Primary Care Physicians (PCPs Sample Clauses

Primary Care Physicians (PCPs. This provision applies to Providers who are PCPs. When a PCP has initiated medication management services for a Covered Person to treat a behavioral health disorder and it is subsequently determined by the PCP or United that the Covered Person should be transferred to a Regional Behavioral Health Authority (RBHA) prescriber for evaluation and/or continued medication management services, the PCP shall cooperate with United in coordinating the transfer of the Covered Person’s care to the RBHA. Provider agrees that, the Integrated RBHA-
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Primary Care Physicians (PCPs. Primary Care Physicians (PCPs) may be individuals or group practices/clinics [Primary Care Clinics (PCCs)]. Acceptable specialty types for PCPs are family/general practice, and internal medicine. Acceptable PCCs include FQHCs, RHCs and the acceptable group practices/clinics specified by ODJFS. As part of their subcontract with an MCP, PCPs must stipulate the total Medicaid member capacity that they can ensure for that individual MCP. Each PCP must have the capacity and agree to serve at least 50 Medicaid members at each practice site in order to be approved by ODJFS as a PCP. The capacity-by-site requirement must be met for all ODJFS-approved PCPs. ODJFS reviews the capacity totals for each PCP to determine if they appear excessive. ODJFS reserves the right to request clarification from an MCP for any PCP whose total stated Appendix H Aged, Blind or Disabled (ABD) population Page 3 capacity for all MCP networks added together exceeds 2000 Medicaid members (i.e., 1 FTE). ODJFS may allow up to an additional 750 member capacity for each nurse practitioner or physician’s assistant that is used to provide clinical support for a PCP. For PCPs contracting with more than one MCP, the MCP must ensure that the capacity figure stated by the PCP in their subcontract reflects only the capacity the PCP intends to provide for that one MCP. ODJFS utilizes each approved PCP’s capacity figure to determine if an MCP meets the provider panel requirements and this stated capacity figure does not prohibit a PCP from actually having a caseload that exceeds the capacity figure indicated in their subcontract. ODJFS expects that MCPs will need to utilize specialty physicians to serve as PCPs for some special needs members. In these situations it will not be necessary for the MCP to submit these specialists to the PVS database as PCPs, however, they must be submitted to PVS as the appropriate required provider type. Also, in some situations (e.g., continuity of care) a PCP may only want to serve a very small number of members for an MCP. In these situations it will not be necessary for the MCP to submit these PCPs to ODJFS for prior approval. These PCPs will not be included in the ODJFS PVS database and therefore may not appear as PCPs in the MCP’s provider directory. These PCPs will, however, need to execute a subcontract with the MCP which includes the appropriate Model Medicaid Addendum. The PCP requirement is based on an MCP having sufficient PCP capacity to serve 40% of the eli...
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Primary Care Physicians (PCPs. This provision applies to Providers who are PCPs. When a PCP has initiated medication management services for a Covered Person to treat a behavioral health disorder and it is subsequently determined by the PCP, Health Plan and/or Subcontractor that the Covered Person should be transferred to a Regional Behavioral Health Authority (RBHA) prescriber for evaluation and/or continued medication management services, the PCP shall cooperate with Health Plan and/or Subcontractor, as applicable, in coordinating the transfer of the Covered Person’s care to the RBHA. Provider agrees that, the Integrated RBHA--entity contracted with ADHS to provide, manage and coordinate all medically necessary behavioral healthcare services for Title XIX eligible adults and all medically necessary physical health services for individuals with serious mental illness--will provide the full continuum of care including all outpatient and inpatient medical and behavioral health care as well as supportive services, per Member’s eligibility and Covered Services.
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Primary Care Physicians (PCPs. If designated as a PCP, Provider must be accessible to Covered Persons 24 hours per day, 7 days per week. Further, PCPs must provide preventative care: (a) to children under age 21 in accordance with AAP recommendations for CHIP Covered Services and the THSteps periodicity schedule published in the THSteps Manual for Medicaid Covered Services; and (b) to adults in accordance with the U.S. Preventative Task Force requirements. PCPs must also assess the medical needs and behavioral health needs of Covered Persons for referral to specialty care providers and provide referrals as needed. PCPs must coordinate Covered Persons’ care with specialty care providers after referral and serve as a Medical Home to Customers. For THSteps, PCPs must: 1. Either be enrolled as THSteps Providers or refer Members due for a THSteps check-up to a THSteps provider; 2. Refer Members for follow-up assessment or interventions clinically indicated as a result of the THSteps check-up, including the developmental and behavioral components of the screening; 3. Submit information from the THSteps forms and documents to the Health Passport.
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Primary Care Physicians (PCPs. If designated as a PCP, Provider must be accessible to Covered Persons 24 hours per day, 7 days per week. Further, PCPs must provide preventative care: (a) to children under age 21 in accordance with AAP recommendations for CHIP Covered Services and the THSteps periodicity schedule published in the THSteps Manual for Medicaid Covered Services; and (b) to adults in accordance with the U.S. Preventative Task Force requirements. PCPs must also assess the medical needs and behavioral health needs of Covered Persons for referral to specialty care providers and provide referrals as needed. PCPs must coordinate Covered Persons’ care with specialty care providers after referral and serve as a Medical Home to Customers.
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Primary Care Physicians (PCPs. This provision applies to Providers who are PCPs. When a PCP has initiated medication management services for a Covered Person to treat a behavioral health disorder and it is subsequently determined by the PCP or Health Plan and/or Subcontractor that the Covered Person should be transferred to a Regional Behavioral Health Authority (RBHA) prescriber for evaluation and/or continued medication management services, the PCP shall cooperate with Health Plan and/or Subcontractor in coordinating the transfer of the Covered Person’s care to the RBHA. Provider agrees that, the Integrated RBHA--entity contracted with ADHS to provide, manage and coordinate all medically necessary behavioral healthcare services for Title XIX eligible adults and all medically necessary physical health services for individuals with serious mental illness--will provide the full continuum of care including all outpatient and
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Related to Primary Care Physicians (PCPs

  • Physician Visits This plan covers the services of a physician or other provider in charge of your medical care while you are inpatient in a general or specialty hospital.

  • Health Care Operations “Health Care Operations” shall have the same meaning as the term “health care operations” in 45 CFR §164.501.

  • Family Care and Medical Leave An unpaid Family Care and Medical Leave shall be granted, to the extent of and subject to the restrictions as set forth below, to an employee who has been employed for at least twelve (12) months and who has served for one hundred thirty days (130) workdays during the twelve (12) months immediately preceding the effective date of the leave. For purposes of this section, furlough days and days worked during off-basis time shall count as "workdays". Family Care and Medical Leave absences of twenty (20) consecutive working days or less can be granted by the immediate administrator or designee. Leaves of twenty (20) or more consecutive working days can be granted only by submission of a formal leave application to the Classified Personnel Assignments Branch.

  • Pharmacy Pharmacy hereby represents that neither Pharmacy, nor, to the best of Pharmacy’s knowledge, Pharmacist, Pharmacy’s employees, agents or independent

  • Hospital 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.

  • Chiropractic Services This plan covers chiropractic visits up to the benefit limit shown in the Summary of Medical Benefits. The benefit limit applies to any visit for the purposes of chiropractic treatment or diagnosis.

  • Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services. This plan covers dental care for members until the last day of the month in which they turn nineteen (19). This plan covers services only if they meet all of the following requirements: • listed as a covered dental care service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered dental care service under this plan. • dentally necessary, consistent with our dental policies and related guidelines at the time the services are provided. • not listed in Exclusions section. • received while a member is enrolled in the plan. • consistent with applicable state or federal law. • services are provided by a network provider.

  • Contract for Professional Services of Physicians, Optometrists, and Registered Nurses In accordance with Senate Bill 799, Acts 2021, 87th Leg., R.S., if Texas Government Code, Section 2254.008(a)(2) is applicable to this Contract, Contractor affirms that it possesses the necessary occupational licenses and experience.

  • Contract for Professional Services of Physicians Optometrists, and Registered Nurses

  • Hospice Individuals whose permanent residence and principal work location are outside the State of Minnesota and outside of the service areas of the health plans participating in Advantage. If these individuals use the plan administrator’s national preferred provider organization in their area, services will be covered at Benefit Level Two. If a national preferred provider is not available in their area, services will be covered at Benefit Level Two through any other provider available in their area. If the national preferred provider organization is available but not used, benefits will be paid at the POS level described in paragraph “i” below. All terms and conditions outlined in the Summary of Benefits will apply.

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