In-Home and Community Services Sample Clauses

In-Home and Community Services. The PH-MCO may not deny personal care services for members under the age of 21 based on the Member’s diagnosis or because the need for personal care services is the result of a cognitive impairment. The personal care services may be in the form of hands- on assistance (actually performing a personal care task for a person) or cuing so that the person performs the task by him/her self. The PH-MCO may not deny a request for Medically Necessary in- home nursing services, home health aide services, or personal care services for a Member under the age of 21 on the basis that a live-in caregiver can perform the task, unless there is a determination that the live-in caregiver is actually able and available to provide the level or extent of care that the Member needs, given the caregiver’s work schedule or other responsibilities, including other responsibilities in the home. The PH-MCO must include in its Provider Network any Home Health Agency that offers in-home nursing services, home health aide services, or personal care services for Members under the age of 21 that is enrolled in Pennsylvania Medical Assistance and is willing to comply with all of the PH-MCO’s quality and non-quality contract standards, utilization management standards and accept PH-MCO rates that are consistent with reimbursement rates paid to similar In - Network Providers. The PH-MCO must submit to the Department for prior review and written approval any Home Health Agency requests for entrance to the Network that it intends to deny based upon quality of care, program integrity or other relevant concerns. The PH-MCO must implement a Public Health Dental Hygiene Practitioner (PHDHP) program or a dental hygienist program under the direct supervision of a dentist. The hygienists must spend the majority of their time face-to-face performing direct patient preventive care in the community.
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In-Home and Community Services. The Pennsylvania Medicaid State Plan requires personal care services coverage for individuals under age 21. Personal care services may not be denied based on the member’s diagnosis or because the need for assistance is the result of a cognitive impairment. The assistance may be in the form of hands-on assistance (actually performing a personal care task for a person) or cuing so that the person performs the task by him/her self. A request for medically necessary in-home nursing services, home health aide services, or personal care services for a member under the age of 21 may not be denied on the basis that a live-in caregiver can perform the task, unless there is a determination that the live-in caregiver is actually able and available to provide the level or extent of care that the member needs, given the caregiver’s work schedule or other responsibilities, including other responsibilities in the home.
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In-Home and Community Services. ‌ The PH-MCO may not deny personal care services for members under the age of 21 based on the Member’s diagnosis or because the need for personal care services is the result of a cognitive impairment. The personal care services may be in the form of hands-on assistance (actually performing a personal care task for a person) or cuing so that the person performs the task by him/her self. The PH-MCO may not deny a request for Medically Necessary in- home nursing services, home health aide services, or personal care services for a Member under the age of 21 on the basis that a live- in caregiver can perform the task, unless there is a determination that the live-in caregiver is actually able and available to provide the level or extent of care that the Member needs, given the caregiver’s work schedule or other responsibilities, including other responsibilities in the home.
Sample 1Sample 2
In-Home and Community Services. ‌ The PH-MCO may not deny personal care services for members under the age of 21 based on the Member’s diagnosis or because the need for personal care services is the result of a cognitive impairment. The personal care services may be in the form of hands- on assistance (actually performing a personal care task for a person) or cuing so that the person performs the task by him/her self. The PH-MCO may not deny a request for Medically Necessary in- home nursing services, home health aide services, or personal care services for a Member under the age of 21 on the basis that a live-in caregiver can perform the task, unless there is a determination that the live-in caregiver is actually able and available to provide the level or extent of care that the Member needs, given the caregiver’s work schedule or other responsibilities, including other responsibilities in the home. The PH-MCO must include in its Provider Network any Home Health Agency that offers in-home nursing services, home health aide services, or personal care services for Members under the age of 21 that is enrolled in Pennsylvania Medical Assistance and is willing to comply with all of the PH-MCO’s quality and non-quality contract standards, utilization management standards and accept PH-MCO rates that are consistent with reimbursement rates paid to similar In- Network Providers. The PH-MCO must submit to the Department for prior review and written approval any Home Health Agency requests for entrance to the Network that it intends to deny based upon quality of care, program integrity or other relevant concerns.
Sample 1Sample 2
In-Home and Community Services. Therapeutic activities provided to persons and/or their families in the home, school, pre-school, after school, nursery/day-care or other residential or non-office setting.
Sample 1

Related to In-Home and Community Services

  • Security Services CONTRACTOR shall provide security services designed for preventing escapes, maintaining order, providing care, custody, control, supervision and management of the inmate population. A successful security program depends heavily on staff training, effective administration, and the establishment of inmate programs. The organization, staffing, and administration of the security program are vital to the Facility. The direction provided by a well-organized and clearly articulated operations manual, and emergency planning provides a solid base for successful administration. The final operations manual shall be submitted to the Bureau prior to the Service Commencement Date and shall be reviewed annually and updated as needed. Documentation of the review shall be provided annually to the On- Site Contract Monitor. Changes to the plan require written permission by the Contract Manager. The Department reserves the right to require changes to plans submitted to the Bureau.

  • Legal Services If this Agreement is for legal services, this section is applicable. Contractor shall: (i) adhere to legal cost and billing guidelines designated by the JBE; (ii) adhere to litigation plans designated by the JBE, if applicable; (iii) adhere to case phasing of activities designated by the JBE, if applicable; (iv) submit and adhere to legal budgets as designated by the JBE; (v) maintain legal malpractice insurance in an amount not less than the amount designated by the JBE; and (vi) submit to legal bill audits and law firm audits if so requested by the JBE, whether conducted by employees or designees of the JBE or by any legal cost-control provider retained by the JBE for that purpose. Contractor may be required to submit to a legal cost and utilization review as determined by the JBE. If (a) the Contract Amount is greater than $50,000, (b) the legal services are not the legal representation of low- or middle-income persons, in either civil, criminal, or administrative matters, and (c) the legal services are to be performed within California, then Contractor agrees to make a good faith effort to provide a minimum number of hours of pro xxxx legal services, or an equivalent amount of financial contributions to qualified legal services projects and support centers, as defined in section 6213 of the Business and Professions Code, during each year of the Agreement equal to the lesser of either (A) thirty (30) multiplied by the number of full time attorneys in the firm’s offices in California, with the number of hours prorated on an actual day basis for any period of less than a full year or (B) the number of hours equal to ten percent (10%) of the Contract Amount divided by the average billing rate of the firm. Failure to make a good faith effort may be cause for nonrenewal of this Agreement or another judicial branch or other state contract for legal services, and may be taken into account when determining the award of future contracts with a Judicial Branch Entity for legal services.

  • General Services (1) Services to be provided on an ongoing basis to the extent applicable to a particular Fund:

  • Health Care The Company will reimburse the Executive for the cost of maintaining continuing health coverage under COBRA for a period of no more than 12 months following the date of termination, less the amount the Executive is expected to pay as a regular employee premium for such coverage. Such reimbursements will cease if the Executive becomes eligible for similar coverage under another benefit plan.

  • Professional Services Bodily injury" or "property damage" arising out of the rendering of or failure to render profes- sional services;

  • Utility Services Company agrees to pay the full cost and expense associated with its use of all utilities, including but not limited to water, sanitary sewer, electric, storm drainage, and telecommunication services.

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