Durable Medical Equipment (DME), Medical Supplies, Prosthetic Devices, Enteral Formula or Food, and Hair Prosthesis (Wigs) This plan covers durable medical equipment and supplies, prosthetic devices and enteral formula or food as described in this section. DME is equipment which: • can withstand repeated use; • is primarily and customarily used to serve a medical purpose; • is not useful to a person in the absence of an illness or injury; and • is for use in the home. DME includes supplies necessary for the effective use of the equipment. This plan covers the following DME: • wheelchairs, hospital beds, and other DME items used only for medical treatment; and • replacement of purchased equipment which is needed due to a change in your medical condition or if the device is not functional, no longer under warranty, or cannot be repaired. DME may be classified as a rental item or a purchased item. In most cases, this plan only pays for a rental DME up to our allowance for a purchased DME. Repairs and supplies for rental DME are included in the rental allowance. Medical supplies are consumable supplies that are disposable and not intended for re- use. Medical supplies require an order by a physician and must be essential for the care or treatment of an illness, injury, or congenital defect. Covered medical supplies include: • essential accessories such as hoses, tubes and mouthpieces for use with medically necessary DME (these accessories are included as part of the rental allowance for rented DME); • catheters, colostomy and ileostomy supplies, irrigation trays and surgical dressings; and • respiratory therapy equipment. This plan covers diabetic equipment and supplies for the treatment of diabetes in accordance with R.I. General Law §27-20-30. Covered diabetic equipment and supplies include: • therapeutic or molded shoes and inserts for custom-molded shoes for the prevention of amputation; • blood glucose monitors including those with special features for the legally blind, external insulin infusion pumps and accessories, insulin infusion devices and injection aids; and • lancets and test strips for glucose monitors including those with special features for the legally blind, and infusion sets for external insulin pumps. The amount you pay differs based on whether the equipment and supplies are bought from a durable medical equipment provider or from a pharmacy. See the Summary of Pharmacy Benefits and the Summary of Medical Benefits for details. Coverage for some diabetic equipment and supplies may only be available from either a DME provider or from a pharmacy. Visit our website to determine if this is applicable or call our Customer Service Department. Prosthetic devices replace or substitute all or part of an internal body part, including contiguous tissue, or replace all or part of the function of a permanently inoperative or malfunctioning body part and alleviate functional loss or impairment due to an illness, injury or congenital defect. Prosthetic devices do not include dental prosthetics. This plan covers the following prosthetic devices as required under R.I. General Law § 27-20-52: • prosthetic appliances such as artificial limbs, breasts, larynxes and eyes; • replacement or adjustment of prosthetic appliances if there is a change in your medical condition or if the device is not functional, no longer under warranty and cannot be repaired; • devices, accessories, batteries and supplies necessary for prosthetic devices; • orthopedic braces except corrective shoes and orthotic devices used in connection with footwear; and • breast prosthesis following a mastectomy, in accordance with the Women’s Health and Cancer Rights Act of 1998 and R.I. General Law 27-20-29. The prosthetic device must be ordered or provided by a physician, or by a provider under the direction of a physician. When you are prescribed a prosthetic device as an inpatient and it is billed by a provider other than the hospital where you are an inpatient, the outpatient benefit limit will apply. Enteral formula or food is nutrition that is absorbed through the intestinal tract, whether delivered through a feeding tube or taken orally. Enteral nutrition is covered when it is the sole source of nutrition and prescribed by the physician for home use. In accordance with R.I. General Law §27-20-56, this plan covers enteral formula taken orally for the treatment of: • malabsorption caused by Crohn’s Disease; • ulcerative colitis; • gastroesophageal reflux; • chronic intestinal pseudo obstruction; and • inherited diseases of amino acids and organic acids. Food products modified to be low protein are covered for the treatment of inherited diseases of amino acids and organic acids. Preauthorization may be required. The amount that you pay may differ depending on whether the nutrition is delivered through a feeding tube or taken orally. When enteral formula is delivered through a feeding tube, associated supplies are also covered. This plan covers hair prosthetics (wigs) worn for hair loss suffered as a result of cancer treatment in accordance with R.I. General Law § 27-20-54 and subject to the benefit limit and copayment listed in the Summary of Medical Benefits. This plan will reimburse the lesser of the provider’s charge or the benefit limit shown in the Summary of Medical Benefits. If the provider’s charge is more than the benefit limit, you are responsible for paying any difference. This plan covers Early Intervention Services in accordance with R.I. General Law §27- 20-50. Early Intervention Services are educational, developmental, health, and social services provided to children from birth to thirty-six (36) months. The child must be certified by the Rhode Island Department of Human Services (DHS) to enroll in an approved Early Intervention Services program. Services must be provided by a licensed Early Intervention provider and rendered to a Rhode Island resident. Members not living in Rhode Island may seek services from the state in which they reside; however, those services are not covered under this plan. Early Intervention Services as defined by DHS include but are not limited to the following: • speech and language therapy; • physical and occupational therapy; • evaluation; • case management; • nutrition; • service plan development and review; • nursing services; and • assistive technology services and devices.
Chiropractic Services This plan covers chiropractic visits up to the benefit limit shown in the Summary of Medical Benefits. The benefit limit applies to any visit for the purposes of chiropractic treatment or diagnosis.
Prosthodontics We Cover prosthodontic services as follows:
Operators Any and all Operators of the Equipment shall be duly experienced, trained and qualified to operate Equipment of this type. Although We may, from time to time, recommend certain qualified Operators with whom We are familiar, We do not supply Operators. You must supply and employ any Operator who operates the Equipment (even if the Operator is the owner of the Equipment or owner of a company that owns the Equipment) and that Operator shall be deemed to be Your employee and acting under Your supervision or control for all purposes and shall be covered as an insured on all of Your applicable insurance policies.
Durable Medical Equipment Durable Medical Equipment is equipment that is Medically Necessary for treatment of an illness or Accidental Injury or to prevent further deterioration. This equipment is designed for repeated use and used to treat a medical condition or illness, and includes items such as oxygen equipment, functional wheelchairs, and crutches. Durable Medical Equipment may require Prior Authorization. Only Durable Medical Equipment considered standard and/or basic as defined by nationally recognized guidelines are Covered.
Supplier’s Staff 3.3.1 Access to the Premises shall be limited to such Staff and the Supplier’s suppliers as are necessary for the Supplier to fulfil its obligations under the Contract. The Supplier shall co-operate with others working on the Premises to such extent as the Authority may reasonably require.
3.3.2 The Authority reserves the right to refuse to admit to, or to withdraw permission to remain on, the Premises:-
(a) for any member of the Staff; or
(b) for any person employed or engaged by any member of the Staff, whose admission or continued presence would be, in the reasonable opinion of the Authority, undesirable.
3.3.3 At the Authority’s written request, the Supplier shall provide a list of the names and business addresses of all persons who may require admission in connection with the Contract to the Premises, specifying the capacities in which they are concerned with the Contract and giving such other particulars as the Authority may reasonably request.
3.3.4 The Supplier’s Staff, engaged within the boundaries of the Premises, shall comply with such rules, regulations and requirements (including those relating to security arrangements) as may be in force from time to time for the conduct of personnel when at or outside those premises.
3.3.5 If the Supplier fails to comply with Clause 3.3.3 within one (1) Month of the date of the request and in the reasonable opinion of the Authority, such failure may be prejudicial to the interests of the Crown, then the Authority may terminate the Contract, provided always that such termination shall not prejudice or affect any right of action or remedy which shall have accrued or shall thereafter accrue to the Authority.
3.3.6 The decision of the Authority as to whether any person is to be refused access to the Premises and as to whether the Supplier has failed to comply with Clause 3.3.3 shall be final and conclusive.
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.
Instructors 7.1 All instructors teaching COLLEGE courses offered as part of this CCAP Agreement must meet the minimum qualifications for instruction in a California community college as set forth in sections 53410 and 58060 of Title V of the California Code of Regulations, as required or hired as part of an Instructional Service Agreement. Instructor qualifications are consistent with requirements courses given by the WVMCCD. Cal. Code Regs., Title 5, § 53410.
7.2 Consistent with the terms negotiated between WVMCCD and the faculty union, WVMFT instructors for courses offered as part of this CCAP Agreement shall be assigned as follows: • Courses will first be offered to regular faculty of COLLEGE that meet the above- stated minimum qualifications and have participated. • If courses are not filled by regular faculty, they will be offered to COLLEGE adjunct faculty who possess contractual rehire preference rights, and who meet the above-stated minimum qualifications. • If courses are still not filled, they may be offered to junior adjunct faculty and employees of CUHSD who meet the above-stated minimum qualifications.
7.3 WVMCCD shall be solely responsible for all salaries, wages, and benefits due to dual enrollment faculty who are WVMCCD employees. The CUHSD shall be solely responsible for the salaries, wages, and benefits due to the dual enrollment faculty who are CUHSD employees, unless otherwise agreed by CUHSD and WVMCCD.
7.4 The CCAP Agreement Appendix A shall specify which participating institution, either CUHSD or WVMCCD, will be the employer of record for purposes of assignment monitoring and reporting to the county office of education. (Ed. Code § 76004 (m)(1).)
7.5 CUHSD will assume reporting responsibilities pursuant to applicable federal teacher quality mandates. (Ed. Code § 76004 (m)(2).)
7.6 Instructors who teach courses offered as part of this CCAP Agreement must provide the supervision and control reasonably necessary for the protection of the health and safety of students and may not have any other assigned duty during the instructional activity. In the event of an emergency during the teaching of a course, instructors will act in accordance with WVMCCD policies, procedures and code of conduct and inform CUHSD as soon as reasonably possible. If the course is held on CUHSD property, instructors shall follow the direction of the Principal or his/her designee to coordinate the safety of the students in attendance during the emergency.
7.7 Instructors who teach courses under this CCAP Agreement shall comply with the fingerprinting requirements set forth in Ed Code section 45125 or as amended; the tuberculosis testing and risk assessment requirements of California Health and Safety Code section121525 or as amended; completion of training on mandated reporting as set forth in Education Code section 44691or as amended; and submission of a New Employee Data Input Form (i.e., Emergency Contact Information). In addition to any other prohibition or provision, no person who has been convicted of a violent or serious felony, as defined by Education Code section 44332.6 (c) shall be eligible to teach any courses offered as part of this CCAP Agreement or otherwise provide services on a CUHSD site. The CCAP Agreement Appendix shall specify additional procedures for faculty under this agreement.
7.8 Prior to teaching, faculty provided by the CUHSD shall receive discipline-specific training and an orientation from WVMCCD at COLLEGE regarding, but not limited to, course curriculum, assessment criteria, pedagogy, course philosophy, testing and grading procedures record keeping, and other instructional responsibilities. Said training shall be approved by WVMCCD. In the event WVMCCD and CUHSD disagree regarding faculty training guidelines, the parties agree to meet and confer in good faith. If the parties cannot reach agreement within a reasonable time, WVMCCD shall make the final decision regarding the appropriate training and orientation for CUHSD faculty.
7.9 Faculty provided by the CUHSD may participate in professional development activities sponsored by the WVMCCD and shall be encouraged to participate in ongoing collegial activities address items such as address course content, course delivery, assessment, evaluation, and/or research and development in the field.
7.10 Faculty performance of all instructors, regardless of whether they are WVMCCD or CUHSD employees shall be evaluated by WVMCCD using the adopted evaluation process and standards for faculty of the WVMCCD. In conducting the evaluation, WVMCCD will provide CUHSD the opportunity to provide input. Such input will be given reasonable consideration.
7.11 WVMCCD shall determine the number of instructors, the ratio of instructors to students, and the subject areas of instruction, subject to approval by CUHSD. In the event of any disagreement, the parties agree to meet and confer in good faith. If the parties do not reach agreement, WVMCCD shall make the final determination.
Supplier Personnel The Customer and Supplier agree and acknowledge that in the event of the Supplier ceasing to provide the Services or part of them for any reason, Call Off Schedule 10 (Staff Transfer) shall apply. The Supplier shall not and shall procure that any relevant Sub-Contractor shall not take any step (expressly or implicitly and directly or indirectly by itself or through any other person) without the prior written consent of the Customer to dissuade or discourage any employees engaged in the provision of the Services from transferring their employment to the Customer and/or the Replacement Supplier and/or Replacement Sub-Contractor. During the Termination Assistance Period, the Supplier shall and shall procure that any relevant Sub-Contractor shall: give the Customer and/or the Replacement Supplier and/or Replacement Sub-Contractor reasonable access to the Supplier's personnel and/or their consultation representatives to present the case for transferring their employment to the Customer and/or the Replacement Supplier and/or to discuss or consult on any measures envisaged by the Customer, Replacement Supplier and/or Replacement Sub-Contractor in respect of persons expected to be Transferring Supplier Employees; co-operate with the Customer and the Replacement Supplier to ensure an effective consultation process and smooth transfer in respect of Transferring Supplier Employees in line with good employee relations and the effective continuity of the Services. The Supplier shall immediately notify the Customer or, at the direction of the Customer, the Replacement Supplier of any period of notice given by the Supplier or received from any person referred to in the Staffing Information, regardless of when such notice takes effect. The Supplier shall not for a period of twelve (12) months from the date of transfer re-employ or re-engage or entice any employees, suppliers or Sub-Contractors whose employment or engagement is transferred to the Customer and/or the Replacement Supplier except that this paragraph 10.5 shall not apply where an offer is made pursuant to an express right to make such offer under Call Off Schedule 10.1 (Staff Transfer) in respect of a Transferring Supplier Employee not identified in the Supplier's Final Supplier Personnel List.
