Physical Health Services Sample Clauses

Physical Health Services. For each Provider type, for each Service Area, the Contractor shall have at least the specified number of Providers within at least the specified time or the specified distance of Enrollees’ residences. If no time or distance is indicated, the Contractor shall have at least one Provider located anywhere in the Commonwealth. Adult PCP (all Service Areas except Oak Bluffs and Nantucket) 2 30 15 Adult PCP (Oak Bluffs and Nantucket Service Areas only) 2 40 40 Pediatric PCP (all Service Areas except Oak Bluffs and Nantucket) 2 30 15 Pediatric PCP (Oak Bluffs and Nantucket Service Areas only) 2 40 40 Hospital (Acute Inpatient Services) 1 40 20 Urgent Care 1 30 15 Rehabilitation Hospital 1 60 30 OB/GYN 2 30 15 Pharmacy 1 30 15 For the Hospital (Acute Inpatient Services) requirement above, for Oaks Bluff and Nantucket Service Areas only, the Contractor may meet this requirement by including in its Provider Network any hospitals located in these Service Areas that provide acute inpatient services or the closest hospital located outside these Service Areas that provide acute inpatient services. Allergy 1 - - Anesthesiology 1 40 20 Audiology 1 40 20 Cardiology 1 40 20 Dermatology 1 40 20 Emergency Medicine 1 40 20 Endocrinology 1 40 20 Gastroenterology 1 40 20 General Surgery 1 40 20 Hematology 1 40 20 Infectious Disease 1 40 20 Medical Oncology 1 40 20 Nephrology 1 40 20 Neurology 1 40 20 Ophthalmology 1 40 20 Oral Surgery 1 - - Orthopedic Surgery 1 40 20 Otolaryngology 1 40 20 Physiatry 1 40 20 Plastic Surgery 1 - - Podiatry 1 40 20 Psychiatry 1 40 20 Pulmonology 1 40 20 Rheumatology 1 40 20 Urology 1 40 20 Vascular Surgery 1 - - For Oaks Bluff and Nantucket Service Areas only, the Contractor shall have at least one Provider in the above specialties, excluding Allergy, Oral Surgery, Plastic Surgery, and Vascular Surgery, within 40 miles or 40 minutes from Enrollees’ residences.
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Physical Health Services. 5.31.1. Chronic Illness Clinics: Access to specialty care shall be provided through regularly scheduled chronic illness clinics and other specialty clinics as necessary, conducted under the direct supervision of the CHO as required by FDC HSB 15.03.05, Chronic Illness Clinic. 5.31.1.1. CONTRACTOR shall provide regularly scheduled chronic illness clinics conducted under the direct supervision of the CHO for the following conditions: 5.31.1.1.1. Respiratory; 5.31.1.1.2. Endocrine; 5.31.1.1.3. Miscellaneous; 5.31.1.1.4. Cardiovascular; 5.31.1.1.5. Tuberculosis; 5.31.1.1.6. Immunity; 5.31.1.1.7. Neurology; 5.31.1.1.8. Gastrointestinal; and 5.31.1.1.9. Oncology.
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Physical Health Services. The benefit package includes primary (including those provided in school-based settings) and specialty physical health services provided by a licensed practitioner performed within the scope of practice as defined by State Law and set forth in MAD Program Manual Section MAD-711, MEDICAL SERVICES PROVIDERS; Section MAD-718.1, MIDWIFE SERVICES; Section MAD-718.2, PODIATRY SERVICES; Section MAD-712, RURAL HEALTH CLINIC SERVICES; and Section MAD-713, FEDERALLY QUALIFIED HEALTH CENTER SERVICES.
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Physical Health Services. For each Provider type, for each Service Area, the Contractor shall have at least the specified number of Providers within at least the specified time or the specified distance of Enrollees’ residences. If no time or distance is indicated, the Contractor shall have at least one Provider located anywhere in the Commonwealth. Adult PCP (all Service Areas except Oak Bluffs and Nantucket) 2 30 15 Adult PCP (Oak Bluffs and Nantucket Service Areas only) 2 40 40 Pediatric PCP (all Service Areas except Oak Bluffs and Nantucket) 2 30 15 Pediatric PCP (Oak Bluffs and Nantucket Service Areas only) 2 40 40 Hospital (Acute Inpatient Services) 1 40 20 Urgent Care 1 30 15 Rehabilitation Hospital 1 60 30 OB/GYN 2 30 15 Pharmacy 1 30 15 For the Hospital (Acute Inpatient Services) requirement above, for Oaks Bluff and Nantucket Service Areas only, the Contractor may meet this requirement by including in its Provider Network any hospitals located in these Service Areas that provide acute inpatient services or the closest hospital located outside these Service Areas that provide acute inpatient services.
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Physical Health Services. 5.31.1. Chronic Illness Clinics: Access to specialty care shall be provided through regularly scheduled chronic illness clinics and other specialty clinics as necessary, conducted under the direct supervision of the CHO as required by FDC HSB 15.03.05,
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Physical Health Services. Physical health services will be provided by LBU staff, as well as student health professionals from institutions of higher education with which LBU has educational affiliations. All student health professionals will be supervised by LBU staff. LBU provides services only through providers licensed to practice in the State of Texas.
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Physical Health Services activating and accessing healthcare through Medi-Cal or other health insurance, linkage to primary care physician, women’s health specialty appointments, ophthalmologist, dentist, physical therapist, etc.
Sample 1
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Related to Physical Health Services

  • 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.

  • 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.

  • 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.

  • 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 – 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.

  • 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.

  • 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.

  • Mental Health The parties recognize the importance of supporting and promoting a psychologically healthy workplace and as such will adhere to all applicable statutes, policy, guidelines and regulations pertaining to the promotion of mental health.

  • 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.

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.

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