Practice Guidelines. 37.1. CONTRACTOR shall adopt practice guidelines (or adopt COUNTY’S practice guidelines) that meet the following requirements:
37.1.1. They are based on valid and reliable clinical evidence or a consensus of health care professionals in the applicable field;
37.1.2. They consider the needs of the clients;
37.1.3. They are adopted in consultation with contracting health care professionals; and
37.1.4. They are reviewed and updated periodically as appropriate (42 C.F.R.§ 438.236(b) and CCR, Title 9, Section 1810.326).
37.2. CONTRACTOR shall disseminate the guidelines to all affected providers and, upon request, to clients and potential clients (42 C.F.R. § 438.236(c)).
Practice Guidelines. Contractor shall comply with and disseminate the Practice Guidelines to all affected staff and, upon request, to beneficiaries and potential beneficiaries. Practice Guidelines can be accessed at xxx.XxxxxXXXX.xxx. [DMC-ODS IA, Exhibit A]
Practice Guidelines. 22.1 Contractor shall adopt practice guidelines (or adopt MHP’s practice guidelines) that meet the following requirements:
22.1.1 They are based on valid and reliable clinical evidence or a consensus of health care professionals in the applicable field;
22.1.2 They consider the needs of the beneficiaries;
22.1.3 They are adopted in consultation with contracting health care professionals; and
22.1.4 They are reviewed and updated periodically as appropriate (42 C.F.R.§ 438.236(b) and CCR, Title 9, Section 1810.326).
22.2 Contractor shall disseminate the guidelines to all affected providers and, upon request, to beneficiaries and potential beneficiaries (42 C.F.R. § 438.236(c)).
22.3 Contractor shall take steps to assure that decisions for utilization management, beneficiary education, coverage of services, and any other areas to which the guidelines apply shall be consistent with the guidelines (42 C.F.R. § 438.236(d)).
Practice Guidelines. A. The Contractor shall adopt practice guidelines. (42 C.F.R. § 438.236(b) and Cal. Code Regs., tit. 9, § 1810.326)
Practice Guidelines. The Contractor shall provide practice guidelines to the Department upon request within ten (10) Business Days, and at no cost to the Department.
Practice Guidelines. The Contractor shall comply with 42 CFR 438.236(b) which requires the adoption of practice guidelines. The Contractor shall comply with the practice guidelines established in Exhibit A, Attachment I Section 1.2(B).
A. The Contractor’s practice guidelines shall:
1) be based on valid and reliable clinical evidence or a consensus of health care professionals in the applicable field;
Practice Guidelines. In accordance with 42 C.F.R. Section 438.236, HMO must adopt practice guidelines, that are based on valid & reliable clinical evidence or a consensus of health care professionals in the particular field; consider the needs of the HMO's Members; are adopted in consultation with contracting health care professionals; and are reviewed and updated periodically as appropriate. The HMO must disseminate the guidelines to all affected providers and, upon request to Members and potential Members. The HMO's decisions regarding utilization management, member education, coverage of services, and other areas included in the guidelines, must be consistent with the HMO's guidelines."
Practice Guidelines. 4.12.7.1 The Contractor shall adopt a minimum of three (3) evidence-based clinical practice guidelines. Such guidelines shall: · Be based on the health needs and opportunities for improvement identified as part of the QAPI program; · Be based on valid and reliable clinical evidence or a consensus of Health Care Professionals in the particular field; · Consider the needs of the Members; · Be adopted in consultation with network Providers; and · Be reviewed and updated periodically as appropriate.
4.12.7.2 The Contractor shall submit all Practice Guidelines in use, which shall include a methodology for measuring and assessing compliance, to DCH for review and prior approval as part of the QAPI program plan as updated.
4.12.7.3 The Contractor shall disseminate the guidelines to all affected Providers and, upon request, to Members.
4.12.7.4 The Contractor shall ensure that decisions for Utilization Management, Member education, coverage of services, and other areas to which the guidelines apply are consistent with the guidelines.
4.12.7.5 In order to ensure consistent application of the guidelines the Contractor shall encourage Providers to utilize the guidelines, and shall measure compliance with the guidelines, until ninety percent (90%) or more of the Providers are consistently in compliance. The Contractor may use Provider incentive strategies to improve Provider compliance with guidelines.
Practice Guidelines a. The Health Plan shall adopt practice guidelines that meet the following requirements:
(1) Are based on valid and reliable clinical evidence or a consensus of Health Care Professionals in a particular field;
(2) Consider the needs of the Enrollees;
(3) Are adopted in consultation with Providers; and
(4) Are reviewed and updated periodically, as appropriate (See 42 CFR 438.236(b)).
b. The Health Plan shall disseminate any revised practice guidelines to all affected Providers and, upon request, to Enrollees and Potential Enrollees.
c. The Health Plan shall ensure consistency with regard to all decisions relating to UM, Enrollee education, Covered Services and other areas to which the practice guidelines apply.
Practice Guidelines. 2.8.4.1. The Contractor shall meet the requirements of this contract, federal managed care regulations (42 CFR Part 438), and 42 CFR Part 2 confidentiality regulations when adopting practice guidelines.
