Agent and Learning Collaborative Sample Clauses
Agent and Learning Collaborative a. OHA will assign an Innovator Agent to Contractor. The Innovator Agent is responsible for: (i) serving as a single point of contact between Contractor and OHA on matters regarding innovation, (ii) facilitating the exchange of information, (iii) working with Contractor and its CAC, (iv) working with Contractor and its governing body, and (v) working with Contractor to identify and develop strategies to support Quality Improvement and the adoption of innovations in care.
b. Contractor shall participate in face-to-face meetings of any CCO Learning Collaborative at least once per month.
1. Covered Services
a. Subject to the provisions of this Contract, Contractor shall provide to Members, at a minimum, those Covered Services that are Medically Appropriate and as described as funded Condition/Treatment Pairs on the Prioritized List of Health Services, including Ancillary Services, as provided for in OAR 410-141-3830 and as identified, defined, and specified in the OHP Administrative Rules.
b. Contractor shall provide the Covered Services, including Diagnostic Services, that are necessary and reasonable to diagnose the presenting condition, regardless of whether or not the final diagnosis is covered.
c. Contractor shall make available to any Member, Potential Member, or Participating Member, as may be requested from time to time, the criteria for Medically Appropriate determinations with respect to the Benefit Package for physical health, Behavioral Health (which includes mental health and Substance Use Disorders), and Oral Health.
d. Contractor shall provide treatment, including Ancillary Services, which is included in or supports the Condition/Treatment Pairs that are above the funding line on the Prioritized List as provided in OAR 410-141-3830.
e. Except as otherwise provided in OAR 410-141-3820, Contractor is not responsible for excluded or limited services as set forth in OAR 410-141-3825.
f. Before denying any Member treatment for a condition that is below the funding line on the Prioritized List, including without limitation, disabilities or co-morbid conditions, Contractor shall determine whether the Member has a funded condition/treatment pair that would entitle the Member to treatment under OAR 410-141-3820.
g. Contractor shall use the same limits and criteria for transplants as those established in the Transplant Services Rules in OAR Chapter 410, Division 124.
h. Except as permitted under Section 1903(i) of the Social Security Act, Contractor is p...
Agent and Learning Collaborative a. OHA will assign an Innovator Agent to Contractor. The Innovator Agent is responsible for: (i) serving as a single point of contact between Contractor and OHA on matters regarding innovation, (ii) facilitating the exchange of information, (iii) working with Contractor and its CAC, (iv) working with Contractor and its governing body, and (v) working with Contractor to
b. Contractor shall participate in face-to-face meetings of any CCO Learning Collaborative at least once per month. Exhibit B – Statement of Work – Part 2 – Covered and Non-Covered Services
Agent and Learning Collaborative a. OHA will assign an Innovator Agent to the Contractor. The Innovator Agent’s roles are to actis responsible for: (i) serving as a single point of contact between the Contractor and OHA on matters regarding innovation, to facilitate(ii) facilitating the exchange of information, to work(iii) working with the Contractor and its Community Advisory CouncilCAC, and to work(iv) working Contract # (XXXXXX) CCO 2.0 Contract Template Exhibit B – -Statement of Work - Part 1 – Governance and Organizational Relationships Page 22 of 358 with the Contractor to identify and develop strategies to support Quality Improvement and the adoption of innovations in care.
Agent and Learning Collaborative a. OHA will assign an Innovator Agent to the Contractor. The Innovator Agent’s roles are to act as a single point of contact between the Contractor and OHA on matters regarding innovation, to facilitate the exchange of information, to work with the Contractor and its Community Advisory Council, and to work with the Contractor to identify and develop strategies to support Quality Improvement and the adoption of innovations in care.
b. Contractor shall participate in face-to-face meetings of any CCO Learning Collaborative at least monthly, if available. Exhibit B –Statement of Work - Part 2 – Covered and Non-Covered Services
1. Covered Services
a. Subject to the provisions of this Contract, Contractor shall provide to Members, at a minimum, those Covered Services that are Medically Appropriate and as described as funded Condition/Treatment Pairs on the Prioritized List of Health Services, including Ancillary Services, contained in OAR 410-141-0520 and as identified, defined and specified in the OHP Administrative Rules.
b. Contractor shall provide the Covered Services, including Diagnostic Services that are necessary and reasonable to diagnose the presenting condition, regardless of whether or not the final diagnosis is covered.
c. Contractor shall make available criteria for Medically Appropriate determinations with respect to Benefit Package for physical health, Behavioral Health (which includes mental health and Substance Use Disorders), and oral health to any Member, Potential Member or Participating Provider, upon request.