Transition of Care for new Enrollees Sample Clauses

Transition of Care for new Enrollees. Contractor will identify new Enrollees who require transition services by using a variety of sources, including: 5.18.4.1 prior claim history as provided by the Department; 5.18.4.2 IPoC provided by the previous Contractor;
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Transition of Care for new Enrollees. If you are receiving ongoing care for an acute, serious or chronic mental health condition from a non- Participating Mental Health Professional at the time you enroll with Health Net, we may temporarily cover services from a provider not affiliated with the Behavioral Health Administrator, subject to applicable Copay- ments and any other exclusions and limitations of this SELECT Plan. Your non-Participating Mental Health Professional must be willing to accept the Behavioral Health Adminis- trator’s standard mental health provider contract terms and conditions and be located in the Plan’s service area in order for the services to be covered under the SELECT 1 benefit level. If you would like more information on how to request continued care, or request a copy of our continuity of care policy, please call the Customer Contact Center at the telephone number on your Health Net ID Card.
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Transition of Care for new Enrollees. You may request continued care from a provider, including a Hospital, that does not contract with Health Net if, at the time of enrollment with Health Net, you were receiving care from such a provider for any of the following conditions: • An Acute Condition; • A Serious Chronic Condition not to exceed twelve months from your Effective Date of coverage under this Plan; • A pregnancy (including the duration of the pregnancy and immediate postpartum care); • A newborn up to 36 months of age not to exceed twelve months from your Effective Date of coverage under this Plan; • A Terminal Illness (for the duration of the Terminal Illness); or • A surgery or other procedure that has been authorized by your prior health plan as part of a documented course of treatment. For definitions of Acute Condition, Serious Chronic Condition and Terminal Illness see the "Definitions" section. Health Net may provide coverage for completion of services from such a provider, subject to applicable Copayments and any exclusions and limitations of this Plan. You must request the coverage within 60 days of your Group’s effective date unless it is shown that it was not reasonably possible to make the request within 60 days of the Group’s effective date and you make the request as soon as reasonably possible. The non-Participating Provider must be willing to accept the same contract terms applicable to providers currently contracted with Health Net, who are not capitated and who practice in the same or similar geographic region. If the provider does not accept such terms, Health Net is not obligated to provide coverage for that provider. If you would like more information on how to request continued care, or request a copy of our continuity of care policy, please contact the Customer Contact Center at the telephone number on your Health Net ID Card.
Sample 1
Transition of Care for new Enrollees. You may request continued care from a provider, including a Hospital, that does not contract with Health Net if, at the time of enrollment with Health Net, you were receiving care from such a provider for any of the following conditions: • An Acute Condition; • A Serious Chronic Condition not to exceed twelve months from the Member’s Effective Date of coverage under this Plan; • A pregnancy (including the duration of the pregnancy and immediate postpartum care); • A newborn up to 36 months of age not to exceed twelve months from your Effective Date of coverage under this Plan; • A Terminal Illness (for the duration of the Terminal Illness); or • A surgery or other procedure that has been authorized by your prior health plan as part of a documented course of treatment. In addition, You may request continued care from a provider, including a Hospital, if you have been enrolled in another Health Net HMO plan that included a larger network than this plan, Health Net will offer the same scope of continuity of care for completion of services, regardless of whether You had the opportunity to retain Your current provider by selecting either:
Sample 1
Transition of Care for new Enrollees. If you are receiving ongoing care for an acute, serious, or chronic mental health condition from a non-Participating Mental Health Professional at the time you enroll with Health Net, we may temporarily cover services from a provider not affiliated with the Behavioral Health Administrator, subject to applicable Copayments and any other exclusions and limitations of this Plan. Your non-Participating Mental Health Professional must be willing to accept the Behavioral Health Administrator’s standard mental health provider contract terms and conditions and be located in the Plan’s service area. If you would like more information on how to request continued care, or request a copy of our continuity of care policy, please call the Customer Contact Center at the telephone number on your Health Net ID Card. Outpatient services are covered as shown in "Schedule of Benefits and Copayments," Section 200, under "Mental Disorders and Chemical Dependency Benefits." Covered services include: • Outpatient office visits/professional consultation including chemical dependency: Includes outpatient crisis intervention, short-term evaluation and therapy, medication management, drug therapy monitoring, longer- term specialized therapy, and individual and group mental health evaluation and treatment. • Outpatient services other than an office visits/professional consultation including chemical dependency: Includes psychological and neuropsychological testing when necessary to evaluate a Mental Disorder, other outpatient procedures, intensive outpatient care program, day treatment and partial hospitalization program. Intensive outpatient care program is a treatment program that is utilized when a patient’s condition requires structure, monitoring, and medical/psychological intervention at least three (3) hours per day, three (3) times per week. Partial hospitalization/day treatment program is a treatment program that may be free-standing or Hospital-based and provides services at least four (4) hours per day and at least four (4) days per week • Behavioral Health Treatment for Pervasive Developmental Disorder or Autism: Professional services for behavioral health treatment, including applied behavior analysis and evidence-based behavior intervention programs that develop or restore, to the maximum extent practicable, the functioning of a Member diagnosed with the Severe Mental Illnesses of pervasive developmental disorder or autism, as shown in the “Schedule of Benefits and Copay...
Sample 1

Related to Transition of Care for new Enrollees

  • Certification Regarding Termination of Contract for Non-Compliance (Tex Gov. Code 552.374)

  • Routing for Operator Services and Directory Assistance Traffic For a Verizon Telecommunications Service dial tone line purchased by CBB for resale pursuant to the Resale Attachment, upon request by CBB, Verizon will establish an arrangement that will permit CBB to route the CBB Customer’s calls for operator and directory assistance services to a provider of operator and directory assistance services selected by CBB. Verizon will provide this routing arrangement in accordance with, but only to the extent required by, Applicable Law. Verizon will provide this routing arrangement pursuant to an appropriate written request submitted by CBB and a mutually agreed-upon schedule. This routing arrangement will be implemented at CBB's expense, with charges determined on an individual case basis. In addition to charges for initially establishing the routing arrangement, CBB will be responsible for ongoing monthly and/or usage charges for the routing arrangement. CBB shall arrange, at its own expense, the trunking and other facilities required to transport traffic to CBB’s selected provider of operator and directory assistance services.

  • Provision of Services by Third Parties The Administrator shall, to the extent it determines that it would be advisable in connection with or incidental to the activities contemplated hereby, arrange for and coordinate the services of other professionals, experts and consultants to provide any or all of the Services, in which case, the costs and expenses of such third parties for providing such services shall be borne by the Administrator other than as set forth in Section 3; it being understood that the Administrator shall not charge to the Issuer any fees in addition thereto with respect to such outsourced Painting-Level Services that are described in Section 1(a)(i) and Entity-Level Services described in Section 1(a)(ii), but the Administrator shall be entitled to reimbursement for third party costs incurred in connection with Non-Routine Services described in Section 1(a)(iii) as set forth in Section 3(b). Reimbursement for Non-Routine Services shall be reimbursed by the Issuer out of the proceeds from a sale of the Painting. In addition, Masterworks may determine to sell the Painting without engaging a third-party intermediary, in which event, the Administrator would charge the buyer of the Painting a reasonable fee not to exceed the lowest published buyer’s premium charged by Sotheby’s, Christie’s or Pxxxxxxx in effect at such time.

  • Selection of Subcontractors, Procurement of Materials and Leasing of Equipment The contractor shall not discriminate on the grounds of race, color, religion, sex, national origin, age or disability in the selection and retention of subcontractors, including procurement of materials and leases of equipment. The contractor shall take all necessary and reasonable steps to ensure nondiscrimination in the administration of this contract. a. The contractor shall notify all potential subcontractors and suppliers and lessors of their EEO obligations under this contract. b. The contractor will use good faith efforts to ensure subcontractor compliance with their EEO obligations.

  • Replacement of Key Personnel The Engineer must notify the State in writing as soon as possible, but no later than three business days after a project manager or other key personnel is removed from association with this contract, giving the reason for removal.

  • Subcontracting for Medicaid Services Notwithstanding any permitted subcontracting of services to be performed under this Agreement, Party shall remain responsible for ensuring that this Agreement is fully performed according to its terms, that subcontractor remains in compliance with the terms hereof, and that subcontractor complies with all state and federal laws and regulations relating to the Medicaid program in Vermont. Subcontracts, and any service provider agreements entered into by Party in connection with the performance of this Agreement, must clearly specify in writing the responsibilities of the subcontractor or other service provider and Party must retain the authority to revoke its subcontract or service provider agreement or to impose other sanctions if the performance of the subcontractor or service provider is inadequate or if its performance deviates from any requirement of this Agreement. Party shall make available on request all contracts, subcontracts and service provider agreements between the Party, subcontractors and other service providers to the Agency of Human Services and any of its departments as well as to the Center for Medicare and Medicaid Services.

  • LIABILITY FOR UNAUTHORIZED USE-LOST/STOLEN CARD NOTIFICATION You agree to notify Credit Union immediately, orally or in writing at Florida Credit Union, X.X. Xxx 0000, Xxxxxxxxxxx, XX 00000 or telephone (000) 000-0000 twenty four

  • Subcontracting for the Provision of Services (a) The parties acknowledge that, subject to the provisions of the Enabling Legislation, the HSP may subcontract the provision of some or all of the Services. For the purposes of this Agreement, actions taken or not taken by the subcontractor, and Services provided by the subcontractor, will be deemed actions taken or not taken by the HSP, and Services provided by the HSP. (b) When entering into a subcontract the HSP agrees that the terms of the subcontract will enable the HSP to meet its obligations under this Agreement. Without limiting the foregoing, the HSP will include a provision that permits the Funder or its authorized representatives, to audit the subcontractor in respect of the subcontract if the Funder or its authorized representatives determines that such an audit would be necessary to confirm that the HSP has complied with the terms of this Agreement. (c) Nothing contained in this Agreement or a subcontract will create a contractual relationship between any subcontractor or its directors, officers, employees, agents, partners, affiliates or volunteers and the Funder. (d) When entering into a subcontract, the HSP agrees that the terms of the subcontract will enable the HSP to meet its obligations under the FLSA.

  • DEPENDENT PERSONAL SERVICES 1. Subject to the provisions of Articles 16, 18 and 19, salaries, wages and other similar remuneration derived by a resident of a Contracting State in respect of an employment shall be taxable only in that State unless the employment is exercised in the other Contracting State. If the employment is so exercised, such remuneration as is derived therefrom may be taxed in that other State. 2. Notwithstanding the provisions of paragraph 1, remuneration derived by a resident of a Contracting State in respect of an employment exercised in the other Contracting State shall be taxable only in the first-mentioned State if: a) the recipient is present in the other State for a period or periods not exceeding in the aggregate 183 days in any twelve-month period commencing or ending in the tax year concerned, and b) the remuneration is paid by, or on behalf of, an employer who is not a resident of the other State, and c) the remuneration is not borne by a permanent establishment or a fixed base which the employer has in the other State. 3. Notwithstanding the preceding provisions of this Article, remuneration derived in respect of an employment exercised aboard a ship or aircraft operated in international traffic by a resident of a Contracting State, may be taxed in that State.

  • Penalties for Non-compliance to Service Level Agreement Where the Supplier/Service Provider fails to deliver the Goods/Services within the agreed and accepted milestone timelines and provided that the cause of the delay was not due to a fault of Transnet, penalties shall be imposed at …………………………………………………… .

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