Specialty Managed Care Plan

2026-11-03

At a minimum , the Contractor must provide directly , or through a Subcontractor , all medically necessary Covered Services , Provider types , and service locations described in the MSM or authorized by Nevada ’ s Section 1115 demonstration , unless specifically excluded under the terms of this Contract . NVHA reserves the right to modify this Contract based on CMS feedback to Nevada ’ s Section 1115 demonstration , including , for example , updating the Contractor ’ s responsibilities to manage the health care of justice - involved individuals and to support their transitions from incarceration into the community . The Contractor must comply with all provisions in NRS 695G . 162 , including , but not limited to : Offering coverage for services provided to an Enrollee via telehealth to the same extent as services provided in person , provided that use of telehealth is medically necessary and clinically appropriate . Providing reimbursement for telehealth services in the same amount as comparable in - person services , including for audio - only interactions relating to behavioral health or substance use disorder ( SUD ) counseling or treatment . The Contractor must ensure coverage or coordination , as applicable , for services required pursuant to the DOJ Settlement ; such services may include , but are not limited to : behavioral health services delivered at home or in the community , in psychiatric residential treatment facilities , and in other acute care settings .

Nevada

2026-05-01