Behavioral Health Treatment Sample Clauses

Behavioral Health Treatment. We will provide coverage for counseling and treatment programs that are necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual. We will provide such coverage when provided by a licensed provider. We will provide coverage for applied behavior analysis when provided by a behavior analyst certified pursuant to the Behavior Analyst Certification Board or an individual who is supervised by such a certified behavior analyst and who is subject to standards in regulations promulgated by the New York Department of Financial Services in consultation with the New York Departments of Health and Education. “Applied behavior analysis” means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior. The treatment program must describe measurable goals that address the condition and functional impairments for which the intervention is to be applied and include goals from an initial assessment and subsequent interim assessments over the duration of the intervention in objective and measurable terms. Our coverage of applied behavior analysis services is limited to 680 hours per Member per Calendar Year.
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Behavioral Health Treatment. Behavioral Health Treatment is covered when prescribed by a physician or licensed psychologist and the treatment is pro- vided under a treatment plan approved by the MHSA. Be- havioral Health Treatment must be prior authorized by the MHSA and Behavioral Health Treatment delivered in the home or other non-institutional setting must be obtained from MHSA Participating Providers. Behavioral Health Treatment for the purposes of providing respite, day care, or educational services, or to reimburse a parent for participating in the treatment is not covered.
Sample 1Sample 2
Behavioral Health Treatment. Behavioral Health Treatment is covered when prescribed by a Physician or licensed psychologist who is a Plan Provider and the treatment is provided under a treatment plan prescribed by a MHSA Participating Provider. Behavioral Health Treat- ment must be prior authorized by the MHSA and obtained from MHSA Participating Providers. Behavioral Health Treatment used for the purposes of providing respite, day care, or educational services, or to reimburse a parent for par- ticipation in the treatment is not covered. ORTHOTICS BENEFITS Medically necessary Orthoses for Activities of Daily Living are covered, including the following: 1. Special footwear required for foot disfigurement which includes, but is not limited to, foot disfigurement from cerebral palsy, arthritis, polio, xxxxx bifida, or by accident or developmental disability; 2. Medically Necessary functional foot Orthoses that are custom made rigid inserts for shoes, ordered by a Physi- cian or podiatrist, and used to treat mechanical problems of the foot, ankle or leg by preventing abnormal motion and positioning when improvement has not occurred with a trial of strapping or an over-the-counter stabilizing de- vice; 3. Medically necessary knee braces for post-operative Re- habilitation following ligament surgery, instability due to injury, and to reduce pain and instability for patients with osteoarthritis. Benefits for Medically Necessary Orthoses are provided at the most cost effective level of care that is consistent with profes- sionally recognized standards of practice. If there are 2 or more professionally recognized appliances equally appropri- ate for a condition, this Plan will provide Benefits based on the most cost effective appliance. Routine maintenance is not covered. No Benefits are provided for backup or alternate items. Benefits are provided for orthotic devices for maintaining normal Activities of Daily Living only. No benefits are pro- vided for orthotic devices such as knee braces intended to provide additional support for recreational or sports activities or for orthopedic shoes and other supportive devices for the feet. Note: See Diabetes Care Benefits in the Plan Benefits section for devices, equipment, and supplies for the management and treatment of diabetes. OUTPATIENT X-RAY, PATHOLOGY AND LABORATORY BENEFITS 1. Laboratory, X-ray, Major Diagnostic Services. All Out- patient diagnostic X-ray and clinical laboratory tests and Services, including diagnostic imaging, electrocardio...
Sample 1
Behavioral Health Treatment. Behavioral Health Treatment is covered when prescribed by a Physician or licensed psychologist who is a Plan Provider and the treatment is provided under a treatment plan prescribed by a MHSA Participating Provider. Behavioral Health Treat- ment must be prior authorized by the MHSA and obtained from MHSA Participating Providers. Behavioral Health Treatment used for the purposes of providing respite, day care, or educational services, or to reimburse a parent for par- ticipation in the treatment is not covered. ORTHOTICS BENEFITS Medically necessary Orthoses for Activities of Daily Living are covered, including the following:
Sample 1
Behavioral Health Treatment. Behavioral Health Treatment is covered when prescribed by a Physician or licensed psychologist and treatment is provid- ed under a treatment plan approved by the MHSA. Behav- ioral Health Treatment must be prior authorized by the MHSA and Behavioral Health Treatment delivered in the home or other non-institutional setting must be obtained from MHSA Participating Providers. Behavioral Health Treatment used for the purposes of provid- ing respite, day care, or educational services, or to reimburse a parent for participation in the treatment is not covered. ORTHOTICS BENEFITS Benefits are provided for orthotic appliances, including: 1. shoes only when permanently attached to such applianc- es; 2. special footwear required for foot disfigurement which includes, but is not limited to, foot disfigurement from cerebral palsy, arthritis, polio, xxxxx bifida, and foot dis- figurement caused by accident or developmental disabil- ity;
Sample 1
Behavioral Health Treatment. We will provide coverage for counseling and treatment programs that are necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual. We will provide such coverage when provided by a licensed provider. We will provide coverage for applied behavior analysis when provided by a behavior analyst certifed pursuant to the Behavior Analyst Certifcation Board or an individual who is supervised by such a certifed behavior analyst and who is subject to standards in regulations promulgated by the New York Department of Financial Services in consultation with the New York Departments of Health and Education. “Applied behavior analysis” means the design, implementation, and evaluation of environmental modifcations, using behavioral stimuli and consequences, to produce socially signifcant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior. The treatment program must describe measurable goals that address the condition and functional impairments for which the intervention is to be applied and include goals from an initial assessment and subsequent interim assessments over the duration of the intervention in objective and measurable terms.Our coverage of applied behavior analysis services is limited to 680 hours per Member per Plan Year. Member Services: 1-800-223-7242, TTY: 711 Crisis Line: 1-800-223-7242, TTY: 711 17
Sample 1

Related to Behavioral Health Treatment

  • 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.

  • 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.

  • Substance Abuse Treatment Information Substance abuse treatment information shall be maintained in compliance with 42 C.F.R. Part 2 if the Party or subcontractor(s) are Part 2 covered programs, or if substance abuse treatment information is received from a Part 2 covered program by the Party or subcontractor(s).

  • 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.

  • OCCUPATIONAL HEALTH & SAFETY (a) It is a mutual interest of the parties to promote health and safety in workplaces and to prevent and reduce the occurrence of workplace injuries and occupational diseases. The parties agree that health and safety is of the utmost importance and agree to promote health and safety and wellness throughout the organization. The employer shall provide orientation and training in health and safety to new and current employees on an ongoing basis, and employees shall attend required health and safety training sessions. Accordingly, the parties fully endorse the responsibilities of employer and employee under the Occupational Health and Safety Act, making particular reference to the following:

  • National Treatment and Most-favoured-nation Treatment (1) Each Contracting Party shall accord to investments of investors of the other Contracting Party, treatment which shall not be less favourable than that accorded either to investments of its own or investments of investors of any third State. (2) In addition, each Contracting Party shall accord to investors of the other Contracting Party, including in respect of returns on their investments, treatment which shall not be less favourable than that accorded to investors of any third State. (3) The provisions of paragraphs (1) and (2) above shall not be construed so as to oblige one Contracting Party to extend to the investors of the other the benefit of any treatment, preference or privilege resulting from: (a) Any existing or future free trade area, customs unions, monetary union or similar international agreement or other forms of regional cooperation to which one of the Contracting Parties is or may become a party, or (b) Any matter pertaining wholly or mainly to taxation.

  • Digital Health The HSP agrees to: (a) assist the LHIN to implement provincial Digital Health priorities for 2017-18 and thereafter in accordance with the Accountability Agreement, as may be amended or replaced from time to time; (b) comply with any technical and information management standards, including those related to data, architecture, technology, privacy and security set for health service providers by MOHLTC or the LHIN within the timeframes set by MOHLTC or the LHIN as the case may be; (c) implement and use the approved provincial Digital Health solutions identified in the LHIN Digital Health plan; (d) implement technology solutions that are compatible or interoperable with the provincial blueprint and with the LHIN Cluster Digital Health plan; and (e) include in its annual Planning Submissions, plans for achieving Digital Health priority initiatives.

  • 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:

  • 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.

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