Mental Health and Substance Use Disorder Sample Clauses

Mental Health and Substance Use Disorder. The Plan provides Benefits for Mental Health and Substance Use Disorder services when they are for the active treatment of Mental Health and Substance Use Disorders. An established plan of treatment may be required. This includes Inpatient, Outpatient, and Day Treatment Program services for Mental Health and Substance Use Disorder when you receive them from a Provider. If you receive services from a Community Mental Health Center or Substance Use Disorder Treatment Facility, services must be:
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Mental Health and Substance Use Disorder. Parity‌ Insurer shall comply with the requirements of 42 CFR 457.496. Insurer shall assist and cooperate with FHKC as needed to ensure the Program is in compliance with parity requirements. In the event Insurer is directly or indirectly preventing the Program from meeting parity requirements, Insurer shall implement appropriate, timely changes to allow the Program to become compliant.
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Mental Health and Substance Use Disorder. Inpatient* – Services are considered inpatient when you are admitted to a facility. Refer to your Schedule of Benefits for Cost Share information. Professional Services (for example, doctors) may be billed separately from the facility charges. Covered Services are paid according to the plan based on place of service, provider type, and provider billing. Mental Health and Substance Use Disorder: Outpatient – Covered Services are paid according to the plan based on place of service, provider type, and provider billing. Refer to your Schedule of Benefits for Cost Share information. Mental Health and Substance Use Disorder Services* – The Plan covers Medically Necessary treatment of Mental Health conditions and Substance Use Disorders. Refer to the Benefit Exclusions section for more information on Services not covered by this Plan. This Plan covers, but is not limited to, the following Services: • Assessment and evaluation in order to diagnose or determine if a Mental Health condition or Substance Use Disorder exists; • Treatment of Mental Health conditions or Substance Use Disorders which are subject to significant improvement through evidence-based therapeutics; • Treatment provided in healthcare facilities, Residential programs or facilities, day or Partial Hospitalization programs, or Intensive Outpatient Services; • Treatment provided at a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredited wilderness therapy program that has been licensed by the State of Oregon as Residential treatment for Mental Health and addiction Services. Samaritan Health Plans covers Services and treatment for those Mental Health and Substance Use Disorder diagnoses covered under the Mental Health and Addiction Equity Act of 2008. Samaritan Health Plans is compliant with state and federal Mental Health parity. Multidisciplinary Programs* – Include, but are not limited to, pain management, and child development and rehabilitation center (CDRC) programs. Services usually consist of a team of providers coordinating and working for the benefit of one Member. These programs do not require an authorization; however, some Services done as a result of treatment can require Prior Authorization. Specific Services that are a part of the Member’s treatment plan can require authorization; for example, MRIs, Hospitalizations, or genetic testing, and any other Services on the Prior Authorization list. Refer to the Prior Authorization section for more information. Cov...
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Mental Health and Substance Use Disorder. The Plan provides Benefits for Mental Health and Substance Use Disorder services when they are for the active treatment of Mental Health and Substance Use Disorders. An established plan of treatment may be required. This includes Inpatient (Inpatient and Residential Treatment), and Outpatient (Outpatient and Day Treatment Program), services for Mental Health and Substance Use Disorder when you receive them from a Provider. If you receive services from a Community Mental Health Center or Substance Use Disorder Treatment Facility, services must be: 1. Supervised by a licensed Physician, licensed psychologist, or licensed clinical social worker; and 2. Part of a plan of treatment for furnishing such services established by the appropriate staff member. The Plan provides Benefits for only the following mental health and substance use disorder treatment services when Medically Necessary: 1. Applied behavioral health services; 2. Room and board, including general nursing for Inpatients; 3. Prescription drugs, biologicals, and solutions administered to inpatients; 4. Supplies and use of equipment required for medical withdrawal monitoring and management; 5. Diagnostic and evaluation services; 6. Intervention and assessment; 7. Facility-based professional and ancillary services; 8. Individual, group, couple and/or family psychotherapy and professional counseling services; 9. Medication checks; 10. Individual or group alcohol and drug counseling services; 11. Psychological and Neuropsychological testing; 12. Emergency treatment for the sudden onset of a mental health or substance use condition requiring immediate and acute treatment. Outpatient visits for substance use disorder conditions may be furnished during the acute withdrawal management stage of treatment or during stages of early recovery and maintenance.
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Related to Mental Health and Substance Use Disorder

  • Behavioral Health Services – Mental Health and Substance Use Disorder Inpatient - Unlimited days at a general hospital or a specialty hospital including detoxification or residential/rehabilitation per plan year. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Outpatient or intermediate careservices* - See Covered Healthcare Services: Behavioral Health Section for details about partial hospital program, intensive outpatient program, adult intensive services, and child and family intensive treatment. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Office visits - See Office Visits section below for Behavioral Health services provided by a PCP or specialist. Psychological Testing 0% - After deductible 40% - After deductible Medication-assisted treatment - whenrenderedby a mental health or substance use disorder provider. 0% - After deductible 40% - After deductible Methadone maintenance treatment - one copayment per seven-day period of treatment. 0% - After deductible 40% - After deductible Cardiac Rehabilitation Outpatient - Benefit is limited to 18 weeks or 36 visits (whichever occurs first) per coveredepisode. 0% - After deductible 40% - After deductible Chiropractic Services In a physician's office - limited to 12 visits per plan year. 0% - After deductible 40% - After deductible Dental Services - Accidental Injury (Emergency) Emergency room - When services are due to accidental injury to sound natural teeth. 0% - After deductible The level of coverage is the same as network provider. In a physician’s/dentist’s office - When services are due to accidental injury to sound natural teeth. 0% - After deductible 40% - After deductible Dental Services- Outpatient Services connected to dental care when performed in an outpatient facility * 0% - After deductible 40% - After deductible Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Network Providers Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Dental Care (Pediatric) - for members under age 19 See Dental Services in Section 3 for benefit limits and details. These services only apply to an enrolled member under the age of 19. Oral evaluations 0% - After deductible 0% - After deductible X-rays 0% - After deductible 0% - After deductible Cleanings (prophylaxis) 0% - After deductible 0% - After deductible Fluoride treatments 0% - After deductible 0% - After deductible Sealants 0% - After deductible 0% - After deductible Space Maintainers 0% - After deductible 0% - After deductible Palliative treatment 50% - After deductible 50% - After deductible Fillings 50% - After deductible 50% - After deductible Simple extractions 50% - After deductible 50% - After deductible Denture repairs and relines/rebasing 50% - After deductible 50% - After deductible Crowns & onlays 50% - After deductible 50% - After deductible Therapeutic Pulpotomies 50% - After deductible 50% - After deductible Root canal therapy 50% - After deductible 50% - After deductible Non-surgical periodontal services 50% - After deductible 50% - After deductible Surgical periodontal services 50% - After deductible 50% - After deductible Periodontal maintenance 50% - After deductible 50% - After deductible Fixed bridges and dentures 50% - After deductible 50% - After deductible Implants 50% - After deductible 50% - After deductible Oral surgery services 50% - After deductible 50% - After deductible General anesthesia or IV sedation - dental office 50% - After deductible 50% - After deductible Biopsies 50% - After deductible 50% - After deductible Occlusal (night) guards 50% - After deductible 50% - After deductible Orthodontic services (braces) - when medically necessary. 50% - After deductible 50% - After deductible Dialysis Services Inpatient/outpatient/in your home 0% - After deductible 40% - After deductible

  • SUBSTANCE ABUSE The dangers and costs that alcohol and other chemical abuses can create in the electrical contracting industry in terms of safety and productivity are significant. The parties to this Agreement resolve to combat chemical abuse in any form and agree that, to be effective, programs to eliminate substance abuse and impairment should contain a strong rehabilitation component. The local parties recognize that the implementation of a drug and alcohol policy and program must be subject to all applicable federal, state, and local laws and regulations. Such policies and programs must also be administered in accordance with accepted scientific principles, and must incorporate procedural safeguards to ensure fairness in application and protection of legitimate interests of privacy and confidentiality. To provide a drug-free workforce for the Electrical Construction Industry, each IBEW local union and NECA chapter shall implement an area-wide Substance Abuse Testing Policy. The policy shall include minimum standards as required by the IBEW and NECA. Should any of the required minimum standards fail to comply with federal, state, and/or local laws and regulations, they shall be modified by the local union and chapter to meet the requirements of those laws and regulations.

  • Substance Abuse Program The SFMTA General Manager or designee will manage all aspects of the FTA-mandated Substance Abuse Program. He/she shall have appointing and removal authority over all personnel working for the Substance Abuse Program personnel, and shall be responsible for the supervision of the SAP.

  • Workplace Violence Prevention and Crisis Response (applicable to any Party and any subcontractors and sub-grantees whose employees or other service providers deliver social or mental health services directly to individual recipients of such services): Party shall establish a written workplace violence prevention and crisis response policy meeting the requirements of Act 109 (2016), 33 VSA §8201(b), for the benefit of employees delivering direct social or mental health services. Party shall, in preparing its policy, consult with the guidelines promulgated by the U.S. Occupational Safety and Health Administration for Preventing Workplace Violence for Healthcare and Social Services Workers, as those guidelines may from time to time be amended. Party, through its violence protection and crisis response committee, shall evaluate the efficacy of its policy, and update the policy as appropriate, at least annually. The policy and any written evaluations thereof shall be provided to employees delivering direct social or mental health services. Party will ensure that any subcontractor and sub-grantee who hires employees (or contracts with service providers) who deliver social or mental health services directly to individual recipients of such services, complies with all requirements of this Section.

  • Substance Abuse Treatment Information Substance abuse treatment information shall be maintained in compliance with 42 C.F.R. Part 2 if the Party or subcontractor(s) are Part 2 covered programs, or if substance abuse treatment information is received from a Part 2 covered program by the Party or subcontractor(s).

  • Substance Abuse Testing The Parties agree that it is in the best interest of all concerned to promote a safe working environment. The Union has no objection to pre-employment substance abuse testing when required by the Employer and further, the Union has no objection to voluntary substance abuse testing to qualify for employment on projects when required by a project owner. The cost and scheduling of such testing shall be paid for and arranged by the Employer. The Union agrees to reimburse the Employer for any failed pre-access Alcohol and Drug test costs.

  • Substance Use Disorder counseling shall be provided by a QCC, or Chemical Dependency Counselor Intern. Substance use disorder education and life skills training shall be provided by counselors or individuals who have been trained in the education. All counselor interns shall work under the direct supervision of a QCC.

  • Infection Control The Contractor is required to apply Infection Control principles as designated and outlined within the Infection Control Plan documents for construction at state hospitals and other Owner facilities when otherwise required by Owner, and set forth within the specifications attachment to the Contract. The ODR may incorporate mandatory adherence agreements for infection control into Construction Documents with penalties for noncompliance and mechanisms to ensure timely correction of problems.

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