Abortions. (a) The Contractor agrees that none of the funds paid through this Contract, and none of the funds in any trust fund paid through this Contract, shall be expended for any abortion.
(b) The Contractor agrees that none of the funds paid through this Contract, and none of the funds in any trust fund paid through this Contract, shall be expended for health benefits coverage that includes coverage of abortion.
(c) The term ‘‘health benefits coverage’’ means the package of services covered by a managed care provider or organization pursuant to a contract or other arrangement. (Sec. 506)
Abortions. 2.7.8.4.1 The CONTRACTOR shall cover abortions and services associated with the abortion procedure only if the pregnancy is the result of an act of rape or incest; or in the case where a woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed.
2.7.8.4.2 The CONTRACTOR shall ensure that a “CERTIFICATION OF MEDICAL NECESSITY FOR ABORTION” form, which is available on TENNCARE’s web site, is completed. The form shall be available in English and Spanish, and assistance shall be provided in completing the form when an alternative form of communication is necessary.
Abortions. The Plan does not provide Benefits for abortions for which Federal funding is not allowed in accordance with the Affordable Care Act, namely all abortions except in the case of rape or incest, or for a pregnancy which, as certified by a physician, places the woman in danger of death unless an abortion is performed. ]
Abortions. 11. In Lieu of Services (ILOS)
a. The settings or services listed below are determined by OHA to be a Medically Appropriate and Cost-Effective substitute for a Covered Service consistent with provisions in OAR 410-141- 3820. Contractor may choose to offer one or more of the following ILOS:
Abortions. The CONTRACTOR shall:
4.2.1.1 Ensure abortions are performed in accordance with 42 CFR § 441, Subpart E and the requirements of the Hyde Amendment (Departments of Labor, Health and Human Services, Education, and Related Agencies Appropriations Act, 1998, Public Law 105-78, §§ 509 and 510).
4.2.1.2 Submit a completed abortion statement form and any other documentation reporting requirements outlined in the Managed Care Process and Procedure Manual.
4.2.1.3 Be reimbursed for abortion services only if performed in accordance with all federal, state and Department provisions.
Abortions. In Lieu of Services (ILOS)
Abortions. The CONTRACTOR shall:
Abortions. The PCO may only provide for abortion in cases of rape, incest or when the life of the Member is in danger.
Abortions. The use of public funds to provide induced abortion services must meet applicable state and federal laws, including the requirements of the Hyde Amendment (currently found in La. R.S. 40.1061.6 and the Consolidated Appropriations Act, 2014, Public Law 113-76, Division H, Title V, §506 and §507). Managed Care Organization (MCO) coverage of induced abortion is restricted to those that meet the following criteria: • A physician has found, and so certifies, that on the basis of his/her professional judgment, the life of the pregnant woman would be endangered if the fetus was carried to term. • The certification statement, which must contain the name and address of the member, must be attached to the claim form. The diagnosis or medical condition which makes the pregnancy life endangering must be specified on the claim. • In the case of terminating a pregnancy due to rape or incest the following requirements must be met: o The member shall report the act of rape or incest to a law enforcement official unless the treating physician certifies in writing that in the physician’s professional opinion, the victim was too physically or psychologically incapacitated to report the rape or incest. o The report of the act of rape or incest to a law enforcement official or the treating physician’s statement that the victim was too physically or psychologically incapacitated to report the rape or incest must be submitted to the MCO along with the treating physician’s claim for reimbursement for performing an abortion. o The member shall certify that the pregnancy is the result of rape or incest, and this certification shall be witnessed by the treating physician. o The “Office of Public Health Certification of Informed Consent-Abortion” form shall be witnessed by the treating physician. Providers must attach a copy of the “Office of Public Health Certification of Informed Consent-Abortion” form to their claim form. The form is to be obtained from the Louisiana Office of Public Health via a request form or by calling (000) 000-0000. Claims associated with an induced abortion, including those of the attending physician, hospital, assistant surgeon, and anesthesiologist must be accompanied by a copy of the attending physician’s certifications, as applicable. Providers are required to submit only hard copy claims for payment consideration. All claim forms and attachments will be retained by the MCO. The MCO will forward a copy of the claim and its accompanying documentation to ...
Abortions. Contractor must provide information in its Member Handbook expressly advising its COFA and Veteran Members that neither OHA nor Contractor provide NEMT services, nor support for or access to physical health and Behavioral Health services which are Non-Covered Services without Care Coordination.
