REHABILITATION SERVICES (OUTPATIENT Sample Clauses

REHABILITATION SERVICES (OUTPATIENT. A. The Contractor shall perform prior authorization review for Speech Therapy (ST) for evaluation and treatment for recipients 21 years of age and older. Recipients under 21 years of age do not require authorization for ST evaluation. B. Physical Therapy (PT) and Occupational Therapy (OT) do not require prior authorization for evaluation. PT and OT do require prior authorization for therapy services. The Contractor shall perform authorization review on Record Abstract Review, including the HSD designated prior authorization form and supporting information submitted by the provider to justify specific requested amounts of service by procedure code consistent with clinical needs. C. The Contractor shall focus on medical necessity and appropriateness of setting. D. An eligible recipient less than 21 years of age who is eligible for a home and community based waiver program receives medically necessary rehabilitation services through the Early and Periodic, Screening, Diagnostic and Treatment (EPSDT) rehabilitation services. The Contractor shall approve a twelve (12) month prior authorization period for outpatient rehabilitation therapies when the medical conditions are expected to be of long-term duration and will require ongoing rehabilitative therapy. Maintenance therapy may be approved.
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Related to REHABILITATION SERVICES (OUTPATIENT

  • Outpatient If you receive infusion therapy services in a hospital's outpatient unit, we cover the use of the treatment room, related supplies, and solutions. For prescription drug coverage, see Section 3.27

  • Cardiac Rehabilitation This plan covers services provided in a cardiac rehabilitation program up to the benefit limit shown in the Summary of Medical Benefits.

  • Outpatient Services Physicians, Urgent Care Centers and other Outpatient Providers located outside the BlueCard® service area will typically require You to pay in full at the time of service. You must submit a Claim to obtain reimbursement for Covered Services.

  • Rehabilitation Program The company agrees to the implementation of an agreed worker’s compensation rehabilitation policy. The operation of this policy shall be reviewed on a regular basis. The parties commit to ensuring that the rehabilitation of injured workers is an accepted practice, and that suitable duties are provided when available. No employee will be terminated whilst on workers compensation during the first 12 months without prior consultation with the union. The parties agree that the person responsible for the management of rehabilitation cases must be adequately trained to do the job. If such a person is not available within the company, then the services of an agreed building industry rehabilitation coordination service will be used. The parties to this Agreement shall ensure that any employee who sustains a work related injury, illness or disease, will be afforded every assistance in utilising a rehabilitation program aimed at returning that employee to meaningful employment within the industry.

  • Inpatient Services Hospital Rehabilitation Facility

  • Inpatient If you are an inpatient in a general or specialty hospital for mental health services, this agreement covers medically necessary hospital services and the services of an attending physician for the number of hospital days shown in the Summary of Medical Benefits. See Section

  • Rehabilitation The Employer may use the results of the drug and alcohol test to require the employee to successfully complete a rehabilitation plan.

  • Preventive Care This plan covers preventive care as described below. “

  • Patient Care Resident shall participate in safe, effective, and compassionate patient care, under supervision, commensurate with Resident's level of advancement and responsibility.

  • Required Services Consultant agrees to perform the services, and deliver to City the “Deliverables” (if any) described in the attached Exhibit A, incorporated into the Agreement by this reference, within the time frames set forth therein, time being of the essence for this Agreement. The services and/or Deliverables described in Exhibit A shall be referred to herein as the “Required Services.”

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