Organ Transplants This plan covers organ and tissue transplants when ordered by a physician, is medically necessary, and is not an experimental or investigational procedure. Examples of covered transplant services include but are not limited to: heart, heart-lung, lung, liver, small intestine, pancreas, kidney, cornea, small bowel, and bone marrow. Allogenic bone marrow transplant covered healthcare services include medical and surgical services for the matching participant donor and the recipient. However, Human Leukocyte Antigen testing is covered as indicated in the Summary of Medical Benefits. For details see Human Leukocyte Antigen Testing section. This plan covers high dose chemotherapy and radiation services related to autologous bone marrow transplantation to the extent required under R.I. Law § 27-20-60. See Experimental or Investigational Services in Section 3 for additional information. To speak to a representative in our Case Management Department please call 1-401- ▇▇▇-▇▇▇▇ or 1-888-727-2300 ext. 2273. The national transplant network program is called the Blue Distinction Centers for Transplants. SM For more information about the Blue Distinction Centers for TransplantsSM call our Customer Service Department or visit our website. When the recipient is a covered member under this plan, the following services are also covered: • obtaining donated organs (including removal from a cadaver); • donor medical and surgical expenses related to obtaining the organ that are integral to the harvesting or directly related to the donation and limited to treatment occurring during the same stay as the harvesting and treatment received during standard post- operative care; and • transportation of the organ from donor to the recipient. The amount you pay for transplant services, for the recipient and eligible donor, is based on the type of service.
Clinical 1.1 Provides comprehensive evidence based nursing care and individual case management to a specific group of patients/clients including assessment, intervention and evaluation.
1.2 Undertakes clinical shifts at the direction of senior staff and the Nursing Director including participation on the on-call/after-hours/weekend roster if required.
1.3 Responsible and accountable for patient safety and quality of care through planning, coordinating, performing, facilitating, and evaluating the delivery of patient care relating to a particular group of patients, clients or staff in the practice setting.
1.4 Monitors, reviews and reports upon the standard of nursing practice to ensure that colleagues are working within the scope of nursing practice, following appropriate clinical pathways, policies, procedures and adopting a risk management approach in patient care delivery.
1.5 Participates in ▇▇▇▇ rounds/case conferences as appropriate.
1.6 Educates patients/carers in post discharge management and organises discharge summaries/referrals to other services, as appropriate.
1.7 Supports and liaises with patients, carers, colleagues, medical, nursing, allied health, support staff, external agencies and the private sector to provide coordinated multidisciplinary care.
1.8 Completes clinical documentation and undertakes other administrative/management tasks as required.
1.9 Participates in departmental and other meetings as required to meet organisational and service objectives.
1.10 Develops and seeks to implement change utilising expert clinical knowledge through research and evidence based best practice.
1.11 Monitors and maintains availability of consumable stock.
1.12 Complies with and demonstrates a positive commitment to Regulations, Acts and Policies relevant to nursing including the Code of Ethics for Nurses in Australia, the Code of Conduct for Nurses in Australia, the National Competency Standards for the Registered Nurse and the Poisons Act 2014 and Medicines and Poisons Regulations 2016.
1.13 Promotes and participates in team building and decision making.
1.14 Responsible for the clinical supervision of nurses at Level 1 and/or Enrolled Nurses/ Assistants in Nursing under their supervision.
Description of Funding Techniques 6.2.1 The following are terms under which standard funding techniques shall be implemented for all transfers of funds to which the funding technique is applied in section 6.3.2 of this Agreement. Funding Technique Name Description Actual Clearance, ZBA - ACH The State shall request funds such that they are deposited by ACH in a State account on the settlement date of payments issued by the State. The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. The amount of the request shall be for the amount of funds that clear the State's account on the settlement date. This funding technique is interest neutral. Actual Clearance, ZBA - Same Day Payment The State shall request funds the same day it pays out funds, in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. A Federal agency will deposit funds in a State account the same day as requested. The amount of the request shall be for the amount of funds that clear the State's account that day. This funding technique is interest neutral. Average Clearance The State shall request funds such that they are deposited by ACH on the dollar- weighted average day of clearance for the disbursement, in accordance with the clearance pattern specified in Exhibit II. The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. The amount of the request shall be for the exact amount of that disbursement. This funding technique is interest neutral. Pre-Issuance The State shall request funds such that they are deposited in a State account not more than three business days prior to the day the State makes a disbursement. The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. The amount of the request shall be the amount the State expects to disburse. This funding technique is not interest neutral.
6.2.2 The following are terms under which funding techniques for administrative costs shall be implemented for all transfers of funds to which the funding technique is applied in section 6.3.2 of this Agreement. Funding Technique Name Description Cost Allocation Plans - Monthly The State shall request funds once a month, such that they are deposited on the median day of the month, to fund activity of the prior month. The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. The amount of the request for a given month's activity shall be based on actual costs distributed in accordance with the State's approved cost allocation plan. This funding technique is interest neutral.
6.2.3 The following are terms under which miscellaneous funding techniques shall be implemented for all transfers of funds to which the funding technique is applied in section 6.3.2 of this Agreement. There are currently no funding techniques listed in Section 6.2.3.
6.2.4 The following are terms under which State unique funding techniques shall be implemented for all transfers of funds to which the funding technique is applied in section 6.3.2 of this Agreement. Funding Technique Name Description Actual Drawdown - Weekly The State shall request funds on a weekly basis. The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. The amount of the request shall be for the actual expenditures which occurred in the past weekly period. This funding technique is interest neutral. Average Clearance - Modified The State shall request funds such that they are deposited by ACH on the dollar weighted average day of clearance for the disbursement in accordance with the clearance pattern Average Clearance Payroll specified in Exhibit II. The Payroll clearance pattern will be applied to an estimate of the actual payroll cost based on the most recent cost allocation distribution. This estimate will be reconciled to actual costs approximately 30-50 days after the end of the quarter. The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. This funding technique is interest neutral. Bi-Weekly Actual - Payroll The State will request funds bi-weekly based on the actual expenditures incurred during the biweekly payroll cycle. The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. The amount of each request shall equal the total actual expenditures posted during the State's bi-weekly payroll cycle. This funding technique is interest neutral. Drawdowns at Fixed Intervals - Monthly (modified) The State shall request funds once a month, such that they are deposited on the day of the month specified for each component. The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. The amount of the request shall be based on the most recent monthly expenditure data available based on either actual or estimated costs, whichever is applicable to the component. If necessary, adjustments will be made when actual grant costs are known, approximately 30-50 days after the end of each quarter. This funding technique is interest neutral. Drawdowns at Fixed Intervals - Quarterly The State shall request funds once a quarter, such that they are deposited on the 30th day of the month following the end of the quarter. The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. The amount of the request shall be based on the actual costs allocated to the program for the quarter. This funding technique is interest neutral. Fixed Administrative Allowances-BI- Weekly Payroll (modified)-Dollar Weighted The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. Reconciliation will occur within 60 days of the end of each quarter. The State shall request 1/6 or 1/7 of the quarterly award, based on the number of pay periods within the quarter. This funding technique is interest neutral. Payment Schedule The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. The State shall draw down 1/12 of the total annual expected expenditures (based on actual expenditures of the prior fiscal year or the current budget) on the median day of the month. An adjusting draw will be made when actual expenditures are known, approximately 30-50 days after the end of the quarter. For Demonstration Projects, where actual expenditures are not available until 30 days after the end of the quarter, an adjusting draw will occur within 45 days after the quarter's end. This funding technique is interest neutral. Post Expenditure Funding The State shall request Federal funds only after related expenditures have been warranted for payment in the State’ s Accounting System. The request shall be made in accordance with the appropriate agency cut-off time specified in Exhibit I and the State clearance days shown in Exhibit II. Federal funds are requested to be received by the next business day. As long as the State does not draw funds prior to the warrant date for the related disbursement, and as long as the State receives the Federal funds no later than two business days after warranted, neither the State nor the Federal Government shall incur an interest liability. The amount of the request shall be for the amount of that disbursement in whole dollars. This funding technique is interest neutral. Weekly Billing The State shall request funds weekly for the program. The amount shall be for all eligible costs that have been recorded since the last request for funds. The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. This funding technique is interest neutral. Weekly Draws The State shall request funds once a week. The Voucher Only amount requested will be based on expenditures incurred and recorded in the State of Maryland's Medicaid Management Information System (MMIS). The Disproportionate Share amount will be based on the amount calculated as due by the Program, since the last request for such funds. The Provider Payments (Non-Voucher only, not processed through MMIS) will be based on cash expenditures reflected in the State of Maryland's Financial Management Information System (FMIS), since the last request for such funds. This technique is considered to be interest neutral and, based on the information available, matches as closely as possible the draw of Federal funds with the time they are paid out for program purposes, in accordance with the clearance pattern specified in Exhibit II (MMIS). The request shall be made in accordance with the appropriate Federal agency cut-off time specified in Exhibit I. This funding technique is interest neutral.
Clinical Trials The studies, tests and preclinical and clinical trials conducted by or on behalf of, or sponsored by, the Company, or in which the Company has participated, that are described in the Registration Statement or the Prospectus, or the results of which are referred to in the Registration Statement or the Prospectus, were and, if still pending, are being conducted in all material respects in accordance with protocols, procedures and controls pursuant to, where applicable, accepted professional and scientific standards for products or product candidates comparable to those being developed by the Company and all applicable statutes, rules and regulations of the FDA, the EMA, Health Canada and other comparable regulatory agencies outside of the U.S. to which they are subject, including, without limitation, 21 C.F.R. Parts 50, 54, 56, 58, 312, and 812; the descriptions of the results of such studies, tests and trials contained in the Registration Statement or the Prospectus do not contain any misstatement of a material fact or omit a material fact necessary to make such statements not misleading; the Company has no knowledge of any studies, tests or trials not described in the Registration Statement or the Prospectus the results of which reasonably call into question in any material respect the results of the studies, tests and trials described in the Registration Statement or Prospectus; and the Company has not received any notices or other correspondence from the FDA, EMA, Health Canada or any other foreign, state or local governmental body exercising comparable authority or any Institutional Review Board or comparable authority requiring or threatening the termination, suspension or material modification of any studies, tests or preclinical or clinical trials conducted by or on behalf of, or sponsored by, the Company or in which the Company has participated, and, to the Company’s knowledge, there are no reasonable grounds for the same. Except as disclosed in the Registration Statement and the Prospectus, there has not been any violation of law or regulation by the Company in its respective product development efforts, submissions or reports to any regulatory authority that could reasonably be expected to require investigation, corrective action or enforcement action.
Orally Administered Anticancer Medication In accordance with RIGL § 27-20-67, prescription drug coverage for orally administered anticancer medications is provided at a level no less favorable than coverage for intravenously administered or injected cancer medications covered under your medical benefit.
