Behavioral Health Care Sample Clauses

Behavioral Health Care. ‌ Endorsement 2‌ Welcome‌‌
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Behavioral Health Care. In addition to the general provisions for Behavioral Health Care Services required in Attachment II, Section VI, Behavioral Health Care, the Health Plan shall provide the following medically necessary community behavioral health services as required for the treatment and coordination of care for enrollees of the Health Plan: a. Medically necessary community behavioral health services related to persons with the following physical health issues stemming from HIV/AIDS: ICD-9-CM Diagnoses: 302.0; 079.53; 042; 304.0; and 304.1. (1) Care plans for these enrollees shall include all appropriate collateral providers necessary to address the complex medical issues involved. (2) Clinical care criteria shall address modalities of treatment that are effective for each diagnosis. (3) The Health Plan’s provider network must include appropriate treatment resources necessary for effective treatment of each diagnosis within the required time periods for access. b. Prevention and risk reduction services in the community. c. Family individual psychosocial education and support in the community. d. Self-management services and wellness management. e. Support groups for parents of children living with HIV/AIDS in the community. f. The Health Plan shall coordinate referrals for services with local providers of case management and home and community-based services for those enrollees also enrolled in the Project AIDS Care Waiver. g. The Health Plan shall ensure that standardized formal assessment instruments are used by HIV PCPs during initial and subsequent patient assessments to: (1) identify enrollees who require behavioral health and substance abuse services and (2) determine the types of behavioral health and substance abuse services that should be furnished. The Health Plan must require formal training or verification of completed training for network providers in the use of these assessment instruments and in techniques for identifying individuals with unmet behavioral health care needs. Copies of appropriate guidelines can be accessed through the sites below: .
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Behavioral Health Care. Background: Recognizing that the public health emergency, necessary mitigation measures like social distancing, and the economic downturn have exacerbated mental health and substance use challenges for many Americans, the interim final rule included an enumerated eligible use for mental health treatment, substance use treatment, and other behavioral health services, including a non-exhaustive list of specific services that would be eligible under this category. Public Comment: Many commenters
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Behavioral Health Care. MAHP has established policies and procedures to ensure access to medical care for members needing behavioral health care and to establish standards for access. A Behavioral Health Practitioner is a member of the QIC. QIC focuses on improving Behavioral Health care through monitoring of HEDIS measures. Our open electronic medical record ensures communication, continuity, and coordination of care between referring and treating practitioners.
Sample 1
Behavioral Health Care. A. The CONTRACTOR shall: i. Deliver all behavioral health services through direct contracts with individual behavioral health provider groups. All administrative functions associated with behavioral health shall be retained and integrated within the CONTRACTOR; ii. Minimize the administrative costs associated with the delivery of behavioral health care; iii. Build a statewide behavioral health provider network that ensures access to all levels of behavioral health services, across a continuum from the most to the least restrictive setting. The network shall be sufficient to ensure that the standards in MAD Policy 606 for access to care providers who want to refer members for behavioral health care and vice versa; iv. Develop and implement written policies and procedures for members on how to access behavioral health services without a referral along with written policies and procedures for primary care and other specialty care providers who want to refer members for behavioral health care and vice versa; v. Develop and implement written policies and procedures for coordination of physical and behavioral health services, monitoring its implementation; vi. Develop and distribute a provider manual, which includes a specific section on behavioral health; and vii. Develop procedures for communicating regularly with behavioral health providers on issues related to provision of services. B. Behavioral Health Clinical Practice Guidelines and Utilization Management i. The CONTRACTOR shall develop and implement written behavioral health clinical practice guidelines for major behavioral health diagnoses for children, youth and adult populations. These guidelines shall be based upon the MAD regulation definition of medical necessity, professionally accepted standards of practice, and national guidelines, and with input from the CONTRACTOR'S practitioners. Behavioral health clinical practice guidelines and utilization management criteria shall be applied consistently across the state. ii. The CONTRACTOR shall provide care coordination for members with multiple and complex special physical, mental, neurobiological, emotional and/or behavioral health care needs on an as needed basis, depending upon the clinical profile of the patient. The CONTRACTOR shall have written policies and procedures, approved by HSD, which govern how members with these multiple and complex needs will be identified and how these specific care coordination services will be provided. iii. The CONTR...
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Behavioral Health Care. ‌ Endorsement 2‌‌‌ representative provides inaccurate information that you rely on in choosing a provider, you will only be responsible for paying your in-network Cost Sharing amount for care received from that provider. Welcome‌‌
Sample 1
Behavioral Health Care. A. The CONTRACTOR shall: i. Deliver all behavioral health services through direct contracts with individual behavioral health provider groups. All administrative functions associated with behavioral health shall be retained and integrated within the CONTRACTOR; ii. Minimize the administrative costs associated with the delivery of behavioral health care; iii. Build a statewide behavioral health provider network that ensures access to all levels of behavioral health services, across a continuum from the most to the least restrictive setting. The network shall be sufficient to ensure that the standards in MAD Policy 606 for access to care providers who want to refer members for behavioral health care and vice versa; iv. Develop and implement written policies and procedures for members on how to access behavioral health services without a referral along with written policies and procedures for primary care and other specialty care providers who want to refer members for behavioral health care and vice versa; v. Develop and implement written policies and procedures for co-ordination of physical and behavioral health services, monitoring its implementation; vi. Develop and distribute a provider manual, which includes a specific section on behavioral health; and vii. Develop procedures for communicating regularly with behavioral health providers on issues related to provision of services.
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Behavioral Health Care 
Sample 1

Related to Behavioral Health Care

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

  • Home Health Care This plan covers the following home care services when provided by a certified home healthcare agency: • nursing services; • services of a home health aide; • visits from a social worker; • medical supplies; and • physical, occupational and speech therapy.

  • Mental Health Services This agreement covers medically necessary services for the treatment of mental health disorders in a general or specialty hospital or outpatient facilities that are: • reviewed and approved by us; and • licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a general or specialty hospital or outpatient facility. We review network and non-network programs, hospitals and inpatient facilities, and the specific services provided to decide whether a preauthorization, hospital or inpatient facility, or specific services rendered meets our program requirements, content and criteria. If our program content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below.

  • Health Services At the time of employment and subject to (b) above, full credit for registered professional nursing experience in a school program shall be given. Full credit for registered professional nursing experience may be given, subject to approval by the Human Resources Division. Non-degree nurses shall be placed on the BA Track of the Teachers Salary Schedule and shall be ineligible for movement to any other track.

  • Health Care The Company will reimburse the Executive for the cost of maintaining continuing health coverage under COBRA for a period of no more than 12 months following the date of termination, less the amount the Executive is expected to pay as a regular employee premium for such coverage. Such reimbursements will cease if the Executive becomes eligible for similar coverage under another benefit plan.

  • Extended Health Care Plan ‌ The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable extended health care plan.

  • Extended Health Care The Hospital shall contribute on behalf of each eligible employee seventy-five percent (75%) of the billed premium under the Extended Health Care Plan (Liberty Health $15-25 deductible plan including hearing aids with a maximum of $300.00 per person and vision care with a maximum of $150.00 every 24 months per person, or its equivalent) provided the balance of the monthly premium is paid by employees through payroll deduction. Any Hospital currently paying more than 75% of the premium shall continue to do so. The drug formulary shall be as defined by Liberty Health Formulary Three.

  • Medical Care The Parents must comply with the School Welfare Officer's recommendations which may include a reasonable decision to release the Pupil home or to his / her education guardian when s/he is unwell.

  • Health Promotion and Health Education Both parties to this Agreement recognize the value and importance of health promotion and health education programs. Such programs can assist employees and their dependents to maintain and enhance their health, and to make appropriate use of the health care system. To work toward these goals:

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