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Hospital
22.1 Enrollment 22-2
22.1.1 Continuity of Hospital Eligibility Through Change of Ownership 22-2
22.1.2 Specialty Team or Center 22-3
22.2 Inpatient/Outpatient Benefits, Limitations, and Authorization Requirements 22-3
22.2.1 Blood Factor Products 22-3
22.2.2 Chemotherapy 22-4
22.2.3 Cochlear Implants 22-4
22.2.4 Electrodiagnostic Testing (Electromyography and Nerve
Conduction Studies) 22-4
22.2.5 Fluocinolone Acetonide Intravitreal Implant (Retisert) 22-4
22.2.6 Laboratory Services 22-4
22.3 Inpatient Services 22-5
22.3.1 Benefits, Limitations, and Authorization Requirements 22-5
22.3.1.1 Inpatient Behavioral Health 22-6
22.3.1.2 Inpatient Rehabilitation Services 22-7
22.3.1.3 Renal (Kidney) Transplants 22-8
22.3.1.4 Stem Cell Transplants 22-9
22.3.2 Reimbursement Information 22-9
22.4 Outpatient Services 22-10
22.4.1 Benefits, Limitations, and Authorization Requirements 22-10
22.4.1.1 Hospital-Based Outpatient Mental Health Services 22-10
22.4.1.2 Hospital-Based Emergency Services Department 22-10
22.4.1.3 Outpatient Observation 22-11
22.4.2 Reimbursement Information 22-12
22.4.2.1 Hospital-Based Emergency Services Department 22-12
22.5 Ambulatory Surgical Centers 22-12
22.5.1 Benefits, Limitations, and Authorization Requirements 22-12
22.5.1.1 Freestanding Surgical Centers 22-12
22.5.2 Reimbursement Information 22-13
22.6 Claims Information 22-13
22.6.1 Inpatient and Outpatient Claims 22-13
22.6.2 HASC Claims 22-14
22.6.3 Inpatient Stays Following Scheduled Day Surgeries 22-14
22.6.4 Inpatient Stays Following Unscheduled (Emergency) Day Surgeries 22-14
22.7 TMHP-CSHCN Services Program Contact Center 22-14
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