Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.
Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.
Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services. This plan covers dental care for members until the last day of the month in which they turn nineteen (19). This plan covers services only if they meet all of the following requirements: • listed as a covered dental care service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered dental care service under this plan. • dentally necessary, consistent with our dental policies and related guidelines at the time the services are provided. • not listed in Exclusions section. • received while a member is enrolled in the plan. • consistent with applicable state or federal law. • services are provided by a network provider.
Orthodontics We Cover orthodontics used to help restore oral structures to health and function and to treat serious medical conditions such as: cleft palate and cleft lip; maxillary/mandibular micrognathia (underdeveloped upper or lower jaw); extreme mandibular prognathism; severe asymmetry (craniofacial anomalies); ankylosis of the temporomandibular joint; and other significant skeletal dysplasias.
Behavioral Health Services – Mental Health and Substance Use Disorder Inpatient - Unlimited days at a general hospital or a specialty hospital including detoxification or residential/rehabilitation per plan year. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Outpatient or intermediate careservices* - See Covered Healthcare Services: Behavioral Health Section for details about partial hospital program, intensive outpatient program, adult intensive services, and child and family intensive treatment. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Office visits - See Office Visits section below for Behavioral Health services provided by a PCP or specialist. Psychological Testing 0% - After deductible 40% - After deductible Medication-assisted treatment - whenrenderedby a mental health or substance use disorder provider. 0% - After deductible 40% - After deductible Methadone maintenance treatment - one copayment per seven-day period of treatment. 0% - After deductible 40% - After deductible Outpatient - Benefit is limited to 18 weeks or 36 visits (whichever occurs first) per coveredepisode. 0% - After deductible 40% - After deductible In a physician's office - limited to 12 visits per plan year. 0% - After deductible 40% - After deductible Emergency room - When services are due to accidental injury to sound natural teeth. 0% - After deductible The level of coverage is the same as network provider. In a physician’s/dentist’s office - When services are due to accidental injury to sound natural teeth. 0% - After deductible 40% - After deductible Services connected to dental care when performed in an outpatient facility * 0% - After deductible 40% - After deductible Inpatient/outpatient/in your home 0% - After deductible 40% - After deductible (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Outpatient durable medical equipment* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient medical supplies* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient diabetic supplies/equipment purchasedat licensed medical supply provider (other than a pharmacy). See the Summary of Pharmacy Benefits for supplies purchased at a pharmacy. 20% - After deductible 40% - After deductible Outpatient prosthesis* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Enteral formula delivered through a feeding tube. Must be sole source of nutrition. 20% - After deductible 40% - After deductible Enteral formula or food taken orally * 20% - After deductible The level of coverage is the same as network provider. Hair prosthesis (wigs) - The benefit limit is $350 per hair prosthesis (wig) when worn for hair loss suffered as a result of cancer treatment. 20% - After deductible The level of coverage is the same as network provider. Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% - After deductible The level of coverage is the same as network provider. Asthma management 0% - After deductible 40% - After deductible Hospital emergency room 0% - After deductible The level of coverage is the same as network provider.
Prosthodontics We Cover prosthodontic services as follows:
HABILITATIVE SERVICES (HABILITATIVE mean healthcare services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech therapy and other services performed in a variety of inpatient and/or outpatient settings for people with disabilities. • that provides medical and surgical care for patients who have acute illnesses or injuries; and • is either listed as a hospital by the American Hospital Association (AHA) or accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
Vlastnictví Zdravotnické zařízení si ponechá a bude uchovávat Zdravotní záznamy. Zdravotnické zařízení a Zkoušející převedou na Zadavatele veškerá svá práva, nároky a tituly, včetně práv duševního vlastnictví k Důvěrným informacím (ve smyslu níže uvedeném) a k jakýmkoli jiným Studijním datům a údajům.
meminta nasihat daripada Pihak Xxxxxx dalam semua perkara berkenaan dengan jualan lelongan, termasuk Syarat-syarat Jualan (iii) membuat carian Hakmilik Xxxxx xxxxxx rasmi di Pejabat Tanah xxx/atau xxxx-xxxx Pihak-pihak Berkuasa yang berkenaan xxx (iv) membuat pertanyaan dengan Pihak Berkuasa yang berkenaan samada jualan ini terbuka kepada semua bangsa atau kaum Bumiputra Warganegara Malaysia sahaja atau melayu sahaja xxx juga mengenai persetujuan untuk jualan ini sebelum jualan lelong.Penawar yang berjaya ("Pembeli") dikehendaki dengan segera memohon xxx mendapatkan kebenaran pindahmilik (jika ada) daripada Pihak Pemaju xxx/atau Pihak Tuanpunya xxx/atau Pihak Berkuasa Negeri atau badan-badan berkenaan (v) memeriksa xxx memastikan samada jualan ini dikenakan cukai. HAKMILIK : Hakmilik strata bagi hartanah ini masih belum dikeluarkan HAKMILIK INDUK / NO. LOT : Pajakan Negeri 35263, Lot No.29096 MUKIM/DAERAH/NEGERI : Setapak / Kuala Lumpur / Wilayah Persekutuan Kuala Lumpur PEGANGAN : Pajakan selama 82-tahun berakhir pada 08/08/2085 KELUASAN LANTAI : 81.104 meter persegi ( 873 kaki persegi ) PEMAJU/PENJUAL : Mega Planner Jaya Sdn Bhd (326287-W)(Dalam Likuidasi) TUANPUNYA : Datuk Bandar Kuala Lumpur PEMBELI : Xxxxxxxx Bin Xxxxx @ Xxxx BEBANAN : Diserahhak kepada RHB Bank Berhad [196501000373 (6171-M)] Hartanah tersebut terletak di tingkat 9 pada bangunan apartment 14-tingkat terletak di Melati Impian Apartment, Setapak Fasa 1, Kuala Lumpur. Hartanah tersebut adalah sebuah unit apartment 3 xxxxx dikenali sebaga Xxxxx Pemaju No. 9, Tingkat No.9, Pembangunan dikenali sebagai Melati Impian Apartment Setapak Fasa 1, Kuala Lumpur xxx mempunyai alamat surat-xxxxxxxx xx Xxxx Xx. 0-0, Xxxxxx Impian Apartment, Xxxxx 0/00X, Xxxxx Xxxxxx, 00000 Xxxxx Xxxxxx, Xxxxxxx Xxxxxxxxxxx Xxxxx Xxxxxx. Harta ini dijual “keadaan seperti mana sediada” dengan harga rizab sebanyak RM 300,000.00 (RINGGIT MALAYSIA: TIGA RATUS RIBU SAHAJA) xxx tertakluk kepada syarat-syarat Jualan xxx melalui penyerahan hakkan dari Pemegang Serahak, tertakluk kepada kelulusan di perolehi oleh pihak Pembeli daripada pihak berkuasa, jika ada, termasuk semua terma, syarat xxx perjanjian yang dikenakan xxx mungkin dikenakan oleh Pihak Berkuasa yang berkenaan. Pembeli bertanggungjawab sepenuhnya untuk memperolehi xxx mematuhi syarat-syarat berkenaan daripada Pihak Berkuasa yang berkenaan, jika ada xxx semua xxx xxx perbelanjaan ditanggung xxx dibayar oleh Xxxxx Xxxxxxx.Pembeli atas talian (online) juga tertakluk kepada terma-terma xxx syarat-syarat terkandung dalam xxx.xxxxxxxxxxxxxxxx.xxx Pembeli yang berminat adalah dikehendaki mendeposit kepada Pelelong 10% daripada harga rizab dalam bentuk Bank Draf atau Cashier’s Order di atas nama RHB Bank Berhad sebelum lelongan awam xxx xxxx xxxx xxxxxx hendaklah dibayar dalam tempoh sembilan puluh (90) hari dari tarikh lelongan kepada RHB Bank Berhad melalui Bank Draf / XXXXXX. Butir-butir pembayaran melalui XXXXXX, xxxx berhubung dengan Tetuan Zahrin Emrad & Sujaihah. Untuk maklumat lanjut, xxxx berhubung dengan TETUAN ZAHRIN EMRAD & SUJIAHAH, yang beralamat di Suite 10.3, 10th Floor, Xxx Xxxx Building, Xx.00, Xxxxx Xxxx Xxxxxx, 00000 Xxxxx Xxxxxx. Tel: 00-0000 0000 / Fax: 00-0000 0000. [ Ruj: ZES/ZHR/RHB-FC/16250-17/0614-pae ], peguamcara bagi pihak pemegang xxxxx xxx atau pelelong yang tersebut dibawah.
Radiation Therapy/Chemotherapy Services This plan covers chemotherapy and radiation services. This plan covers respiratory therapy services. When respiratory services are provided in your home, as part of a home care program, durable medical equipment, supplies, and oxygen are covered as a durable medical equipment service.