services to eligible Medicaid members. Members may receive Medicaid services only from enrolled providers, except in medical emergencies. Medicaid reimburses emergency medical services necessary to prevent the death or serious impairment of the health of a member even when provided by a non-certified provider. Medicaid providers must submit a prior authorization request to the Medicaid fiscal agent before providing certain Medicaid services. Individuals who are enrolled in Medicare (Part A and/or B) and are eligible for full-benefit Medicaid (see SECTION 21.2 FULL-BENEFIT MEDICAID), including SSI recipients, are referred to as dual eligible individuals. Effective January 1, 2006, Medicaid no longer provides prescription drug coverage for these individuals. These dual eligible individuals do not have to file an application for "Extra Help” and are deemed eligible for "Extra Help” from CMS to pay their Medicare Part D costs. A Medicare Part D Prescription Drug Plan (PDP) card will be issued to them, and it must be used for prescription drugs instead of their ForwardHealth card. Individuals who are enrolled in Medicare (Part A and/or B) and are Medicare Beneficiaries (see SECTION 32.1 MEDICARE SAVINGS PROGRAMS), except for QDWI, are also considered to be dual eligibles. These dual eligibles are also be deemed eligible for "Extra Help” from CMS to pay their Medicare Part D costs. Examples of Medicaid covered services include: 1. Case management services. 2. Chiropractic services. 3. Dental services. 4. Family planning services and supplies. 5. FQHC services. 6. HealthCheck (Early and Periodic Screening, Diagnosis and Treatment & ESPDT) of people under 21 years of age. 7. Home and community-based services authorized under a waiver. 8. Home health services or nursing services if a home health agency is unavailable. 9. Hospice care. 10. Inpatient hospital services other than services in an institution for mental disease. 11. Inpatient hospital, skilled nursing facility, and intermediate care facility services for patients in institutions for mental disease who are: a. under 21 years of age. b. under 22 years of age and received services immediately before reaching age 21. c. 65 years of age or older. 12. Intermediate care facility services, other than services at an institution for mental disease. 13. Laboratory and X-ray services.