Outpatient Funding Sample Clauses

Outpatient Funding. 32 a. In accordance with Exhibit B to the Agreement, COUNTY shall pay amounts from 33 COUNTY’s available Outpatient Funding to INTERMEDIARY, which funds shall be used by 34 INTERMEDIARY to reimburse non-hospital based outpatient service and other ancillary Providers not 35 otherwise specified in the Agreement and approved in writing by ADMINISTRATOR, including, but 36 not limited to, ambulance, home health Providers, durable medical equipment, laboratories, imaging, 37 surgery centers, and urgent care centers which may include professional services; as negotiated by
Sample 1
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Outpatient Funding. 8 a. In accordance with Exhibit B to the Agreement, COUNTY shall pay amounts from 9 COUNTY’s available Outpatient Funding to INTERMEDIARY, which funds shall be used by 10 INTERMEDIARY to reimburse non-hospital based outpatient service and other ancillary Providers not 11 otherwise specified in the Agreement and approved in writing by ADMINISTRATOR, including, but 12 not limited to, ambulance, home health Providers, durable medical equipment, laboratories, imaging, 13 surgery centers, and urgent care centers which may include professional services; as negotiated by 14 ADMINISTRATOR. 15 b. In the event that the total of all claims for Outpatient Funding exceeds the amount of 16 Outpatient Funding available for the Fiscal Year, any additional payments for non-hospital based 17 outpatient services shall be made proportionately from available Hospital Funding and Physician 18 Funding, in accordance with all claims submitted for Outpatient Funding.
Sample 1
Outpatient Funding. 15 a. In accordance with Exhibit E to this Agreement, COUNTY shall pay amounts from 16 COUNTY’S available Outpatient Funding to INTERMEDIARY, which funds shall be used by 17 INTERMEDIARY to reimburse non-hospital based outpatient service providers not otherwise specified 18 in this Agreement and approved in writing by ADMINISTRATOR, including, but not limited to, 19 laboratories, imaging, surgery, and urgent care centers which may include professional services; as 20 negotiated by ADMINISTRATOR. At sole discretion of ADMINISTRATOR, INTERMEDIARY may 21 be directed to reimburse ambulance, home health providers, and 22 available Outpatient Funding. Said direction may be provided 23 Agreement. durable medical equipment from at any time during term of this 24 b. INTERMEDIARY shall, from the available Outpatient Funding reimburse those 25 ambulance costs associated with the transfer of MSI Eligibles from UCI Medical Center to a Receiving 26 Hospital, or the transportation costs associated with the transfer of MSI Eligibles to a Specialized 27 Receiving Hospital. 28 c. In the event that the total of all payments to non-hospital outpatient providers is less 29 than the amount of Outpatient Funding available, at ADMINISTRATOR’S sole discretion, the balance 30 of MSI Funds shall either carry forward and be included in as Outpatient Funding in a subsequent 31 agreement, moved to another Funding category to ensure expenditure of MOE, or shall be retained by 32 COUNTY. 33 d. In the event that the total of all claims for Outpatient Funding exceeds the amount of 34 Outpatient Funding available for the Program Year, any additional payments for non-hospital based 35 outpatient services shall be made proportionately from available 36 37 18 of 21 Hospital Funding and Physician 1 Funding, in accordance with all claims submitted for Outpatient Funding 2 e. Pharmacy Claims – INTERMEDIARY shall, with available Outpatient Funding, 3 reimburse those outpatient pharmaceutical costs typically not claimed through the COUNTY’S 4 Pharmacy Benefits Manager for the MSI Program, including, but not limited to, chemotherapy and other 5 injectable drugs provided in Physician offices. 6 1) Except as otherwise authorized, in writing, by ADMINISTRATOR, reimbursement 7 of pharmaceutical costs by INTERMEDIARY shall not exceed that which would otherwise be paid by 8 COUNTY’S Pharmacy Benefits Manager. ADMINISTRATOR shall provide INTERMEDIARY the 9 reimbursement rates in effect with COUNTY’S Pharma...
Sample 1

Related to Outpatient Funding

  • Outpatient If you receive infusion therapy services in a hospital's outpatient unit, we cover the use of the treatment room, related supplies, and solutions. For prescription drug coverage, see Section 3.27

  • Outpatient Services Physicians, Urgent Care Centers and other Outpatient Providers located outside the BlueCard® service area will typically require You to pay in full at the time of service. You must submit a Claim to obtain reimbursement for Covered Services.

  • Patient Care Resident shall participate in safe, effective, and compassionate patient care, under supervision, commensurate with Resident's level of advancement and responsibility.

  • Inpatient If you are an inpatient in a general or specialty hospital for mental health services, this agreement covers medically necessary hospital services and the services of an attending physician for the number of hospital days shown in the Summary of Medical Benefits. See Section

  • Radiation Therapy/Chemotherapy Services This plan covers chemotherapy and radiation services. This plan covers respiratory therapy services. When respiratory services are provided in your home, as part of a home care program, durable medical equipment, supplies, and oxygen are covered as a durable medical equipment service.

  • Inpatient Services Hospital Rehabilitation Facility

  • In-Service Education The parties recognize the value of in-service both to the employee and the Employer and shall encourage employees to participate in in-service. All employees scheduled by the Employer to attend in-service seminars shall receive regular wages.

  • Ambulance Escort Where a nurse is assigned to provide patient care for a patient in transit, the following provisions shall apply: i) Where a full-time nurse performs such duties during her or his regular shift, the full-time nurse shall be paid her or his regular rate of pay. Where a full-time nurse performs such duties outside her or his regular shift or on a day off, she or he shall be paid the appropriate overtime rate. ii) Where a part-time nurse performs such duties during an assigned shift, she or he shall be paid her or his regular rate of pay. Where a part-time nurse continues to perform such duties in excess of her or his assigned shift, she or he shall be paid the appropriate overtime rate. (b) Where such duties extend beyond the nurse's regular shift, the Hospital will not require the nurse to return to regular duties at the hospital without at least eight (8) hours of time off. Where such time off extends into the nurse's next regularly scheduled shift she or he will maintain her or his regular earnings for that full shift. (c) Hours spent between the time the nurse is relieved of patient care responsibilities and the time the nurse returns to the hospital or to such other location agreed upon between the Hospital and the nurse will be paid at straight time or at appropriate overtime rates, if applicable under Article 14. 01. It is understood that the nurse shall return to the hospital or to such other location agreed upon between the Hospital and the nurse at the earliest opportunity. Prior to the nurse's departure on escort duty, or at such other time as may be mutually agreed upon between the Hospital and the nurse, the Hospital will establish with the nurse arrangements for return travel. (d) The nurse shall be reimbursed for reasonable out of pocket expenses including room, board and return transportation and consideration will be given to any special circumstances not dealt with under the foregoing provisions. NOTE 1: (Note 1 applies to full-time nurses only) The Hospital agrees to continue to pay any greater monetary benefit for ambulance escort duty if such greater benefit has been paid by the Hospital immediately prior to this Agreement. This note applies at Hospitals where this superior condition exists as of December 14, 1987. NOTE 2: (Note 2 applies to part-time nurses only) The Hospital agrees to continue to pay any greater monetary benefit for ambulance escort duty if such greater benefit was paid by the Hospital under a Collective Agreement immediately prior to this Agreement. This note applies at Hospitals where this superior condition exists as of December 14, 1987.

  • 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.

  • Health Promotion and Health Education Both parties to this Agreement recognize the value and importance of health promotion and health education programs. Such programs can assist employees and their dependents to maintain and enhance their health, and to make appropriate use of the health care system. To work toward these goals:

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