Oral Health Services Sample Clauses

Oral Health Services. The HHS will provide oral health services to people who meet the eligibility criteria for accessing public dental services in Queensland. Services will be delivered in line with guidance from the Office of the Chief Dental Officer. This clause does not apply to this HHS. This clause does not apply to this HHS. This clause does not apply to this HHS.
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Oral Health Services. (1) Contractor shall provide to Members all oral health Covered Services within the scope of the Member’s Benefit Package of Dental Services, in accordance with OAR Chapter 410 Division 141 applicable to DCOs and with the terms of this Contract. (2) Contractor shall establish written policies and procedures for Emergency Dental Services and Urgent Care Services for Emergency Dental Conditions that are consistent with OAR 410-141-3220(8). The policies and procedures must describe when treatment of an Emergency Dental Condition or Urgent Care Service should be provided in an ambulatory dental office setting, and when Emergency Dental Services should be provided in a hospital setting. (a) For routine oral health care the Member shall be seen within eight weeks unless there is a documented special clinical reason which would make access longer than eight weeks appropriate. Routine oral health treatment or treatment of incipient decay does not constitute emergency care. (b) For an Emergency Dental Service, the Member must be seen or treated within 24 hours; and for an Urgent Dental Service, the Member must be seen or treated within 72 hours or as indicated in initial screening. The treatment of an Emergency Dental Condition is limited to Covered Services. OHA recognizes that some Non-Covered Services may meet the criteria of treatment for the Emergency Dental Condition, however this Contract does not extend to those Non-Covered Services.
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Oral Health Services. (1) Contractor shall provide to Members all Oral Health Covered Services within the scope of the Member’s Benefit Package of Dental Services, in accordance with the terms of this Contract, and as set forth in OAR Chapter 410, Division 141 applicable to Dental Care Organizations. (2) Contractor shall establish written policies and procedures for routine oral care, Urgent oral care, and Dental Emergency Services for children, pregnant individuals, and non- pregnant individuals that are consistent with OAR 410-141-3515. The policies and procedures must describe when treatment of an emergency Oral Health condition or urgent Oral Health condition should be provided in an ambulatory dental office setting, and when Dental Emergency Services should be provided in a Hospital setting. (a) Routine Oral Health treatment or treatment of incipient decay does not constitute emergency care. (b) The treatment of an emergency Oral Health condition is limited to Covered Services. OHA recognizes that some Non-Covered Services may meet the criteria for treatment of an emergency Oral Health condition; however, this Contract does otnot extend to those Non-Covered Services. (3) Contractor shall make all reasonable efforts for its qualified representatives to meaningfully participate in OHA meetings and workgroups relating to the advancement and improvement of Oral Health in the state. Further, Contractor shall make all reasonable efforts to meaningfully engage third-party Oral Health stakeholders in meetings and activities that advance and improve Oral Health for Contractor’s Members. Third-party Oral Health stakeholders may include dental providers, Subcontracted Dental Care Organizations, and other similarly interested third-parties.
Sample 1
Oral Health Services. (1) Contractor shall provide to Members all Oral Health Covered Services within the scope of the Member’s Benefit Package of Dental Services, in accordance with the terms of this Contract and as set forth in OAR Chapter 410 Division 141 applicable to Dental Care Organizations. (2) Contractor shall establish written policies and procedures for Emergency Dental Services and Urgent Care Services for Emergency Dental Conditions that are consistent with OAR 410-141-3220(10) and (15)(d). The policies and procedures must describe when treatment of an Emergency Dental Condition or Urgent Care Service should be provided in an ambulatory dental office setting, and when Emergency Dental Services should be provided in a Hospital setting. (a) For routine Oral Health care, the Member shall be seen within eight weeks unless there is a documented special clinical reason which would make access longer than eight weeks appropriate. Routine Oral Health treatment or treatment of incipient decay does not constitute emergency care. (b) Subject to OAR 410-141-3220(10)(d)(A) and (B), for an Emergency Dental Service, the Member must be seen or treated within 24 hours, and for an Urgent Dental Service within one to two weeks or earlier as indicated in initial screening. The treatment of an Emergency Dental Condition is limited to Covered Services. OHA recognizes that some Non-Covered Services may meet the criteria of treatment for the Emergency Dental Condition, however this Contract does not extend to those Non-Covered Services.
Sample 1
Oral Health Services. (1) Contractor shall provide to Members all Oral Health Covered Services within the scope of the Member’s Benefit Package of Dental Services, in accordance with the terms of this Contract and as set forth in OAR Chapter 410 Division 141 applicable to Dental Care Organizations. (2) Contractor shall establish written policies and procedures for Emergency Dental Services and Urgent Care Services for Emergency Dental Conditions that are consistent with OAR 410-141-3515. The policies and procedures must describe when treatment of an Emergency Dental Condition or Urgent Care Service should be provided in an ambulatory dental office setting, and when Emergency Dental Services should be provided in a Hospital setting. (a) For routine Oral Health care, the Member shall be seen within eight weeks unless there is a documented special clinical reason which would make access longer than eight weeks appropriate. Routine Oral Health treatment or treatment of incipient decay does not constitute emergency care. (b) Subject to OAR 410-141-3515, for an Emergency Dental Condition, the Member must be seen or treated within 24 hours, and for an Urgent Dental Service within one to two weeks or earlier as indicated in initial screening. The treatment of an Emergency Dental Condition is limited to Covered Services. OHA recognizes that some Non-Covered Services may meet the criteria of treatment for the Emergency Dental Condition, however this Contract does not extend to those Non-Covered Services.
Sample 1
Oral Health Services. (1) Contractor shall provide to Members all oral health Covered Services within the scope of the Member’s Benefit Package of Dental Services, in accordance with OAR Chapter 410 Division 141 applicable to Dental Care Organizations (“DCOs”) and with the terms of this Contract. (2) Contractor shall establish written policies and procedures for Emergency Dental Services and Urgent Care Services for Emergency Dental Conditions that are consistent with OAR 410-141-3220(8). The policies and procedures must describe when treatment of an Emergency Dental Condition or Urgent Care Service should be provided in an ambulatory dental office setting, and when Emergency Dental Services should be provided in a hospital setting. (a) For routine oral health care, the Member shall be seen within eight weeks unless there is a documented special clinical reason which would make access longer than eight weeks appropriate. Routine oral health treatment or treatment of incipient decay does not constitute emergency care. (b) For an Emergency Dental Service, the Member must be seen or treated within 24 hours; and for an Urgent Dental Service, the Member must be seen or treated within 72 hours or as indicated in initial screening. The treatment of an Emergency Dental Condition is limited to Covered Services. OHA recognizes that some Non-Covered Services may meet the criteria of treatment for the Emergency Dental Condition, however this Contract does not extend to those Non-Covered Services.
Sample 1
Oral Health Services. Contractor shall provide to Members all oral healthOral Health Covered Services within the scope of the Member’s Benefit Package of Dental Services, in accordance with the terms of this Contract and as set forth in OAR Chapter 410 Division 141 applicable to DCOs and with the terms of this ContractDental Care Organizations.
Sample 1
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Oral Health Services. Oral health services in Rarotonga are currently located within the Tupapa Primary Health Care Centre. Oral health clinical services include the diagnosis of oral disease entities and the delivery of a broad range of restorative care (e.g. fillings), minor oral surgery procedures such as simple tooth extractions, impacted third molar extractions, simple periodontal treatments and provision of removable prostheses. Though KRA indicators for the Oral Health Division were not met during the NHSP 2017-21 period, prosthetic care, orthodontic, endodontic and less-complicated oral maxillofacial surgery services were expanded. The public health arm of the service deals with preventative aspects of dental care in schools and the wider community, including primary school toothbrush programmes.
Sample 1

Related to Oral 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 Grantee will receive allocated funding to secure Mental Health Services and Programs for youth under Xxxxxxx’s supervision. Services may include screening, assessment, diagnoses, evaluation, or treatment of youth with Mental Health Needs. The Department’s provision of State Aid Grant Mental Health Services funds shall not be understood to limit the use of other state and local funds for mental health services. State Aid Grant Mental Health Services funds may be used for all mental health services and programs as defined herein, however these funds may not be used to supplant local funds or for unallowable expenditure. Youth served by State Aid Grant Mental Health Services funds must meet the definition of Target Population for Mental Health Services provided in the Contract.

  • Home Health Care This plan covers the following home care services when provided by a certified home healthcare agency: • nursing services; • services of a home health aide; • visits from a social worker; • medical supplies; and • physical, occupational and speech therapy.

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.

  • COVERED HEALTHCARE SERVICES This section describes covered healthcare services. This plan covers services only if they meet all of the following requirements: • Listed as a covered healthcare service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered healthcare service under this plan. • Medically necessary, consistent with our medical policies and related guidelines at the time the services are provided. • Not listed in Exclusions Section. • Received while a member is enrolled in the plan. • Consistent with applicable state or federal law. We review medical necessity in accordance with our medical policies and related guidelines. Our medical policies can be found on our website. Our medical policies are written to help administer benefits for the purpose of claims payment. They are made available to you for informational purposes and are subject to change. Medical policies are not meant to be used as a guide for your medical treatment. Your medical treatment remains a decision made by you with your physician. If you have questions about our medical policies, please call Customer Service. When a new service or drug becomes available, when possible, we will review it within six (6) months of one of the events described below to determine whether the new service or drug will be covered: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final Food and Drug Administration (FDA) approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). During the review period, new services and drugs are not covered. For all covered healthcare services, please see the Summary of Medical Benefits and the Summary of Pharmacy Benefits to determine the amount that you pay and any benefit limits.

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