Complex Care Fee. Effective April 1, 2008 there shall be a General Practice Complex Care Fee as outlined in Schedule “D”.
Complex Care Fee Sample Clauses
Related to Complex Care Fee
Skilled Care in a Nursing Facility This plan covers skilled nursing services in a skilled nursing facility if: • the services are prescribed by a physician: • your condition needs skilled nursing services, skilled rehabilitation services or skilled nursing observation; • the services are provided by or supervised by licensed technical or professional medical personnel; and • the services are not custodial care, respite care, day care, or for the purpose of assisting with activities of daily living.
Child Care Expenses (a) Where an employee is requested or required by the Employer to attend:
Community Based Adult Intensive Service (AIS) and Child and Family Intensive Treatment (CFIT) – AIS/CFIT programs offer services primarily based in the home and community for qualifying adults and children with moderate- to-severe mental health conditions. These programs consist at a minimum of ongoing emergency/crisis evaluations, psychiatric assessment, medication evaluation and management, case management, psychiatric nursing services, and individual, group, and family therapy. In a Provider’s Office/In Your Home This plan covers individual psychotherapy, group psychotherapy, and family therapy when rendered by: • Psychiatrists; • Licensed Clinical Psychologists; • Licensed Independent Clinical Social Workers; • Advance Practice Registered Nurses (Clinical Nurse Specialists/Nurse Practitioners- Behavioral Health); • Licensed Mental Health Counselors; and • Licensed Marriage and Family Therapists. Psychological Testing This plan covers psychological testing as a behavioral health benefit when rendered by: • neuropsychologists; • psychologists; or • pediatric neurodevelopmental specialists. This plan covers neuropsychological testing as described in the Tests, Labs and Imaging section.
Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services.
Skilled Nursing Facilities a. The following Health Care Services may be Covered Services when you are a patient in a Skilled Nursing Facility: i. room and board;
Hospice Care If you have a terminal illness and you agree with your physician not to continue with a curative treatment program, this plan covers hospice care services received in your home, in a skilled nursing facility, or in an inpatient facility.
Compassionate Care Leave (a) Compassionate care leave will be granted to an employee for up to eight (8) weeks within a twenty-six (26) week period to provide care or support to a family member who is at risk of dying within that 26-week period in accordance with section 49.1 of the Employment Standards Act, 2000.
Preventive Care and Early Detection Services This plan covers, early detection services, preventive care services, and immunizations or vaccinations in accordance with state and federal law, including the Affordable Care Act (ACA), as set forth below and in accordance with the guidelines of the following resources: • services that have an A or B rating in the current recommendations of the U.S. Preventative Services Task Force (USPSTF); • immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; • preventive care and screenings for infants, children, and adolescents as outlined in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); or • preventive care and screenings for women as outlined in the comprehensive guidelines as supported by HRSA. Covered early detection services, preventive care services and adult and pediatric immunizations or vaccinations are based on the most currently available guidelines and are subject to change. The amount you pay for preventive services will be different from the amount you pay for diagnostic procedures and non-preventive services. See the Summary of Medical Benefits and the Summary of Pharmacy Benefits for more information about the amount you pay. Preventive Office Visits This plan covers the following preventive office visits. • Annual preventive visit - one (1) routine physical examination per plan year per member age 36 months and older; • Pediatric preventive office and clinic visits from birth to 35 months - 11 visits; • Well Woman annual preventive visit - one (1) routine gynecological examination per plan year per female member.
CAISO Monthly Billed Fuel Cost [for Geysers Main only] The CAISO Monthly Billed Fuel Cost is given by Equation C2-1. CAISO Monthly Billed Fuel Cost Equation C2-1 = Billable MWh ◆ Steam Price ($/MWh) Where: • Steam Price is $16.34/MWh. • For purposes of Equation C2-1, Billable MWh is all Billable MWh Delivered after cumulative Hourly Metered Total Net Generation during the Contract Year from all Units exceeds the Minimum Annual Generation given by Equation C2-2. Equation C2-2 Minimum Annual Generation = (Annual Average Field Capacity ◆ 8760 hours ◆ 0.4) - (A+B+C) Where: • Annual Average Field Capacity is the arithmetic average of the two Field Capacities in MW for each Contract Year, determined as described below. Field Capacity shall be determined for each six-month period from July 1 through December 31 of the preceding calendar year and January 1 through June 30 of the Contract Year. Field Capacity shall be the average of the five highest amounts of net generation (in MWh) simultaneously achieved by all Units during eight-hour periods within the six-month period. The capacity simultaneously achieved by all Units during each eight-hour period shall be the sum of Hourly Metered Total Net Generation for all Units during such eight-hour period, divided by eight hours. Such eight-hour periods shall not overlap or be counted more than once but may be consecutive. Within 30 days after the end of each six-month period, Owner shall provide CAISO and the Responsible Utility with its determination of Field Capacity, including all information necessary to validate that determination. • A is the amount of Energy that cannot be produced (as defined below) due to the curtailment of a Unit during a test of the Facility, a Unit or the steam field agreed to by CAISO and Owner. • B is the amount of Energy that cannot be produced (as defined below) due to the retirement of a Unit or due to a Unit’s Availability remaining at zero after a period of ten Months during which the Unit’s Availability has been zero. • C is the amount of Energy that cannot be produced (as defined below) because a Force Majeure Event reduces a Unit’s Availability to zero for at least thirty (30) days or because a Force Majeure Event reduces a Unit’s Availability for at least one hundred eighty (180) days to a level below the Unit Availability Limit immediately prior to the Force Majeure Event. • The amount of Energy that cannot be produced is the sum, for each Settlement Period during which the condition applicable to A, B or C above exists, of the difference between the Unit Availability Limit immediately prior to the condition and the Unit Availability Limit during the condition.
Urgent Care Services All Medically Necessary Covered Services received in Urgent Care Centers, Retail Clinics or your Primary Care Physician’s office after-hours to treat an Urgent Medical Condition will be covered by AvMed. Any request for reimbursement of payment made by a Member for services received must be filed within 90 days or as soon as reasonably possible but not later than one year unless the Member was legally incapacitated. If Urgent Medical Services and Care are required while outside the continental United States, Alaska or Hawaii, it is the Member’s responsibility to pay for such services at the time they are received. For information on filing a Claim for such services, see Part XIII. REVIEW PROCEDURES AND HOW TO APPEAL A CLAIM (BENEFIT) DENIAL.
