Behavioral Health Outpatient Services Sample Clauses

Behavioral Health Outpatient Services. Services that are provided in the home or community setting and to Enrollees who are able to return home after care without an overnight stay in a hospital or other inpatient facility.
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Behavioral Health Outpatient Services mental health and substance use disorder services set forth in Appendix C, as applicable, of the Contract, which are provided in an ambulatory care setting, such as a mental health or substance use clinic, hospital outpatient department, community mental health center, or Provider’s office.
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Behavioral Health Outpatient Services. 1. CONTRACTOR shall provide outpatient mental health services primarily to COUNTY Medi-Cal eligible Clients up to the age of twenty-one (21) years old. 2. CONTRACTOR shall conduct outreach to develop and maintain CONTRACTOR’s own referral sources to ensure sufficient caseloads to meet contractual obligations. 3. CONTRACTOR shall provide medically necessary services to Medi-Cal eligible, special population Clients that may include, but not be limited to, preschool children, wards and dependents of the courts, dually diagnosed children, group home and xxxxxx children, and TAY. Services shall be provided at a level and frequency and duration that is consistent with each Client’s level of dysfunction and treatment goals, and consistent with individualized, solution-focused, evidenced-based practices. The population to whom services are to be provided shall include, but may not be limited to: a. Children who are acutely or chronically and seriously mentally ill, and for whom hospitalization or other out-of-home placement is imminent without immediate intervention. b. Children who are severely emotionally ill but not in an emergency situation who, without appropriate treatment, will deteriorate and later require more intensive and costly treatment, and possibly face removal from their homes. c. Families whose children can be diverted from the regular mental health care system through parent education and consultation services. d. Children at risk for psychiatric hospitalization. e. Children who are having difficulty in school, or are at risk of being placed in special education. f. Children who are in special education. g. Minors of all ages who are in group home placement and who meet the COUNTY’s admission criteria under the Medi-Cal Outpatient Consolidation Plan. x. Xxxxxx children of all ages and underserved Clients whose mental health problems are causing them impaired functioning in different life domains. i. Similar children who may be referred by a CalOPTIMA primary care provider. 4. In the situation where a Medi-Cal Client no longer meets Medi-Cal eligibility as verified by the State Medi-Cal website or Medi-Cal Eligibility Data System (MEDS), CONTRACTOR, upon reasonable discovery of this situation, shall discharge the Client from IRIS and refer the Client to appropriate services in the community. If necessary, CONTRACTOR can request, in writing, approval from ADMINISTRATOR to continue to provide services for a specified amount of time/sessions as deter...
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Related to Behavioral Health Outpatient Services

  • Outpatient Services Physicians, Urgent Care Centers and other Outpatient Providers located outside the BlueCard® service area will typically require You to pay in full at the time of service. You must submit a Claim to obtain reimbursement for Covered Services.

  • 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.

  • Inpatient Services Hospital Rehabilitation Facility

  • 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.

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.

  • Outpatient If you receive infusion therapy services in a hospital's outpatient unit, we cover the use of the treatment room, related supplies, and solutions. For prescription drug coverage, see Section 3.27

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.

  • 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.

  • Chiropractic Services This plan covers chiropractic visits up to the benefit limit shown in the Summary of Medical Benefits. The benefit limit applies to any visit for the purposes of chiropractic treatment or diagnosis.

  • Patient Care Resident shall participate in safe, effective, and compassionate patient care, under supervision, commensurate with Resident's level of advancement and responsibility.

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