Common use of Network Provider Practice Guidelines, General Standards Clause in Contracts

Network Provider Practice Guidelines, General Standards. (A) The Contractor and its Network Providers shall adopt practice guidelines. The guidelines shall: (1) be based on valid and reliable clinical evidence or a consensus of providers in the particular field; (2) consider the needs of the Contractor’s Enrollees; (3) be adopted in consultation with Network Providers; and (4) be reviewed and updated periodically as appropriate. (B) The Contractor shall disseminate the practice guidelines to all affected Network Providers and, upon request, to Enrollees. (C) The Contractor’s decisions for utilization management, Enrollee education, coverage of services, and other areas to which the guidelines apply shall be consistent with the practice guidelines. (D) The Contractor shall use the American Society of Addiction Medicine (ASAM) level of care placement criteria for management of substance use disorder services.