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: a. An episodic service or course of treatment intended to meet a need that is anticipated to be short term in nature, which may be authorized for a limited length of time or number of units of service that is expected to be sufficient to meet the short term need. b. A trial-basis service or course of treatment intended to test whether a particular service or course of treatment is an effective way to support the long term care outcome or need of the member, which may be authorized for a length of time or number of units of service that is expected to be sufficient for the IDT, including the member, to determine whether or not the services or course of treatment is in fact effective in meeting the member’s outcome or need. Services may be discontinued when a limitation in an original service authorization for an episodic service or course of treatment is reached. If the member requests additional services the IDT staff must respond in accordance with paragraph 8, Responding to Direct Requests By a Member for a Service, of this section.

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 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 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: a. : An episodic service or course of treatment intended to meet a need that is anticipated to be short term in nature, which may be authorized for a limited length of time or number of units of service that is expected to be sufficient to meet the short short-term need. b. . A trial-basis service or course of treatment intended to test whether a particular service or course of treatment is an effective way to support the long long-term care outcome or need of the member, which may be authorized for a length of time or number of units of service that is expected to be sufficient for the IDT, including the member, to determine whether or not the services or course of treatment is in fact effective in meeting the member’s outcome or need. Services may be discontinued when a limitation in an original service authorization for an episodic service or course of treatment is reached. If the member requests additional services the IDT staff must respond in accordance with paragraph 8, Responding to Direct Requests By a Member for a Service, of this section.

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: a. An episodic service or course of treatment intended to meet a need that is anticipated to be short term in nature, which may be authorized for a limited length of time or number of units of service that is expected to be sufficient to meet the short term need. b. A trial-basis service or course of treatment intended to test whether a particular service or course of treatment is an effective way to support the long term care outcome or need of the member, which may be authorized for a length of time or number of units of service that is expected to be sufficient for the IDT, including the member, to determine whether or not the services or course of treatment is in fact effective in meeting the member’s outcome or need. Services may be discontinued when a limitation in an original service authorization for an episodic service or course of treatment is reached. If the member requests additional services the IDT staff must respond in accordance with paragraph 8, Responding to Direct Requests By a Member for a Service, Service of this section.

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: a. : An episodic service or course of treatment intended to meet a need that is anticipated to be short term in nature, which may be authorized for a limited length of time or number of units of service that is expected to be sufficient to meet the short term need. b. . A trial-basis service or course of treatment intended to test whether a particular service or course of treatment is an effective way to support the long term care outcome or need of the member, which may be authorized for a length of time or number of units of service that is expected to be sufficient for the IDT, including the member, to determine whether or not the services or course of treatment is in fact effective in meeting the member’s outcome or need. Services may be discontinued when a limitation in an original service authorization for an episodic service or course of treatment is reached. If the member requests additional services the IDT staff must respond in accordance with paragraph 8, Responding to Direct Requests By a Member for a Service, of this section.

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: a. An episodic service or course of treatment intended to meet a need that is anticipated to be short term in nature, which may be authorized for a limited length of time or number of units of service that is expected to be sufficient to meet the short term need. b. A trial-basis service or course of treatment intended to test whether a particular service or course of treatment is an effective way to support the long term care outcome or need of the member, which may be authorized for a length of time or number of units of service that is expected to be sufficient for the IDT, including the member, to determine whether or not the services or course of treatment is in fact effective in meeting the member’s outcome or need. Services may be discontinued when a limitation in an original service authorization for an episodic service or course of treatment is reached. If the member requests additional services the IDT staff must respond in accordance with paragraph 8, Responding to Direct Requests By a Member for a ServiceResponding to Direct Requests By a Member for a Service, of this section.

Authorization Limits. The MCO PO 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 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 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: a. An episodic service or course of treatment intended to meet a need that is anticipated to be short term in nature, which may be authorized for a limited length of time or number of units of service that is expected to be sufficient to meet the short short-term need. b. A trial-basis service or course of treatment intended to test whether a particular service or course of treatment is an effective way to support the long long-term care outcome or need of the member, which may be authorized for a length of time or number of units of service that is expected to be sufficient for the IDT, including the member, to determine whether or not the services or course of treatment is in fact effective in meeting the member’s outcome or need. Services may be discontinued when a limitation in an original service authorization for an episodic service or course of treatment is reached. If the member requests additional services the IDT staff must respond in accordance with paragraph 8, Responding to Direct Requests By a Member for a Service, of this section.