Common use of Practice Guidelines Clause in Contracts

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)).