Common use of Authorization Limits Clause in Contracts

Authorization Limits. The MCO may place appropriate limits on a service on the basis of criteria such as medical necessity; or for the purpose of utilization management, provided the services furnished can reasonably be expected to support the member’s long term care outcomes as defined in Article I, Definitions, beginning on page 3. After the initial MCP, when a specific service is identified as necessary to support a member’s long term care outcomes on an ongoing basis and the IDT has determined that the current provider is effective in providing the service, the service shall generally be authorized for the duration of the current MCP (i.e., until the next regularly scheduled MCP update) in an amount necessary to support the member’s outcomes. The number of units of service or duration of a service authorized may be more limited when the authorization is for:

Authorization Limits. The MCO may place appropriate limits on a service on the basis of criteria such as medical necessity; or for the purpose of utilization management, provided the services furnished can reasonably be expected to support the member’s long term care outcomes as defined in Article I, Definitions, beginning on page 3. After the initial MCP, when a specific service is identified as necessary to support a member’s long term care outcomes on an ongoing basis and the IDT has determined that the current provider is effective in providing the service, the service shall generally be authorized for the duration of the current MCP (i.e., until the next regularly scheduled MCP update) in an amount necessary to support the member’s outcomes. The number of units of service or duration of a service authorized may be more limited when the authorization is for:

Authorization Limits. The MCO may place appropriate limits on a service on the basis of criteria such as medical necessity; or for the purpose of utilization management, provided the services furnished can reasonably be expected to support the member’s long term care outcomes as defined in Article I, Definitions, beginning on page 3. After the initial MCP, when a specific service is identified as necessary to support a member’s long term care outcomes on an ongoing basis and the IDT has determined that the current provider is effective in providing the service, the service shall generally be authorized for the duration of the current MCP (i.e., until the next regularly scheduled MCP update) in an amount necessary to support the member’s outcomes. The number of units of service or duration of a service authorized may be more limited when the authorization is for: