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).
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Specialty Care Centers. 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
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Specialty Care Centers. Quality Assurance 16.1 Internal Quality Assurance Program 16.2 Standards of Care
Sample 1Sample 2Sample 3
Specialty Care Centers. Quality Assurance
Sample 1
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
Sample 1

Related to Specialty Care Centers

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.

  • 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.

  • Hospice Care If you have a terminal illness and you agree with your physician not to continue with a curative treatment program, this plan covers hospice care services received in your home, in a skilled nursing facility, or in an inpatient facility.

  • Healthcare Section 1. Bargaining unit employees with one (1) year or more of service will be provided coverage for the duration of this contract through the “Full Coverage” Team Care Plan (“Team Care MM200”), which includes dental, vision, life, short term disability, medical and prescription drug benefits. Prior to January 1, 2020, bargaining unit employees with less than one (1) year of service will be provided coverage through the “Medical Only” plan. On January 1, 2020, all bargaining unit employees enrolled in the Medical Only plan shall be enrolled in the Full Coverage plan, and the Medical Only plan will eliminated. The rates for 2019 and a further description of the plan and rates are referenced

  • Child Care The County will continue to support the concept of non-profit child care facilities similar to the “Kid’s at Work” program established in the Public Works Department.

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.

  • Ambulance The deductible and coinsurance for services not subject to copays applies.

  • Vision Care Services For purposes of coordination of benefits, vision care services covered under other plans are not considered an allowable expense, as defined in the Coordination of Benefits and Subrogation in Section 7.

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

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