Hospital-based Services Sample Clauses

Hospital-based Services. Provider agrees to: a. Provide an adequate hospital network in Delaware (Provider will make all reasonable efforts to contract with local hospitals in each Delaware county). b. Provide emergency services to Inmates on a twenty-four (24) hour basis. c. Provide Inpatient hospitalization for Inmates who require acute care hospital level of care. d. Partner with local emergency medical services (“EMS”) and ambulance services for response to facilities and for the transfer of Inmates to include responsibility for EMS costs to transport Inmates. Coordinate transports with DDOC security staff. e. Inmates under the age of 65 who are hospitalized and admitted (not in “observation” status) for over 24 hours are Medicaid eligible and their inpatient hospital claims (“Covered Claims”) will be paid by Medicaid. Excluding circumstances beyond the Provider’s control, the Provider will meet with Inmates to help fill out Medicaid application. In situations beyond the Provider’s control, the Provider will meet with Inmates at the earliest time possible. The Covered Claims are submitted by the hospitals and physicians directly to the Medicaid Office and are paid by the Medicaid Office directly to the hospital or physician. DDOC then receives a monthly report from the Medicaid Office of all Covered Claims they have paid for hospitalized and admitted Inmates from the previous month. DDOC will review the monthly report and then submit it to Provider for its review and confirmation of the hospital services provided. Once this process is complete, it is DDOC’s responsibility to reimburse the Medicaid office for the State’s share of all approved paid claims. DDOC’s share of Covered Claims, if any, will be deducted from Provider’s monthly invoice. f. Inmates who are hospitalized and under observation watch status are not Medicaid eligible and rates must be negotiated between the hospital and Provider.
Sample 1
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Hospital-based Services. Patients who are at a hospital under observation status are not Medicaid eligible and rates must be negotiated between the hospital and the Provider. The Provider shall: 1. In accordance with DDOC Policy D-08 Hospital and Specialty Care, maintain written agreement(s) with one or more local hospitals in each county to provide: a. Emergency services to patients on a twenty-four (24) hour basis. b. Inpatient hospitalization for patients who require acute care hospital-level care. 2. Maintain written agreement(s) with local emergency medical services (EMS) and ambulance services for response to facilities and for the transfer of patients. 3. Be responsible for the costs of all emergency transports of patients by EMS a. Coordinate transportation with DDOC security staff. Provider is advised that patients who are hospitalized and admitted (not in “observation” status) for over 24 hours are Medicaid eligible. On the first day of hospitalization the Provider shall facilitate the completion of the Medicaid application on behalf of the patient. The claims are submitted by the hospitals and physicians directly to the Delaware Medicaid Office and are paid by the Delaware Medicaid Office directly to the hospital or physician. DDOC then receives a monthly report from the Delaware Medicaid Office of all claims it has paid on behalf of DDOC for hospitalized and admitted patients from the previous month. DDOC utilizes the Federal Medical Assistance Percentage (FMAP) for Medicaid and Multiplier to calculate the State Match amount reimbursable to the Delaware Medicaid Office and processes payment to the Delaware Medicaid Office for the State Match amount, monthly. Once this process is complete, DDOC removes any paid claims outside of the Provider’s executed contract term(s) and submits the final report to the Provider for its review and confirmation of the hospital services provided. The Provider is then required to reimburse the DDOC for the State Match amount on the next billing cycle, as a credit, reducing the monthly base payment. If claims for dates of service within the contract period are received and paid by the Delaware Medicaid Office after termination of the contract whether naturally, for cause or for convenience, the Provider is still responsible for reimbursing the DDOC for payment of those claims. If there are no outstanding invoices to credit, the DDOC will require reimbursement via check.
Sample 1

Related to Hospital-based Services

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.

  • Hospital 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.

  • Education services 1.1 Catholic education is intrinsic to the mission of the Church. It is one means by which the Church fulfils its role in assisting people to discover and embrace the fullness of life in Xxxxxx. Catholic schools offer a broad, comprehensive curriculum imbued with an authentic Catholic understanding of Xxxxxx and his teaching, as well as a lived appreciation of membership of the Catholic Church. Melbourne Archdiocese Catholic Schools Ltd (MACS) governs the operation of MACS schools and owns, governs and operates the School. 1.2 Parents and guardians, as the first educators of their children, enter into a partnership with the Catholic school to promote and support their child’s education. Parents and guardians must assume a responsibility for maintaining this partnership by supporting the school in the provision of education to their children within the scope of School's registration and furthering the spiritual and academic life of their children.

  • Medical Services Plan Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. The City shall pay one hundred percent (100%) of the premiums required by the plan.

  • Required Services Consultant agrees to perform the services, and deliver to City the “Deliverables” (if any) described in the attached Exhibit A, incorporated into the Agreement by this reference, within the time frames set forth therein, time being of the essence for this Agreement. The services and/or Deliverables described in Exhibit A shall be referred to herein as the “Required Services.”

  • 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.

  • FURNISHED SERVICES The County agrees to: A. Guarantee access to and make provisions for the Contractor to enter upon public and private lands as required to perform their work. B. Make available all pertinent data and records for review. C. Provide general bid and Contract forms and special provisions format when needed.

  • Preventive Services All necessary procedures to prevent the occurrence of oral disease, including: Cleaning and scaling Topical application of fluoride Space maintainers

  • Food Services The School District will provide for all applicable Student meals as required by State and Federal law and School District rules and procedures as applicable when students attend a College site. Students may purchase food from College food service facilities when on the College campus.

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