Dispensing and Monitoring Requirements Sample Clauses

Dispensing and Monitoring Requirements. The Contractor shall administer pharmacy benefits in accordance with all applicable state and federal laws and regulations. The Contractor shall comply with the requirements of IC 12-15-35.5-3 in establishing prescribing limits to mental health drugs. For any drugs which require prior authorization, the Contractor shall provide a response by telephone or other telecommunication device within twenty-four (24) hours of a request for prior authorization. Additionally, the Contractor shall provide for the dispensing of at least a seventy-two (72) hour supply of a covered outpatient prescription drug in an emergency situation as required under 42 U.S.C 1396r- 8(d)(5)(B). The Contractor shall employ an automated system for approval of a seventy-two (72) hour emergency supply of a restricted drug. The automated system shall allow the pharmacist to dispense the seventy-two (72) hour supply and then follow-up with the Contractor or provider the next business day. The Contractor, implementing a unified PDL, shall implement prior authorization approved for all plans, by the DUR Board. The Contractor shall participate in the development and recommendation of PA criteria brought before the DUR Board. If it elects to utilize its own PA process, the Contractor may require prior authorization requirements, such as general member information, a justification of need for drug related to the medical needs of the member and a planned course of treatment, if applicable, as related to the number drug provided and duration of treatment. The Contractor will be required to have a process in place to allow drugs that are medically necessary but not included on the formulary to be accessed by members. The Contractor will be required to accept prior authorization requests via telephone, fax, web-based system, or in writing. The Contractor shall provide online and real-time rules-based point-of-sale (POS) claims processing for pharmacy benefits. The Contractor shall maintain prospective drug utilization review edits and apply these edits at the POS. Independently developed and implemented PA criteria will be displayed, in a common format, alongside fee for service and other Contractor criteria. Additionally, the Contractor shall implement retrospective drug use review to identify patterns of fraud, abuse, gross overuse, or inappropriate or medically unnecessary care, among physicians, pharmacists and individuals receiving benefits, or associated with specific drugs or groups of drugs....
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Dispensing and Monitoring Requirements. The Contractor shall administer pharmacy benefits in accordance with all applicable state and federal laws and regulations. For any drugs which require prior authorization, the Contractor shall provide a response by telephone or other telecommunication device within twenty -four
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Dispensing and Monitoring Requirements. The Contractor shall administer pharmacy benefits in accordance with all applicable state and federal laws and regulations. For any drugs which require prior authorization, the Contractor shall provide a response by telephone or other telecommunication device within twenty-four (24) hours of a request for prior authorization. Additionally, the Contractor shall provide for the dispensing of at least a seventy-two (72) hour supply of a covered outpatient prescription drug in an emergency situation as required under 42 U.S.C 1396r- 8(d)(5)(B). The Contractor shall comply with the requirements of IC 12-15- 35.5-3 in establishing prior authorization requirements for mental health drugs. The Contractor may require prior authorization requirements, such as general member information, a justification of need for drug related to the medical needs of the member and a planned course of treatment, if applicable, as related to the number drug provided and duration of treatment. The Contractor will be required to have a process in place to allow drugs that are medically necessary but not included on the formulary to be accessed by members. The Contractor shall provide online and real-time rules-based point-of-sale (POS) claims processing for pharmacy benefits. The Contractor shall maintain prospective drug utilization review edits and apply these edits at the POS. These criteria and edits must be reviewed and approved by the DUR Board prior to implementation. Additionally, the Contractor shall implement a retrospective drug utilization program to analyze for drugs or specific groups of drugs to document utilization trends and intervene with identified prescriber practice outliers leading to educational interventions which emphasize clinically sound and cost effective care. The Contractor must also implement a program to identify and report fraud and abuse among providers and members.
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Dispensing and Monitoring Requirements. 54 3.8.5 E-Prescribing 55 3.8.6 Carve-Out of Select Drugs 55 3.8.7 340B 56 3.8.8 Pharmacy Continuity of Care 56 3.8.9 SUPPORT Act Compliance 56 3.9 Smoking Cessation and Tobacco Dependence Treatment 57 3.10 Behavioral Health Services 57 3.10.1 Identification of Behavioral Health Care Needs 59 3.10.2 Behavioral Health Care Coordination 60 3.10.3 Behavioral Health Continuity of Care 61 3.10.4 Institution for Mental Disease (IMD) 62 3.11 Dental Services 63 3.12 Inpatient Hospitalization Notification 63 3.13 Carved-Out Services 63 3.13.1 Medicaid Rehabilitation Option (MRO) Services 64 3.13.2 1915(i) State Plan Home and Community-Based Services 64 3.13.3 Individualized Family Services Plan (IFSP) 64 3.13.4 Individualized Education Plan (IEP) Services 64 3.13.5 Carved Out Drug Classes 64 3.14 Excluded Services 65 3.14.1 Long-Term Institutional Care 65 3.14.2 Psychiatric Treatment in a State Hospital 65 3.14.3 Psychiatric Residential Treatment Facility (PRTF) Services 65 3.14.4 Intermediate Care Facilities for Individuals with Intellectual Disabilities 66 3.14.5 Home and Community-Based Services (HCBS) 66 3.15 Continuity of Care 66 3.16 Out-of-Network Services 67 3.16.1 Directed Payment for Eligible Out-of-State Children’s Hospitals 67 3.17 Enhanced Services 69 3.18 Opioid Treatment Program (OTP) 70 3.19 Non-Emergency Medical Transportation Services 71 3.20 Residential Substance Use Disorder (SUD) Services 71 3.21 Hospice Services 72 4.1 Marketing and Outreach 72 4.2 Member Enrollment and Contractor Selection 73 4.3 Enrollment and Practice Discrimination 74 4.4 Enrollment Packet 75 4.4.1 Provider Network Information 75 4.4.2 Member Handbook 76 4.4.3 Member ID Card 80 4.5 Member Disenrollment 80 4.6 Member-Contractor Communications 81 4.6.1 Member Services Helpline and 24 Hour Nurse Line 82 4.6.2 Electronic Communications 84 4.7 Member Information, Education and Outreach 85 4.7.1 Member and Stakeholder Education and Engagement 85 4.7.2 General Member Information Requirements 86 4.7.3 Additional Information Available Upon Request 87 4.7.4 Oral Interpretation Services 90 4.7.5 Health Equity 90 4.7.6 Advance Directive Information 92 4.7.7 Member Website 93 4.7.8 Preventive Care Information 94 4.7.9 Cost and Quality Information 94 4.7.10 Member Education 95 4.8 Member-Provider Communications 95 4.9 Member and Potential Member Communications Review and Approval 96 4.10 Member Rights 96 4.11 Redetermination Assistance 97 4.12 Member Inquiries, Grievances & Appeals 98 4...
Sample 1
Dispensing and Monitoring Requirements. 54 3.8.5 E-Prescribing 55 3.8.6 Carve-Out of Select Drugs 55 3.8.7 340B 55 3.8.8 Pharmacy Continuity of Care 56 3.8.9 SUPPORT Act Compliance 56 3.9 Smoking Cessation and Tobacco Dependence Treatment 57 3.10 Behavioral Health Services 57 3.10.1 Identification of Behavioral Health Care Needs 59 3.10.2 Behavioral Health Care Coordination 59 3.10.3 Behavioral Health Continuity of Care 61 3.10.4 Institution for Mental Disease (IMD) 62 3.11 Dental Services 63 3.12 Inpatient Hospitalization Notification 63 3.13 Carved-Out Services 63 3.13.1 Medicaid Rehabilitation Option (MRO) Services 64 3.13.2 1915(i) State Plan Home and Community-Based Services 64 3.13.3 Individualized Family Services Plan (IFSP) 64 3.13.4 Individualized Education Plan (IEP) Services 64 3.13.5 Carved Out Drug Classes 64 3.14 Excluded Services 64 3.14.1 Long-Term Institutional Care 65 3.14.2 Psychiatric Treatment in a State Hospital 65 3.14.3 Psychiatric Residential Treatment Facility (PRTF) Services 65 3.14.4 Intermediate Care Facilities for Individuals with Intellectual Disabilities 65 3.14.5 Home and Community-Based Services (HCBS) 66 3.15 Continuity of Care 66 3.16 Out-of-Network Services 67 3.16.1 Directed Payment for Eligible Out-of-State Children’s Hospitals 67 3.17 Enhanced Services 68 3.18 Opioid Treatment Program (OTP) 70
Sample 1
Dispensing and Monitoring Requirements. The Contractor shall administer pharmacy benefits in accordance with all applicable state and federal laws and regulations. For any drugs which require prior authorization, the EXHIBIT 1 SCOPE OF WORK Contractor shall provide a response by telephone or other telecommunication device within twenty-four (24) hours of a request for prior authorization. Additionally, the Contractor shall provide for the dispensing of at least a seventy-two (72) hour Emergency supply of a covered outpatient prescription drug, as required under 42 U.S.C 1396r- 8(d)(5)(B), without prior authorization. The Contractor may require prior authorization requirements, such as general member information, a justification of need for drug related to the medical needs of the member and a planned course of treatment, if applicable, as related to the quantity of drug provided and duration of treatment. The Contractor will be required to have a process in place to allow member access to medically necessary non-preferred (non-formulary) drugs. To conform to 42 CFR 437-438.3(s) and the Medicaid and CHIP Managed Care Final Rule (CMS-2390-F), once universal medically necessary prior authorization criteria for access to a prescription drug is developed, the Contractor’s criteria must be consistent with the amount, duration and scope of that criteria and may not be more stringent. The Contractor shall provide online and real-time rules-based point-of-sale (POS) claims processing for pharmacy benefits. The Contractor shall maintain prospective drug utilization review edits and apply these edits at the POS. These criteria and edits must be reviewed and approved by the DUR Board prior to implementation. The Contractor shall maintain prospective drug utilization review criteria and edits for covered outpatient drugs that the Contractor limits to medical benefit coverage. All criteria and edits applied to covered outpatient drugs for the pharmacy benefit and/or the medical benefit will be posted online, linked to the xxxxx://xxx.xx.xxx/medicaid/ website. Additionally, the Contractor shall implement a retrospective drug utilization program to analyze for drugs or specific groups of drugs to document utilization trends and intervene with identified prescriber practice outliers leading to educational interventions which emphasize clinically sound and cost-effective care. The Contractor must also implement a program to identify and report fraud and abuse among providers and members.
Sample 1

Related to Dispensing and Monitoring Requirements

  • Reporting and Monitoring Please provide a brief description of the mechanisms proposed for this project for reporting to the UNDP and partners, including a reporting schedule.

  • Credentialing Requirements Registry Operator, through the facilitation of the CZDA Provider, will request each user to provide it with information sufficient to correctly identify and locate the user. Such user information will include, without limitation, company name, contact name, address, telephone number, facsimile number, email address and IP address.

  • Trunking Requirements The Parties will provide designed Interconnection facilities that meet the same technical criteria and service standards, such as probability of blocking in peak hours and transmission standards, in accordance with current industry standards.

  • Evaluation, Testing, and Monitoring 1. The System Agency may review, test, evaluate and monitor Grantee’s Products and services, as well as associated documentation and technical support for compliance with the Accessibility Standards. Review, testing, evaluation and monitoring may be conducted before and after the award of a contract. Testing and monitoring may include user acceptance testing. Neither the review, testing (including acceptance testing), evaluation or monitoring of any Product or service, nor the absence of review, testing, evaluation or monitoring, will result in a waiver of the State’s right to contest the Grantee’s assertion of compliance with the Accessibility Standards. 2. Grantee agrees to cooperate fully and provide the System Agency and its representatives timely access to Products, records, and other items and information needed to conduct such review, evaluation, testing, and monitoring.

  • Staffing Requirements Licensee will be in full compliance with the main studio staff requirements as specified by the FCC.

  • Forecasting Requirements 19.5.1 The Parties shall exchange technical descriptions and forecasts of their Interconnection and traffic requirements in sufficient detail necessary to establish the Interconnections necessary for traffic completion to and from all Customers in their respective designated service areas.

  • Screening Requirements Progenity shall ensure that all prospective and current Covered Persons are not Ineligible Persons, by implementing the following screening requirements. a. Progenity shall screen all prospective Covered Persons against the Exclusion List prior to engaging their services and, as part of the hiring or contracting process or medical staff credentialing process, shall require such Covered Persons to disclose whether they are Ineligible Persons. b. Progenity shall screen all current Covered Persons against the Exclusion List within 90 days after the Effective Date and on a monthly basis thereafter. c. Progenity shall implement a policy requiring all Covered Persons to disclose immediately if they become an Ineligible Person. Nothing in this Section III.H affects Progenity’s responsibility to refrain from (and liability for) billing Federal health care programs for items or services furnished, ordered, or prescribed by an excluded person. Progenity understands that items or services furnished, ordered, or prescribed by excluded persons are not payable by Federal health care programs and that Progenity may be liable for overpayments and/or criminal, civil, and administrative sanctions for employing or contracting with an excluded person regardless of whether Progenity meets the requirements of Section III.H.

  • Child Abuse Reporting Requirements A. Grantees shall comply with child abuse and neglect reporting requirements in Texas Family Code Chapter 261. This section is in addition to and does not supersede any other legal obligation of the Grantee to report child abuse. B. Grantee shall use the Texas Abuse Hotline Website located at xxxxx://xxx.xxxxxxxxxxxxxx.xxx/Login/Default.aspx as required by the System Agency. Grantee shall retain reporting documentation on site and make it available for inspection by the System Agency.

  • Licensing Requirements (a) Employer and Employee hereby covenant and agree that this Agreement and/or Employee’s employment may be subject to the approval of one or more gaming regulatory authorities (the “Authorities”) pursuant to the provisions of the relevant gaming regulatory statutes (the “Gaming Acts”) and the regulations promulgated thereunder (the “Gaming Regulations”). Employer and Employee hereby covenant and agree to use their best efforts to obtain any and all approvals required by the Gaming Acts and/or Gaming Regulations. In the event that (i) an approval of this Agreement or Employee’s employment by the Authorities is required for Employee to carry out Employee’s duties and responsibilities set forth in Section 3 of this Agreement, (ii) Employer and Employee have used their best efforts to obtain such approval, and (iii) this Agreement or Employee’s employment is not so approved by the Authorities, then this Agreement shall immediately terminate and shall be null and void, thus extinguishing any and all obligations of either party, subject to any surviving obligations of Employee under Sections 9, 10 and 21. (b) If applicable, Employer and Employee hereby covenant and agree that, in order for Employee to discharge the duties required under this Agreement, Employee must apply for or hold a license, registration, permit or other approval (the “License”) as issued by the Authorities pursuant to the terms of the relevant Gaming Act and as otherwise required by this Agreement. In the event Employee fails to apply for and secure, or the Authorities refuse to issue or renew Employee’s License, Employee, at Employer’s sole cost and expense, shall promptly defend such action and shall take such reasonable steps as may be required to either remove the objections or secure or reinstate the Authorities’ approval, respectively. The foregoing notwithstanding, if the source of the objections or the Authorities’ refusal to renew or maintain Employee’s License arise as a result of any of the acts, omissions or events described in Section 1(c) of this Agreement, then Employer’s obligations under this Section 8 also shall not be operative and Employee shall promptly reimburse Employer upon demand for any expenses incurred by Employer pursuant to this Section 8. (c) Employer and Employee hereby covenant and agree that the provisions of this Section 8 shall apply in the event Employee’s duties require that Employee also be licensed by governmental agencies other than the Authorities.

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