Non-Covered Behavioral Health Services Sample Clauses

Non-Covered Behavioral Health Services a. The following services are not covered by the Health Plan: (1) Specialized therapeutic xxxxxx care; (2) Therapeutic group care services; (3) Behavioral health overlay services; (4) Community substance abuse services, except as required by this Contract; (5) Residential care; (6) Statewide Inpatient Psychiatric Program (SIPP) services; (7) Clubhouse services; and (8) Comprehensive behavioral assessment. b. The Health Plan shall not be responsible for the provision of behavioral health services to enrollees assigned to a FACT team by DCF. c. The Health Plan is responsible for the provision of behavioral health care services to its enrollees with open Florida Safe Families Network (FSFN) cases as follows: (1) Xxx Xxxx 0, xxx Xxxxxx, Highlands, Manatee and Polk counties in Area 6, the Health Plan is responsible for providing behavioral health services. (2) In Xxxx 00, the Health Plan is not responsible for providing behavioral health services. Such Area 10 enrollees shall receive their behavioral health services through FFS Medicaid or through the Area 10 child welfare delivery system once that system is implemented. (3) For all other counties, the Health Plan is not responsible for providing behavioral health services if those enrollees are also enrolled in the Child Welfare Prepaid Mental Health Plan (CWPMHP). Those enrollees shall receive their behavioral health services through the CWPMHP.
Sample 1
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Non-Covered Behavioral Health Services. Chemical Dependence Services
Sample 1
Non-Covered Behavioral Health Services a) Chemical Dependence Services i) Outpatient Rehabilitation and Treatment Services A) Methadone Maintenance Treatment Program (MMTP) Consists of drug detoxification, drug dependence counseling, and rehabilitation services which include chemical management of the patient with methadone. Facilities that provide methadone maintenance treatment do so as their principal mission and are certified by OASAS under 14 NYCRR Part 828. B) Medically Supervised Ambulatory Chemical Dependence Outpatient Clinic Programs Medically Supervised Ambulatory Chemical Dependence Outpatient Clinic Programs are licensed under Title 14 NYCRR Part 822 and provide chemical dependence outpatient treatment to individuals who suffer from chemical abuse or dependence and their family members or significant others. C) Medically Supervised Chemical Dependence Outpatient Rehabilitation Programs Medically Supervised Chemical Dependence Outpatient Rehabilitation Programs provide full or half-day services to meet the needs of a specific target population of chronic alcoholic persons who need a range of services which are different from those typically provided in an alcoholism outpatient clinic. Programs are licensed by as Chemical Dependence Outpatient Rehabilitation Programs under Title 14 NYCRR § 822.9. D) Outpatient Chemical Dependence for Youth Programs Outpatient Chemical Dependence for Youth Programs (OCDY) licensed under Title 14 NYCRR Part 823, establish programs and service regulations for OCDY programs. OCDY programs offer discrete, ambulatory clinic services to chemically-dependent youth in a treatment setting that supports abstinence from chemical dependence (including alcohol and substance abuse) services.
Sample 1
Non-Covered Behavioral Health Services a) Chemical Dependence Services i) Outpatient Rehabilitation and Treatment Services A) Methadone Maintenance Treatment Program (MMTP) Consists of drug detoxification, drug dependence counseling, and rehabilitation services which include chemical management of the patient with methadone. Facilities that provide methadone maintenance treatment do so as their principal mission and are certified by OASAS under 14 NYCRR Part 828. B) Medically Supervised Ambulatory Chemical Dependence Outpatient Clinic Programs Medically Supervised Ambulatory Chemical Dependence Outpatient Clinic Programs are licensed under Title 14 NYCRR Part 822 and provide chemical dependence outpatient treatment to individuals who suffer from chemical abuse or dependence and their family members or significant others.
Sample 1

Related to Non-Covered Behavioral Health Services

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. 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.

  • Mental Health Services This agreement covers medically necessary services for the treatment of mental health disorders in a general or specialty hospital or outpatient facilities that are: • reviewed and approved by us; and • licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a general or specialty hospital or outpatient facility. We review network and non-network programs, hospitals and inpatient facilities, and the specific services provided to decide whether a preauthorization, hospital or inpatient facility, or specific services rendered meets our program requirements, content and criteria. If our program content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below.

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

  • Health Services At the time of employment and subject to (b) above, full credit for registered professional nursing experience in a school program shall be given. Full credit for registered professional nursing experience may be given, subject to approval by the Human Resources Division. Non-degree nurses shall be placed on the BA Track of the Teachers Salary Schedule and shall be ineligible for movement to any other track.

  • Medical Care and Emergency Leave An employee is entitled to a leave of absence without pay because of any of the following: 1. A personal illness, injury or medical emergency. 2. The death, illness, injury or medical emergency of an individual described in this Article. 3. An urgent matter that concerns an individual described in this Article. For the purposes of this Article, the individuals referred to in this Article are: - the employee’s spouse - a parent, step-parent or xxxxxx parent of the employee or the employee’s spouse - a child, step-child or xxxxxx child of the employee or the employee’s spouse - a grandparent, step-grandparent, grandchild or step-grandchild of the employee or of the employee’s spouse - the spouse of a child of the employee - the employee’s brother or sister - a relative of the employee who is dependent on the employee for care or assistance. An employee who wishes to take leave under this section shall advise his or her Hospital that he or she will be doing so. If the employee must begin the leave before advising the Hospital, the employee shall advise the Hospital of the leave as soon as possible after beginning it. An employee is entitled to take a total of 10 days’ leave under this section each year. If an employee takes any part of a day as leave under this section, the Hospital may deem the employee to have taken one day’s leave on that day for the purposes of this Article. The Hospital may require an employee who takes leave under this section to provide evidence reasonable in the circumstances that the employee is entitled to the leave. Upon the conclusion of an employee’s leave under this Article, the Hospital shall reinstate the employee to the position the employee most recently held with the Hospital, if it still exists, or to a comparable position, if it does not.

  • Extended Health Care Plan ‌ The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable extended health care plan.

  • Family Care and Medical Leave An unpaid Family Care and Medical Leave shall be granted, to the extent of and subject to the restrictions as set forth below, to an employee who has been employed for at least twelve (12) months and who has served for 130 workdays during the twelve (12) months immediately preceding the effective date of the leave. For purposes of this Section, furlough days and days worked during off-basis time shall count as "workdays". Family Care and Medical Leave absences of twenty (20) consecutive working days or less can be granted by the immediate administrator or designee. Leaves of twenty (20) or more consecutive working days can be granted only by submission of a formal leave application to the Personnel Commission.

  • OCCUPATIONAL HEALTH & SAFETY (a) It is a mutual interest of the parties to promote health and safety in workplaces and to prevent and reduce the occurrence of workplace injuries and occupational diseases. The parties agree that health and safety is of the utmost importance and agree to promote health and safety and wellness throughout the organization. The employer shall provide orientation and training in health and safety to new and current employees on an ongoing basis, and employees shall attend required health and safety training sessions. Accordingly, the parties fully endorse the responsibilities of employer and employee under the Occupational Health and Safety Act, making particular reference to the following:

  • Mental Health The parties recognize the importance of supporting and promoting a psychologically healthy workplace and as such will adhere to all applicable statutes, policy, guidelines and regulations pertaining to the promotion of mental health.

  • Medical Care Leave An Employee who is unable to make the necessary arrangements for maintenance of personal health care outside of scheduled work time, shall be granted time off with pay. Such time off shall not exceed sixteen (16) working hours per calendar year. Hours in excess of sixteen (16) hours per calendar year shall be deducted from the Employee's sick leave accumulation.

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