Substance Use Disorder Treatment Sample Clauses

Substance Use Disorder Treatment. This agreement covers medically necessary services for the treatment of substance use disorder in a hospital, substance use disorder treatment facility, or an acute substance use disorder rehabilitation/residential facility that is:  reviewed and approved by us; and  licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a hospital, a substance use disorder treatment facility, or an acute substance use disorder residential/rehabilitative facility. We review network and non-network programs, hospital or inpatient facilities, acute substance use disorder rehabilitation/residential facilities and the specific services provided. We decide whether a program, hospital or inpatient facility, acute substance use disorder rehabilitation/residential facility, or specific services rendered meets our program requirements, content and criteria. If our program requirements, content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below. If you are an acute inpatient in a general or specialty hospital for behavioral health services, we cover medically necessary acute hospital services for detoxification. See Section 3.21 - Inpatient Hospital Services for additional information. Preauthorization is recommended.

Substance Use Disorder Treatment. This agreement covers medically necessary services for the treatment of substance use disorder in a hospital, substance use disorder treatment facility, or an acute substance use disorder rehabilitation/residential facility that is: • reviewed and approved by us; and • licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a hospital, a substance use disorder treatment facility, or an acute substance use disorder residential/rehabilitative facility. We review network and non-network programs, hospital or inpatient facilities, acute substance use disorder rehabilitation/residential facilities and the specific services provided. We decide whether a program, hospital or inpatient facility, acute substance use disorder rehabilitation/residential facility, or specific services rendered meets our program requirements, content and criteria. If our program requirements, content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below.

Substance Use Disorder Treatment. Obtain a substance use disorder evaluation from a Washington state-certified agency and file written proof of the evaluation with Probation Services within 90 days of entering into this Agreement. Defendant shall also successfully comply with all treatment recommendations and file written proof of such compliance through completion with Probation Services at least quarterly (every 3 months).

Substance Use Disorder Treatment. If clinically indicated, the Care Coordinator may refer the individual to a DBHR-licensed SUD treatment program. The Care Coordinator shall use a LRA/AOT referral form, as provided by DBHR.

Substance Use Disorder Treatment. Rehabilitative services of diagnostic evaluation and face-to-face individual or group counseling using therapeutic techniques that are provided in certified programs.

Substance Use Disorder Treatment. If clinically indicated, the HARPS Team may refer the individual to a DBHR-licensed SUD treatment program. The HARPS Team shall use an LRA/AOT referral form, as provided by DBHR.

Substance Use Disorder Treatment. Sharp Health Plan covers Medically Necessary services for the diagnosis or treatment of Substance Use Disorders that fall under any of the diagnostic categories listed in the mental and behavioral disorders chapter of the most recent edition of the International Classification of Diseases or that are listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, which include but are not limited to the following services: • Physician services, including consultation and referral to other health care providers and prescription drugs when furnished or administered by a health care provider or facility • Outpatient professional services, including but not limited to individual, group and family substance use counseling • Medication management • Diagnostic laboratory and diagnostic and therapeutic radiologic services • Drug testing, both presumptive and definitive, including for initial and ongoing patient assessment during Substance Use Disorder treatment • Home health services • Intensive home-based treatment • Preventive health services, as described under Preventive Care Services • Emergency health care services, including ambulance and ambulance transport services and Out-of-Area coverage, as described under Emergency Services and Care.

Substance Use Disorder Treatment. Any court ordered treatment or therapy, or any treatment or therapy ordered as a condition of parole, probation, custody, or What Is Not Covered?‌‌ visitation is not covered unless determined to be Medically Necessary for diagnosis or treatment of a Substance Use Disorder. This does not apply to services received as part of a Community Assistance Recovery and Empowerment (CARE) Agreement or CARE Plan approved by a court. Any services provided to you by an Employee Assistance Program (EAP) offered by an employer are not Covered Benefits. Sharp Health Plan does not provide EAP services. Services for conditions that the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) identifies as something other than a mental health condition or Substance Use Disorder are not covered. Changes in terminology, organization, or classification of Mental Health and Substance Use Disorders in future versions of the DSM or ICD shall not affect the conditions covered by the Plan as long as a condition is commonly understood to be a Mental Health or Substance Use Disorder by health care providers practicing in relevant clinical specialties. Benefits or coverage for Medically Necessary services shall not be limited or excluded on the basis that those services should be covered by a public entitlement program, including, but not limited to, special education or an individualized education program, Medicaid, Medicare, Supplemental Security Income, or Social Security Disability Insurance. Vision services are not covered unless specifically listed as covered in this Member Handbook. Vision services that are specifically not covered for Members age 19 and older include, but are not limited to: • Eye surgery for the sole purpose of correcting refractive error (e.g., radial keratotomy). • Orthoptic services (a technique of eye exercises designed to correct the visual axes of eyes not properly coordinated for binocular vision). • Eyeglasses or contact lenses (for adults 19 and older). • Routine vision examinations (for adults 19 and older). • Eye refractions for the fitting of glasses. • Cosmetic materials, including anti- reflective coating, color coating, mirror coating, blended lenses, cosmetic lenses, laminated lenses, oversize lenses, photochromic lenses, tinted lenses (except Pink #1 and Pink #2), and progressive multifocal lenses. • Plano lenses (less than ± .50 d...