Summary


This amendment updates and removes definitions in the rule text to be consistent with current policy. It also clarifies member eligibility requirements, clarifies hospital admission requirements, clarifies policy for an inpatient psychiatric stay of a Prepaid Mental Health Plan (PMHP) member, and clarifies service coverage and limitations. It further includes new sections that outline policy for provider-preventable conditions and utilization control, and references policy for cost sharing and reimbursement.