Specialty Care Centers Sample Clauses

Specialty Care Centers. The Contractor will implement policies and procedures to allow Enrollees with a life-threatening or a degenerative and disabling condition or disease, which requires prolonged specialized medical care to receive a referral to an accredited or designated specialty care center with expertise in treating the life-threatening or degenerative and disabling disease or condition, consistent with New York State PHL Section 4403(6)(d).

Specialty Care Centers. Section 16 Quality Assurance 16.1 Internal Quality Assurance Program 16.2 Standards of Care Section 17 Monitoring and Evaluation 17.1 Right To Monitor Contractor Performance 17.2 Cooperation During Monitoring And Evaluation 17.3 Cooperation During On-Site Reviews 17.4 Cooperation During Review of Services by External Review Agency TABLE OF CONTENTS October 1, 2004 TABLE OF CONTENTS FOR MODEL CONTRACT Section 18 Contractor Reporting Requirements 18.1 Time Frames for Report Submissions 18.2 SDOH Instructions for Report Submissions 18.3 Liquidated Damages 18.4 Notification of Changes in Report Due Dates, Requirements or Formats 18.5 Reporting Requirements a. Annual Financial Statements b. Quarterly Financial Statements c. Other Financial Reports d. Encounter Data e. Quality of Care Performance Measures f. Complaint Reports g. Fraud and Abuse Reporting Requirements h. Participating Provider Network Reports i. Appointment Availability/Twenty-Four Hour (24) Access and Availability Surveys j. Clinical Studies k. Independent Audits l. New Enrollee Health Screening Completion Report m. Additional Reports n. LDSS Specific Reports 18.6 Ownership and Related Information Disclosure 18.7 Revision of Certificate of Authority 18.8 Public Access to Reports 18.9 Professional Discipline 18.10 Certification Regarding Individuals Who Have Been Debarred or Suspended by Federal or State Government 18.11 Conflict of Interest Disclosure 18.12 Physician Incentive Plan Reporting

Specialty Care Centers. Section 16 Quality Assurance 16.1 Internal Quality Assurance Program 16.2 Standards of Care

Specialty Care Centers. Section 16 Quality Assurance

Specialty Care Centers. The Contractor will implement policies and procedures to allow Enrollees with a life-threatening or a degenerative and disabling condition or disease, which requires prolonged specialized medical care to receive a referral to an accredited or designated participating specialty care center with expertise in treating the life-threatening or degenerative and disabling disease or condition, consistent with New York State P.H.L. Section 4403(6)(d) unless the Contractor does not have a specialty care center qualified to meet a particular enrollee's needs. In such case, the Contractor shall make a referral to an appropriate provider consistent with the P.H.L. Section 4403(6)(a) or Insurance Law Section 4804 (d). FHPlus - Section 15 (EQUALITY OF ACCESS AND TREATMENT) October 1, 2001 15-4