Molinalogo

• Behavioral health (refer to the covered behavioral health services for all members section below for more details)
• Breast reconstruction after mastectomy
• Chemotherapy and radiation
• Circumcisions, when medically necessary (prior authorization required)
• Diabetes testing and testing supplies
• Cardiac (heart) and pulmonary (breathing) rehabilitation
• Dialysis
• Durable medical equipment (DME) and supplies
• Emergency care (includes care to stabilize you after an emergency)
• Emergency dental care
  • Limited to $1,000 per year
• Emergency and non-emergency transportation
• End of life care
• Family planning services
  • Birth control
  • Contraceptives
  • Family planning counseling
• Hearing loss evaluation
• High tech radiology, including:
  • Magnetic resonance imaging (MRI)
  • Magnetic resonance angiogram (MRA)
  • Positron emission tomography (PET scan)
• HIV/AIDS therapy and counseling services
• Home health care
• Hospital services
  • Inpatient
  • Outpatient
• Immunizations (shots)
• Incontinence briefs (for members over 21 years of age, when needed)
• Inpatient hospital stays may include:
  • Physical therapy
  • Occupational therapy
  • Speech therapy
• Laboratory, x-rays, medical imaging
• Maternity care
• Medical equipment and supplies
• Medical foods
• Nursing facility stay
  • Limited to 90 calendar days per year
• Nutritional assessments and medical foods
• Occupational therapy
• Orthotics and prosthetics
• Out-of-network services
• Pain management services
• Physical therapy
• Podiatry (foot and ankle)
• Pregnancy care
• Prescription medications and injections
• Primary care provider (PCP) office visits, including:
  • Wellness exams
  • Preventive care
• Preventive screenings and tests:
  • Pap tests
  • Mammogram
  • Colonoscopy
• Rehabilitation therapy
• Respirational therapy
• Specialist office visits
• Second opinions
• Surgery
• Smoking cessation
• Transplants that are approved by AHCCCS (organ and tissue)
• Urgent care

All members also get well visits as part of their covered services. As part of your wellness visit, you get services, but not limited to, well woman exams, breast exams and prostate exams for members 21 years and older. These also include a medical history, physical exam, health screening, health counseling and any medically necessary shots.

In addition to the covered services for all members, members under 21 years of age get the following benefits:

• Chiropractic care (when medically necessary)
• Early and Periodic Screening, Diagnostic and Treatment (EPSDT) includes:
  • Wellness exams
  • Hearing exams and hearing aids
  • Preventive dental care
  • Orthotics covered for AHCCCS members under 21 years of age
• Dental screenings and treatments
• Glasses
• Outpatient physical, occupational and speech therapy
• Personal care services that are necessary to meet a medical need. This includes help with:
  • Activities of daily care
  • Bathing
  • Toileting
  • Walking
• Vision exams

Some services have specific limits:

• Behavioral health services
  • See section below on covered behavioral health services
• Home-and community-based services
  • Members should use the home-and community-based services instead of a nursing home when medically able
• Nursing home
  • Up to 90 days per contract year (contract year is from October 1-September 30)
• Personal care items
  • Only covered when used to treat a medical condition
• Vision care
  • Limited to medical eye conditions
  • Eye exams and glasses covered for children under 21 years of age
  • Eyeglasses covered for adults after undergoing cataract surgery
• Orthotic devices
  • Molina only covers orthotic devices when all three below are met:
    • The orthotic is medically necessary
    • The orthotic costs less than all other treatments and surgery to treat the same conditions
    • The orthotic is ordered by a doctor or primary care practitioner (nurse practitioner or physician assistant)

• Behavioral health counseling and therapy:
  • Individual
  • Group and family
• Screening, evaluation, assessment and testing
• Substance use services:
  • Intensive outpatient
  • Residential
  • Inpatient
• Multisystemic therapy (for members under 21 years of age)
• Auricular acupuncture (a type of acupuncture that involves inserting needles into specific points on the ear) *
• Skills, trainings and development and psychosocial rehabilitation living skills training
• Behavioral health prevention/promotion education and medication training
• Help and training to maintain employment
• Laboratory, radiology and medical imaging
• Medical management
• Electroconvulsive therapy
• Care management
• Personal care services
• Home care training and family support
• Self-help and peer services
• Home care training for home care client
• Unskilled respite care
• Wraparound services to maintain supportive housing
• Behavioral health respite care
  • Limited to 600 hours per year, October 1-September 30 (contract year)
• Sign language or oral interpretative services provided at no cost to the member
• Emergency and non-emergency transportation
• Crisis intervention:
  • Mobile, community-based
  • Stabilization, facility-based
  • Over the phone via crisis line
• Hospital
• Subacute facility
• Residential treatment center
• Behavioral health residential facility (without room and board*)
• Supervised behavioral health services and day programs
• Community psychiatric supportive treatment and adult behavioral health therapeutic homes

*Services not available with Title XIX/XXI funding but may be provided if other funds are available