Behavioral Health Services – Mental Health and Substance Use Disorder Inpatient - Unlimited days at a general hospital or a specialty hospital including detoxification or residential/rehabilitation per plan year. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Outpatient or intermediate careservices* - See Covered Healthcare Services: Behavioral Health Section for details about partial hospital program, intensive outpatient program, adult intensive services, and child and family intensive treatment. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Office visits - See Office Visits section below for Behavioral Health services provided by a PCP or specialist. Psychological Testing 0% - After deductible 40% - After deductible Medication-assisted treatment - whenrenderedby a mental health or substance use disorder provider. 0% - After deductible 40% - After deductible Methadone maintenance treatment - one copayment per seven-day period of treatment. 0% - After deductible 40% - After deductible Outpatient - Benefit is limited to 18 weeks or 36 visits (whichever occurs first) per coveredepisode. 0% - After deductible 40% - After deductible In a physician's office - limited to 12 visits per plan year. 0% - After deductible 40% - After deductible Emergency room - When services are due to accidental injury to sound natural teeth. 0% - After deductible The level of coverage is the same as network provider. In a physician’s/dentist’s office - When services are due to accidental injury to sound natural teeth. 0% - After deductible 40% - After deductible Services connected to dental care when performed in an outpatient facility * 0% - After deductible 40% - After deductible Inpatient/outpatient/in your home 0% - After deductible 40% - After deductible (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Outpatient durable medical equipment* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient medical supplies* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient diabetic supplies/equipment purchasedat licensed medical supply provider (other than a pharmacy). See the Summary of Pharmacy Benefits for supplies purchased at a pharmacy. 20% - After deductible 40% - After deductible Outpatient prosthesis* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Enteral formula delivered through a feeding tube. Must be sole source of nutrition. 20% - After deductible 40% - After deductible Enteral formula or food taken orally * 20% - After deductible The level of coverage is the same as network provider. Hair prosthesis (wigs) - The benefit limit is $350 per hair prosthesis (wig) when worn for hair loss suffered as a result of cancer treatment. 20% - After deductible The level of coverage is the same as network provider. Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% - After deductible The level of coverage is the same as network provider. Asthma management 0% - After deductible 40% - After deductible Hospital emergency room 0% - After deductible The level of coverage is the same as network provider.
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.
Educational Leave Leave without pay may be granted for educational leave for the duration of actual attendance in an educational program.
Family Medical Leave or Critical Illness Leave a) Family Medical Leave or Critical Illness leaves granted to a permanent teacher, long-term occasional teacher or teacher hired into a term position under this Article shall be in accordance with the provisions of the Employment Standards Act, as amended.
b) The teacher will provide to the employer such evidence as necessary to prove entitlement under the Employment Standards Act.
c) A teacher contemplating taking such leave(s) shall notify the employer of the intended date the leave is to begin and the anticipated date of return to active employment.
d) Seniority and experience continue to accrue during such leave(s).
e) Where a teacher is on such leave(s), the Employer shall continue to pay its share of the benefit premiums, where applicable. To maintain participation and coverage under the Collective Agreement, the teacher must agree to provide for payment for the teacher’s share of the benefit premiums, where applicable.
f) In order to receive pay for such leaves, a teacher must access Employment Insurance and the Supplemental Employment Benefit (SEB) in accordance with g) to j), if allowable by legislation. An employee who is eligible for E.I. is not entitled to benefits under a school board’s sick leave and short term disability plan.
g) The Employer shall provide for permanent teachers, long-term occasional teachers and teachers hired into a term position who access such Leaves, a SEB plan to top up their E.I.
PERSONAL/XXXXX’S LEAVE 7.3.1 All full time employees shall be entitled to accrue paid personal / carer's leave on the basis of 10 days per year (or pro-rata thereof for any period less than one year). Part-time employees are entitled to a pro-rata benefit. Paid personal / carer's leave is cumulative.
7.3.2 All accrued personal leave shall be available for use as carer's leave in accordance with the provisions outlined below.
7.3.3 As part of its commitment to provide a family-friendly workplace, the employer will allow employees to use any amount of accrued personal /xxxxx's leave to enable employees to:
(a) provide primary care to partners, children and/or other household or family members.
(b) attend the funerals of family or household members or close family relatives (if compassionate leave is not available in the circumstances).
7.3.4 The leave provided for in this clause will be granted subject to the following:
(a) The employee must notify the employer of the reason and likely duration of the absence before 7.00 am on the first day of the absence, unless this is not possible due to an unexpected emergency in which case the employee must notify the employer as soon as practicable.
(b) Where circumstances permit, an employee must endeavour to arrange leave to minimise the impact on operational needs.
(c) The provision of appropriate documentary evidence.
1. For sick leave, a medical certificate or if not reasonably practicable to provide a medical certificate- a statutory declaration made by the employee.
2. For xxxxx's leave, a medical certificate in respect to the family or household member, or a statutory declaration by the employee.
3. For compassionate leave, any evidence that the employer reasonably requires.
7.3.5 The employee is not entitled to take more than 10 days of paid xxxxx’s leave (1/26th of the nominal hours worked by the employee) per year, regardless of the amount of personal leave the employee has accumulated over time.
7.3.6 An employee may request to cash out any amount of paid personal/carer’s leave that they have accrued that is excess of 3/52 of the number of nominal hours worked over the past 12 months. For example, an employee working 38 hours per week over 12 months must retain 15 days of paid personal/carer’s leave and may cash out any further personal/carer’s leave that has been accumulated.
7.3.7 In addition to the above, a request to cash out personal/carer’s leave will only be granted where:
(a) the employee elects to cash out their leave in writing; and
(b) the employer agrees.
7.3.8 Casual Employees engaged in continuous service shall be entitled to personal leave limited to the provision of sub clause 7.3.
Personal Leaves 8.11.4.1 As approved by the Board, personal leaves without pay may be granted in cases of exceptional need for up to six (6) months. Any such leave exceeding one (1) semester shall not be counted toward tenure or promotion or for computing salary increments. These leaves may be extended by the PVPAA upon recommendation of the xxxx for up to one (1) year.
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.
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.
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.
Personal Leave With Pay Full-time employees who are eligible to accrue sick leave may use up to a maximum of six days personal leave with pay per year provided that such days shall be charged against the employee's currently accrued sick leave. This leave is non-cumulative.
