Care Services. The MCO must implement procedures to:
Care Services. 4.1 It is a requirement of this Agreement that the parties to it have also entered into a Care Agreement.
Care Services. The MCO must implement procedures to: Ensure that each member has an ongoing source of primary care appropriate to his/her needs and a person or entity formally designated as primarily responsible for coordinating the health care services furnished to the member. Coordinate the services the MCO furnishes to the member with the services the member receives from any other provider of health care or insurance plan, including mental health and substance abuse services. Share with other agencies serving the member the results of its identification and assessment of special health care needs so that those activities need not be duplicated.
Care Services.
2.1 In exchange for the Dementia Care Package Fee, the Provider will provide the Care Services to the Resident, subject to all relevant laws, regulations and other mandatory requirements.
2.2 The Provider will review the Care Plan every two months, or whenever the Provider believes it is required to meet the needs of the Resident and may make periodic changes to the Care Services where the Provider believes it is appropriate. Where practicable, the Provider will give the Resident prior notice of any material changes to the Care Services or the time allocated to such Care Services and also, where practicable, the Provider will consult with the Resident prior to making any material changes to the Care Services, but where, in the Provider’s opinion, the urgency of the Resident’s care needs make it impractical to consult with the Resident before making the changes, the Provider will implement the changes without such consultation.
2.3 Revisions under clause 2.2 to the Care Services received by the Resident may result in an alteration to the Dementia Care Package Fee charged. Any proposed alterations to the Dementia Care Package Fee resulting from changes to the Care Services received by the Resident:
2.3.1 will be notified to the Resident;
2.3.2 will take effect, except as provided in clause 2.4, from the date stated in the notification (which date may be before the date of notification if, in the Provider’s opinion, the urgency of the Resident’s care needs make it impractical to notify beforehand) and irrespective of whether or not the Resident countersigns acknowledgement of such notice as required by this clause 2.3; and
2.3.3 will be discussed with the Resident except where, in the Provider’s
2.4 After receiving notification of a change under clause 2.2, whether or not it includes a change to the Dementia Care Package Fee as referred to in clause 2.3, the Resident will have 28 days in which to terminate this Agreement by giving 28 days’ written notice to the Provider and if the Resident gives such notice of termination and leaves the Home at the end of the period of such notice of termination, the relevant change notified under clause 2.2, and (as the case may be) clause 2.3, will not come into effect.
Care Services. The care services to be delivered by the Provider pursuant to the Care Plan as determined and assessed from time to time pursuant to clause 2, provided that unless and until otherwise determined and assessed from time to time pursuant to clause 2, Care Package Band A will apply. Care Package Band A comprises up to 1 hour per day of a non-nurse carer or up to 30 minutes per day of a carer who is a nurse, or a proportionate blend thereof (for example, up to 30 minutes per day of a non-nurse carer plus up to 15 minutes per day of a carer who is a nurse)
Care Services. 1.1 Prior to admission the Home’s General Manager or another member of the Home’s team will carry out an assessment of the care needs of the Resident. From this assessment a Service Fee will be calculated based on the needs of the Resident.
1.2 Within 7 days after admission, the Home’s General Manager or another member of the Home’s team, working with (so far as practicable) the Resident, family and others who have been involved with the Resident’s care, will carry out a full assessment of the care needs of the Resident and formulate a Care Plan (“Care Plan”) and may adjust the Service Fee accordingly.
1.3 The Care Plan will be reviewed regularly to monitor the effectiveness of the care delivered against the Care Plan and whether it remains appropriate for the needs of the Resident. The Home may then adjust the Care Plan as appropriate (again with, so far as practicable, the Resident, family and others who have been involved with the Resident’s care) and may adjust the Service Fee accordingly.
1.4 When the Resident arranges for a Medical Practitioner to visit, the Home will, where practical, facilitate the visits. Similarly, when the Resident is accessing NHS services, the Home will endeavour to assist, including assisting with the supply of NHS medication.
Care Services. The care services to be delivered by the Provider pursuant to the Care Plan as determined and assessed from time to time pursuant to clause 2, provided that unless and until otherwise determined and assessed from time to time pursuant to clause 2, Dementia Care Package Band A will apply. Dementia Care Package Band A comprises up to 3 hours 30 minutes per day of a non-nurse carer or up to 1 hour 45 minutes per day of a carer who is a nurse, or a proportionate blend thereof (for example, up to 3 hours per day of a non-nurse carer plus up to 15 minutes per day of a carer who is a nurse)
Care Services. The PO must implement procedures to: Ensure that each member has an ongoing source of primary care appropriate to his/her needs and a person or entity formally designated as primarily responsible for coordinating the health care services furnished to the member. Coordinate the services the PO furnishes to the member with the services the member receives from any other provider of health care or insurance plan, including mental health and substance abuse services. Share with other agencies serving the member the results of its identification and assessment of special health care needs so that those activities need not be duplicated.
Care Services. The services of a Home Health Care Agency in the Member’s home are covered when provided by a registered nurse or licensed vocational nurse and /or licensed physical, occupational, speech therapist or respiratory therapist. These services are in the form of visits that may include, but are not limited to, skilled nursing services, medical social services, rehabilitation therapy (including physical, speech and occupation- al), pulmonary rehabilitation therapy and cardiac rehabilitation therapy. Home Health Care Services must be ordered by your Physician, approved by your Physician Group or Health Plan and provided under a treatment plan describing the length, type and frequency of the visits to be provided. The following conditions must be met in order to receive Home Health Care Services: The skilled nursing care is appropriate for the medical treatment of a condition, illness, disease or injury; The Member is homebound because of illness or injury (this means that the Member is normally unable to leave home unassisted, and, when the Member does leave home, it must be to obtain medical care, or for short, infrequent non-medical reasons such as a trip to get a haircut, or to attend religious services or adult day care); The Home Health Care Services are part-time and intermittent in nature; a visit lasts up to 4 hours in duration in every 24 hours; and The services are in place of a continued hospitalization, confinement in a Skilled Nursing Facility, or outpatient services provided outside of the Member's home. Additionally, Home Infusion Therapy is also covered. A provider of infusion therapy must be a licensed pharmacy. Home nursing services are also provided to ensure proper patient education, training, and monitoring of the administration of prescribed home treatments. Home treatments may be provided directly by infusion pharmacy nursing staff or by a qualified home health agency. The patient does not need to be homebound to be eligible to receive Home Infusion Therapy. See the "Definitions" section. Note: Diabetic supplies covered under medical supplies include blood glucose monitors and insulin pumps. Custodial Care services and Private Duty Nursing, as described in the "Definitions" section and any other types of services primarily for the comfort or convenience of the Member, are not covered even if they are available through a Home Health Care Agency. Home Health Care Services do not include Private Duty Nursing or shift care. Private Duty Nursing...
Care Services. Covered services, related to an emergency medical condition that are provided after a member is stabilized in order to maintain the stabilized condition, or, under the circumstances described in 42 CFR 438.114(e), to improve or resolve the member’s condition. Prepaid Limited Health Service Organization (PLHSO) – An entity certified by TDCI under applicable provisions of TCA Title 56, Chapter 51.
