Vascular Specialist Sample Clauses

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Vascular Specialist. T.H. C.T.S. Vascular Assistant T.H. C.T.S. Vascular Associate

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• Health Screening The Contractor shall conduct a Health Needs Screen (HNS) for new members that enroll in the Contractor’s plan. The HNS will be used to identify the member’s physical and/or behavioral health care needs, special health care needs, as well as the need for disease management, care management and/or case management services set forth in Section 3.8. The HNS may be conducted in person, by phone, online or by mail. The Contractor shall use the standard health screening tool developed by OMPP, i.e., the Health Needs Screening Tool, but is permitted to supplement the OMPP Health Needs Screening Tool with additional questions developed by the Contractor. Any additions to the OMPP Health Needs Screening Tool shall be approved by OMPP. The HNS shall be conducted within ninety (90) calendar days of the Contractor’s receipt of a new member’s fully eligible file from the State. The Contractor is encouraged to conduct the HNS at the same time it assists the member in making a PMP selection. The Contractor shall also be required to conduct a subsequent health screening or comprehensive health assessment if a member’s health care status is determined to have changed since the original screening, such as evidence of overutilization of health care services as identified through such methods as claims review. Non-clinical staff may conduct the HNS. The results of the HNS shall be transferred to OMPP in the form and manner set forth by OMPP. As part of this contract, the Contractor shall not be required to conduct HNS for members enrolled in the Contractor’s plan prior to January 1, 2017 unless a change in the member’s health care status indicates the need to conduct a health screening. For purposes of the HNS requirement, new members are defined as members that have not been enrolled in the Contractor’s plan in the previous twelve (12) months. Data from the HNS or NOP form, current medications and self-reported medical conditions will be used to develop stratification levels for members in Hoosier Healthwise. The Contractor may use its own proprietary stratification methodology to determine which members should be referred to specific care coordination services ranging from disease management to complex case management. OMPP shall apply its own stratification methodology which may, in future years, be used to link stratification level to the per member per month capitation rate. The initial HNS shall be followed by a detailed Comprehensive Health Assessment Tool (CHAT) by a health care professional when a member is identified through the HNS as having a special health care need, as set forth in Section 4.2.4, or when there is a need to follow up on problem areas found in the initial HNS. The detailed CHAT may include, but is not limited to, discussion with the member, a review of the member’s claims history and/or contact with the member’s family or health care providers. These interactions shall be documented and shall be available for review by OMPP. The Contractor shall keep up-to-date records of all members found to have special health care needs based on the initial screening, including documentation of the follow-up detailed CHAT and contacts with the member, their family or health care providers.

• Surgery Services and Mastectomy Related Treatment This plan provides benefits for mastectomy surgery and mastectomy-related services in accordance with the Women’s Health and Cancer Rights Act of 1998 and Rhode Island General Law 27-20-29 et seq. For the member receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician, physician assistant, or an advance practice registered nurse and the patient, for: • all stages of reconstruction of the breast on which the mastectomy was performed; • surgery and reconstruction of the other breast to produce a symmetrical appearance; • prostheses; and • treatment of physical complications at all stages of the mastectomy, including lymphedema. See the Summary of Medical Benefits for the amount you pay.

• 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.

• 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 Cardiac Rehabilitation Outpatient - Benefit is limited to 18 weeks or 36 visits (whichever occurs first) per coveredepisode. 0% - After deductible 40% - After deductible Chiropractic Services In a physician's office - limited to 12 visits per plan year. 0% - After deductible 40% - After deductible Dental Services - Accidental Injury (Emergency) 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 Dental Services- Outpatient Services connected to dental care when performed in an outpatient facility * 0% - After deductible 40% - After deductible Dialysis Services Inpatient/outpatient/in your home 0% - After deductible 40% - After deductible Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Network Providers Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Durable Medical Equipment (DME), Medical Supplies, Diabetic Supplies, Prosthetic Devices, and Enteral Formula or Food, Hair Prosthetics 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. Early Intervention Services (EIS) 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. Education - Asthma Asthma management 0% - After deductible 40% - After deductible Emergency Room Services Hospital emergency room 0% - After deductible The level of coverage is the same as network provider.

• CHILD AND DEPENDENT ADULT/ELDER ABUSE REPORTING CONTRACTOR shall establish a procedure acceptable to ADMINISTRATOR to ensure that all employees, agents, subcontractors, and all other individuals performing services under this Agreement report child abuse or neglect to one of the agencies specified in Penal Code Section 11165.9 and dependent adult or elder abuse as defined in Section 15610.07 of the WIC to one of the agencies specified in WIC Section 15630. CONTRACTOR shall require such employees, agents, subcontractors, and all other individuals performing services under this Agreement to sign a statement acknowledging the child abuse reporting requirements set forth in Sections 11166 and 11166.05 of the Penal Code and the dependent adult and elder abuse reporting requirements, as set forth in Section 15630 of the WIC, and shall comply with the provisions of these code sections, as they now exist or as they may hereafter be amended.

• Radiation Therapy/Chemotherapy Services This plan covers chemotherapy and radiation services. Respiratory Therapy 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.

• Specialist A dentist who focuses on a specific area of dentistry, including oral surgery, endodontia, periodontia, orthodontia and pediatric dentistry, or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. Spouse: The person to whom the Subscriber is legally married, including a same sex Spouse. Spouse also includes a domestic partner. Subscriber: The person to whom this Contract is issued. UCR (Usual, Customary and Reasonable): The cost of a dental service in a geographic area based on what Providers in the area usually charge for the same or similar medical service. Us, We, Our: BlueShield of Northeastern New York and anyone to whom We legally delegate performance, on Our behalf, under this Contract. Utilization Review: The review to determine whether services are or were Medically Necessary or experimental or investigational (including treatment for a rare disease or a clinical trial). You, Your: The Member.

• Destination CSU-Pueblo scholarship This articulation transfer agreement replaces all previous agreements between CCA and CSU-Pueblo in Bachelor of Science in Physics (Secondary Education Emphasis). This agreement will be reviewed annually and revised (if necessary) as mutually agreed.

• Health plan specification The Employer will require health plans participating in the Group Insurance Program to develop and implement health promotion and health education programs for State employees and their dependents.

• STAFF ORIENTATION 4101 The Employer shall provide an appropriate orientation program for nurses newly employed. The orientation program shall include such essential information as policies, nursing procedures, the location of supplies and equipment, fire, safety and disaster plans. Where necessary, orientation shall be provided for nurses moving to a new area of practice. 4102 The Employer shall provide a program of inservice education for nurses pertinent to patient care. 4103 The Employer shall provide, access to reference materials as is required in relation to maintaining current knowledge of general nursing care. APPENDIX "A" - SALARIES A1. Effective April 1, 2013 - Monthly salaries include a 2% general increase. - Hourly salary is calculated as (monthly salary x 12) ÷ annual hours. Nurse Classification Annual Hours Start Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 20 Year 1 Licensed Practical Nurse 2015 Hourly 25.198 26.022 26.836 27.825 28.732 29.745 30.804 31.420 Monthly 4,231.164 4,369.528 4,506.212 4,672.281 4,824.582 4,994.681 5,172.505 5,275.942 Annual 50,773.970 52,434.330 54,074.540 56,067.375 57,894.980 59,936.175 62,070.060 63,311.300 Nurse II 2015 Hourly 32.917 34.066 35.218 36.419 37.593 38.811 39.587 Monthly 5,527.313 5,720.249 5,913.689 6,115.357 6,312.491 6,517.014 6,647.317 Annual 66,327.755 68,642.990 70,964.270 73,384.285 75,749.895 78,204.165 79,767.805 Nurse II (20 Year Scale) 2015 Hourly 33.575 34.747 35.923 37.148 38.345 39.587 Monthly 5,637.802 5,834.600 6,032.070 6,237.768 6,438.765 6,647.317 Annual 67,653.625 70,015.205 72,384.845 74,853.220 77,265.175 79,767.805 Nurse III 2015 Hourly 34.168 35.321 36.523 37.697 38.787 39.975 41.201 42.025 Monthly 5,737.377 5,930.985 6,132.820 6,329.955 6,512.984 6,712.469 6,918.335 7,056.698 Annual 68,848.520 71,171.815 73,593.845 75,959.455 78,155.805 80,549.625 83,020.015 84,680.375 Nurse III (20 Year Scale) 2015 Hourly 34.851 36.027 37.254 38.451 39.563 40.775 42.025 Monthly 5,852.064 6,049.534 6,255.568 6,456.564 6,643.287 6,846.802 7,056.698 Annual 70,224.765 72,594.405 75,066.810 77,478.765 79,719.445 82,161.625 84,680.375 Nurse IV 2015 Hourly 35.340 36.649 37.959 39.387 41.024 42.612 44.273 45.158 Monthly 5,934.175 6,153.978 6,373.949 6,613.734 6,888.613 7,155.265 7,434.175 7,582.781 Annual 71,210.100 73,847.735 76,487.385 79,364.805 82,663.360 85,863.180 89,210.095 90,993.370 Nurse IV (20 Year Scale) 2015 Hourly 36.047 37.382 38.718 40.175 41.844 43.464 45.158 Monthly 6,052.892 6,277.061 6,501.398 6,746.052 7,026.305 7,298.330 7,582.781 Annual 72,634.705 75,324.730 78,016.770 80,952.625 84,315.660 87,579.960 90,993.370 Nurse V 2015 Hourly 37.305 38.733 40.369 41.957 43.690 45.388 47.157 48.100 Monthly 6,264.131 6,503.916 6,778.628 7,045.280 7,336.279 7,621.402 7,918.446 8,076.792 Annual 75,169.575 78,046.995 81,343.535 84,543.355 88,035.350 91,456.820 95,021.355 96,921.500 Nurse V (20 Year Scale) 2015 Hourly 38.051 39.508 41.177 42.797 44.564 46.296 48.100 Monthly 6,389.397 6,634.052 6,914.305 7,186.330 7,483.038 7,773.870 8,076.792 Annual 76,672.765 79,608.620 82,971.655 86,235.955 89,796.460 93,286.440 96,921.500 Nurse Practitioner 2015 Hourly 42.515 45.635 47.511 49.385 51.408 52.437 Monthly 7,138.977 7,662.877 7,977.889 8,292.565 8,632.260 8,805.046 Annual 85,667.725 91,954.525 95,734.665 99,510.775 103,587.120 105,660.555 Nurse Practitioner (20 Year Scale) 2015 Hourly 43.365 46.548 48.461 50.373 52.437 Monthly 7,281.706 7,816.185 8,137.410 8,458.466 8,805.046 Annual 87,380.475 93,794.220 97,648.915 101,501.595 105,660.555 Weekend Worker Rates Annual Hours Start Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 20 Year 1 Weekend Worker - Licensed Practical Nurse 2015 Hourly 28.977 29.925 30.861 31.999 33.042 34.206 35.425 36.133 Monthly 4,865.721 5,024.906 5,182.076 5,373.165 5,548.303 5,743.758 5,948.448 6,067.333 Annual 58,388.655 60,298.875 62,184.915 64,477.985 66,579.630 68,925.090 71,381.375 72,807.995 Weekend Worker - Nurse II 2015 Hourly 37.855 39.176 40.501 41.882 43.232 44.633 45.526 Monthly 6,356.485 6,578.303 6,800.793 7,032.686 7,259.373 7,494.625 7,644.574 Annual 76,277.825 78,939.640 81,609.515 84,392.230 87,112.480 89,935.495 91,734.890 Weekend Worker - Nurse II (20 Year Scale) 2015 Hourly 38.612 39.959 41.311 42.720 44.097 45.526 Monthly 6,483.598 6,709.782 6,936.805 7,173.400 7,404.621 7,644.574 Annual 77,803.180 80,517.385 83,241.665 86,080.800 88,855.455 91,734.890 Weekend Worker - Nurse III 2015 Hourly 39.293 40.619 42.002 43.352 44.605 45.971 47.381 48.329 Monthly 6,597.950 6,820.607 7,052.836 7,279.523 7,489.923 7,719.297 7,956.060 8,115.245 Annual 79,175.395 81,847.285 84,634.030 87,354.280 89,879.075 92,631.565 95,472.715 97,382.935 Weekend Worker - Nurse III (20 Year Scale) 2015 Hourly 40.079 41.431 42.842 44.219 45.497 46.891 48.329 Monthly 6,729.932 6,956.955 7,193.886 7,425.107 7,639.705 7,873.780 8,115.245 Annual 80,759.185 83,483.465 86,326.630 89,101.285 91,676.455 94,485.365 97,382.935 Weekend Worker - Nurse IV 2015 Hourly 40.641 42.146 43.653 45.295 47.177 49.003 50.914 51.932 Monthly 6,824.301 7,077.016 7,330.066 7,605.785 7,921.805 8,228.420 8,549.309 8,720.248 Annual 81,891.615 84,924.190 87,960.795 91,269.425 95,061.655 98,741.045 102,591.710 104,642.980 Weekend Worker - Nurse IV (20 Year Scale) 2015 Hourly 41.454 42.989 44.526 46.201 48.121 49.983 51.932 Monthly 6,960.818 7,218.570 7,476.658 7,757.918 8,080.318 8,392.979 8,720.248 Annual 83,529.810 86,622.835 89,719.890 93,095.015 96,963.815 100,715.745 104,642.980 Weekend Worker - Nurse V 2015 Hourly 42.900 44.543 46.425 48.251 50.244 52.196 54.230 55.315 Monthly 7,203.625 7,479.512 7,795.531 8,102.147 8,436.805 8,764.578 9,106.121 9,288.310 Annual 86,443.500 89,754.145 93,546.375 97,225.765 101,241.660 105,174.940 109,273.450 111,459.725 Weekend Worker - Nurse V (20 Year Scale) 2015 Hourly 43.758 45.434 47.353 49.216 51.249 53.240 55.315 Monthly 7,347.698 7,629.126 7,951.358 8,264.187 8,605.561 8,939.883 9,288.310 Annual 88,172.370 91,549.510 95,416.295 99,170.240 103,266.735 107,278.600 111,459.725 1 Eligibility for the 20 Year increment is determined in accordance w ith Article 2105.