Hysterectomies Sample Clauses

Hysterectomies. The CONTRACTOR shall: 4.2.14.1. Cover the cost of hysterectomies when they are non-elective and medically necessary as provided in 42 CFR §441.255 (2010, as amended). 4.2.14.2. Ensure non-elective, medically necessary hysterectomies shall meet the requirements as outlined in the Managed Care Policy and Procedure Guide and applicable Department manuals and guides.
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Hysterectomies. 2.7.8.3.1 Hysterectomy shall mean a medical procedure or operation for the purpose of removing the uterus. The CONTRACTOR shall cover hysterectomies only if the following requirements are met: 2.7.8.3.1.1 The hysterectomy is medically necessary; 2.7.8.3.1.2 The member or her authorized representative, if any, has been informed orally and in writing that the hysterectomy will render the member permanently incapable of reproducing; and 2.7.8.3.1.3 The member or her authorized representative, if any, has signed and dated an “ACKNOWLEDGMENT OF HYSTERECTOMY INFORMATION” form which is available on the Bureau of TennCare’s web site, prior to the hysterectomy. Informed consent shall be obtained regardless of diagnosis or age in accordance with federal requirements. The form shall be available in English and Spanish, and assistance shall be provided in completing the form when an alternative form of communication is necessary. Refer to “ACKNOWLEDGMENT OF HYSTERECTOMY INFORMATION” form and instructions for additional guidance and exceptions. 2.7.8.3.2 The CONTRACTOR shall not cover hysterectomies under the following circumstances: 2.7.8.3.2.1 If it is performed solely for the purpose of rendering an individual permanently incapable of reproducing; 2.7.8.3.2.2 If there is more than one purpose for performing the hysterectomy, but the primary purpose is to render the individual permanently incapable of reproducing; or 2.7.8.3.2.3 It is performed for the purpose of cancer prophylaxis.
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Hysterectomies. The Contractor shall cover the cost of hysterectomies when they are non-elective and medically necessary as provided in 42 CFR 441.255 (2005, as amended). Plan provided, non-elective, medically necessary hysterectomies shall meet the requirements as outlined in MCO Policy and Procedure Guide. Expenditures for the medical services as previously described have been factored into the capitated rate described in § 2.1 of this Contract and the Contractor will not receive any additional payments.
Sample 1
Hysterectomies. Coverage will be provided for vaginal hysterectomies and abdominal hysterectomies. Coverage includes a minimum stay in the Hospital of: 1. Not less than twenty-three (23) hours for a laparoscopy-assisted vaginal hysterectomy; and 2. Not less than forty-eight (48) hours for a vaginal hysterectomy. In consultation with the Contracting Provider, the Member may elect to stay less than the minimum prescribed above when appropriate.
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Hysterectomies. Hysterectomy shall mean a medical procedure or operation for the purpose of removing the uterus. The CONTRACTOR shall cover hysterectomies only if the following requirements are met:
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Hysterectomies. The CCN shall cover the cost of medically necessary hysterectomies as provided in 42 CFR §441.255 (2005, as amended). CCN provided non-elective, medically necessary hysterectomies shall meet the requirements as outlined in the CCN-P Policy and Procedure Guide. Expenditures for the medical services as previously described have been factored into the prepaid PMPM rate described in § 2.1 of this Provider Agreement and the CCN will not receive any additional payments.
Sample 1
Hysterectomies. The CONTRACTOR shall: Cover the cost of hysterectomies when they are non-elective and medically necessary as provided in 42 CFR §441.255 (2010, as amended). Ensure non-elective, medically necessary hysterectomies shall meet the requirements as outlined in the Managed Care Policy and Procedure Guide and applicable Department manuals and guides. Independent Laboratory and X-Ray Services The CONTRACTOR is required to pay for medically necessary laboratory and X-ray services. Detailed service provisions are found within the Managed Care Policy and Procedure Guide and applicable Department manuals and guides. The CONTRACTOR shall: Requires that all laboratory testing sites providing services under the contract have either a Clinical Laboratory Improvement Amendments (CLIA) certificate or waiver of a certificate of registration along with a CLIA identification number. [42 CFR 493.1; 42 CFR 493.3] Inpatient Hospital Services Inpatient hospital services are services—provided under the direction of a Physician—furnished to a patient who is admitted to an acute care medical facility for a period of time, as defined in the Department’s Hospital Provider Manual. These services may include, but are not limited to a full range of necessary diagnostic and therapeutic care—including surgical, dental, medical, general nursing, radiological and rehabilitative services in emergency or Non-Emergency conditions. Additional inpatient hospital services would include room and board, miscellaneous hospital services, medical supplies, and equipment. Please refer to the Medicaid Managed Care Policy and Procedure Guide for additional details about services and payment responsibilities based on Enrollment status. The CONTRACTOR shall: Upon the Member’s Day of admission to a hospital, cover the facility charges associated with the entire stay (admission through discharge). Institutional Long-Term Care (LTC) Facilities/Nursing Facilities (NFs) For the purposes of this contract, these are services provided in a facility that is licensed as a nursing facility or hospital that provides swing bed or Administrative Days. The CONTRACTOR shall: Ensure admission Procedures of the Member adhere to the Medicaid requirements of participation for nursing facilities, including level of care certification, preadmission screening and resident review (PASARR), resident assessment, notification of patient’s rights, and other responsibilities. Obtain a level of care certification (DHHS Form 185) from Com...
Sample 1
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Hysterectomies. 2.7.7.3.1 Hysterectomy shall mean a medical procedure or operation for the purpose of removing the uterus. The CONTRACTOR shall cover hysterectomies only if the following requirements are met: 2.7.7.3.1.1 The hysterectomy is medically necessary; 2.7.7.3.1.2 The member or her authorized representative, if any, has been informed orally and in writing that the hysterectomy will render the member permanently incapable of reproducing; and 2.7.7.3.1.3 The member or her authorized representative, if any, has signed and dated an “ACKNOWLEDGMENT OF HYSTERECTOMY INFORMATION” form 2.7.7.3.2 The CONTRACTOR shall not cover hysterectomies under the following circumstances: 2.7.7.3.2.1 If it is performed solely for the purpose of rendering an individual permanently incapable of reproducing; 2.7.7.3.2.2 If there is more than one purpose for performing the hysterectomy, but the primary purpose is to render the individual permanently incapable of reproducing; or 2.7.7.3.2.3 It is performed for the purpose of cancer prophylaxis.
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Related to Hysterectomies

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  • Prosthodontics We Cover prosthodontic services as follows:

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