Common use of Practice Guidelines Clause in Contracts

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. 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 (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.