All of the following
procedures and services require Prior Plan Notification and must be
provided in a SHP participating facility
o Inpatient and Observation Admissions, as noted above
o Admission to any rehabilitation and skilled nursing facility
o All surgical procedures, inpatient or outpatient
o The following have special reporting requirements (refer to Forms Section):
Abortions
Hysterectomies
Sterilization procedures
o Cosmetic or Reconstructive Surgery, including but not limited to:
Breast reconstruction or reduction
Blepharoplasty
Venous procedures
Sclerotherapy
o Services and items:
Allergy (immunotherapy), exept for those
services identified on the QAF
Ambulance transportation (non emergent)
Amniocentesis
Cardiac and pulmonary rehabilitation
programs
Circumcisions after 12 weeks of age
Court-ordered services
Chemotherapy
Dialysis
DME, including apnea monitors and
bili-blankets
Upper endoscopies at colonoscopies at
hospitals
Genetic testing
Gamma Knife, Cyberknife
Hearing aids
Home Health Services
Hospice care
Hyperbaric Oxygen Therapy (HBO)
Investigational and experimental
procedures and treatments
IV Infusions
Laboratory services in POS 22 and 24
Lithotripsy
Mental Health (See Mental Health
Section)
Nutritional counseling
MRI’s, MRA’s
Oral Surgery
