Patient-Centered Medical Homes Sample Clauses

Patient-Centered Medical Homes. The Contractor shall encourage the development of NCQA-recognized Patient- Centered Medical Homes and coordinate with any Division-level initiatives related to the development and NCQA recognition of Patient-Centered Medical Homes, as defined by the Division. Based on the collaboration with the Division, the Division will define specific reporting requirements which may change as the initiative is implemented. The Division will notify the Contractor of the reporting requirements in writing at least sixty (60) days before the report containing the required information is due.
Sample 1Sample 2Sample 3See All (6)
AutoNDA by SimpleDocs
Patient-Centered Medical Homes. Benefits may include delivery of Benefits through patient centered medical homes for Covered Persons with chronic conditions, serious illnesses or complex health care needs who agree to participate in a patient centered medical home program. This includes associated costs for coordination of care such as:  Liaison services between the Covered Person and the health care provider, nurse coordinator, and the care coordination team;  Creation and supervision of a care plan;  Education of the Covered Person and the Covered Person's family regarding the Covered Person's disease, treatment compliance and self-care techniques; and  Assistance with coordination of care, including arranging consultations with Specialist Physicians and obtaining Medically Necessary supplies and services, including community resources. Special Note Regarding Medicare If you are enrolled in Medicare on a primary basis (Medicare pays before we pay Benefits under the Policy), the prior authorization requirements do not apply to you. Since Medicare is the primary payer, we will pay as secondary payer as described in Section 7: Coordination of Benefits. You are not required to obtain authorization before receiving Covered Health Services.
Sample 1
Patient-Centered Medical Homes. The MetroHealth System has established Patient Centered Medical Homes to provide high-quality, coordinated care and case-management to demonstration enrollees. All individuals enrolled for the demonstration will be encouraged to elect a MetroHealth network Patient Centered Medical Home (PCMH) at the initial date of enrollment. The participant has the option, at any time, to elect a different PCMH or a different primary care provider within a different PCMH in the demonstration’s provider network. Individuals that do not have a relationship with a network PCMH Primary Care Provider (PCP) at the time of enrollment will choose their primary care provider and be assigned to the PCMH with which that PCP is affiliated. If the individual does not choose a PCP/PCMH at the time of initial enrollment, she/he will select the PCP at the time of their first primary care visit. The PCMH is charged with assisting individuals in coordinating care and assisting the enrollee in obtaining care that will improve health outcomes.
Sample 1
Patient-Centered Medical Homes. Benefits may include delivery of Benefits through patient centered medical homes for Covered Persons with chronic conditions, serious illnesses or complex health care needs who agree to participate in a patient centered medical home program. This includes associated costs for coordination of care such as: • Liaison services between the Covered Person and the health care provider, nurse coordinator, and the care coordination team; • Creation and supervision of a care plan; • Education of the Covered Person and the Covered Person's family regarding the Covered Person's disease, treatment compliance and self-care techniques; and • Assistance with coordination of care, including arranging consultations with Specialist Physicians and obtaining Medically Necessary supplies and services, including community resources.
Sample 1
Patient-Centered Medical Homes. Health Plan agrees to promote and facilitate the capacity of its Providers to provide patient-centered care by using systematic, patient-centered medical home management processes and health information technology to deliver improved quality of care, health outcomes, and patient compliance and satisfaction. Members must be cared for by a physician who leads a medical team that coordinates all aspects of the preventive, acute, and chronic needs of Members, using best available evidence and appropriate technology.
Sample 1
Patient-Centered Medical Homes. A. Delivery of benefits through patient centered medical homes for individuals with chronic conditions, serious illnesses or complex health care needs who agree to participate in a patient centered medical home program. This includes associated costs for coordination of care, such as:
Sample 1

Related to Patient-Centered Medical Homes

  • Paramedical Services Services of the following registered/certified practitioners up to the maximums shown on the "Summary of Benefits" pages:

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

  • Emergency Medical Services The City’s Fire Department and MedStar (or other entity engaged by the City after the Effective Date) will provide emergency medical services.

  • Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services.

  • Clinical Management for Behavioral Health Services (CMBHS) System The CMBHS is the official record of documentation by System Agency. Grantee shall:

  • Surgical Services All necessary procedures for extractions and other surgical procedures normally performed by a dentist.

  • Durable Medical Equipment (DME), Medical Supplies Prosthetic Devices, Enteral Formula or Food, and Hair Prosthesis (Wigs) • Items typically found in the home that do not need a prescription and are easily obtainable such as, but not limited to: o adhesive bandages; o elastic bandages; o gauze pads; and o alcohol swabs. • DME and medical supplies prescribed primarily for the convenience of the member or the member’s family, including but not limited to, duplicate DME or medical supplies for use in multiple locations or any DME or medical supplies used primarily to assist a caregiver. • Non-wearable automatic external defibrillators. • Replacement of durable medical equipment and prosthetic devices prescribed because of a desire for new equipment or new technology. • Equipment that does not meet the basic functional need of the average person. • DME that does not directly improve the function of the member. • Medical supplies provided during an office visit. • Pillows or batteries, except when used for the operation of a covered prosthetic device, or items for which the sole function is to improve the quality of life or mental wellbeing. • Repair or replacement of DME when the equipment is under warranty, covered by the manufacturer, or during the rental period. • Infant formula, nutritional supplements and food, or food products, whether or not prescribed, unless required by R.I. Law §27-20-56 for Enteral Nutrition Products, or delivered through a feeding tube as the sole source of nutrition. • Corrective or orthopedic shoes and orthotic devices used in connection with footwear, unless for the treatment of diabetes. Experimental or Investigational Services • Treatments, procedures, facilities, equipment, drugs, devices, supplies, or services that are experimental or investigational except as described in Section 3. Gender Reassignment Services • Reversal of gender reassignment surgery.

  • Medical Services We do not Cover medical services or dental services that are medical in nature, including any Hospital charges or prescription drug charges.

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.

  • Medical Care The Parents must comply with the School Welfare Officer's recommendations which may include a reasonable decision to release the Pupil home or to his / her education guardian when s/he is unwell.

Time is Money Join Law Insider Premium to draft better contracts faster.