Approval of Department. The Contractor shall provide information to any Enrollee upon request about any Physician Incentive Plan and/or any payments to Provider made pursuant to an incentive arrangement under this Section to a provider as required by applicable state or federal law. If a Contractor includes a Physician Incentive Plan, the activities included shall comply with requirements set forth in 42 C.F.R. 422.208 and 42 C.F.R. 422.210. The Contractor shall report disclosures to the Department for Physician Incentive Plans including the following:
Approval of Department. The Contractor must provide information to any Member upon request about any Physician Incentive Plan and/or any payments to Provider made pursuant to an incentive arrangement under this Section to a provider as required by applicable state or federal law.
Approval of Department. Written notice is to be submitted to the Department and if applicable to DOI. The prohibition on advances to Subcontractors contained in this subsection shall not apply to Capitation Payments or payments made by the Contractor to Contractor’s Network for provision of Covered Services.
Examples of Approval of Department in a sentence
No partner, joint venturer, member or shareholder of Construction Manager may assign, convey, transfer, pledge, mortgage or otherwise encumber its ownership interest in Construction Manager without the prior Approval of Department, in Department’s sole discretion.
Approval of Department of Telecommunications for FDI approval is awaited.
Approval of Department of Environmental Protection.§ 13245.1. Connection to existing municipal sanitary sewer.§ 13250.
Discussion and Possible Approval of Department Recommended State Fiscal Year 2022 AllocationsKim Garcia, Behavioral Health Wellness and Prevention/Social Services Program Specialist III Mrs.
Discussion and Possible Approval of Department Reallocations RecommendationsKim Garcia, Behavioral Health Wellness and Prevention/Social Services Program Specialist IIIMrs.
More Definitions of Approval of Department
Approval of Department. The Contractor shall require that Behavioral Health Service Providers refer Members with known or suspected and untreated physical health problems or disorders to their PCP for examination and treatment, with the Member's or the Member's legal guardian's consent. Behavioral Health Providers may only provide physical health care services if they are licensed to do so. This requirement shall be specified in all Provider Manuals. The Contractor shall require that behavioral health Providers send initial and quarterly (or more frequently if clinically indicated) summary reports of a Members' behavioral health status to the PCP, with the Member's or the Member's legal guardian's consent. This requirement shall be specified in all Provider Manuals.
Approval of Department. CMS recognized guidelines, LCDs and NCDs, may be utilized by all MCOs when other criteria do not specifically address the provider request. There must be written policies for applying the criteria based on an assessment of the local delivery system. The Department may also, at its discretion, require the use of other criteria it creates or identifies for services or populations not otherwise covered by the named criteria in this section. Criteria must be based on established scientific evidence which should be specifically referenced in documentation, and strive to incorporate local factors such as Kentucky’s demography, epidemiology or provider network attributes. The Contractor shall implement such criteria within ninety (90) Days of receipt of notice from the Department. The Contractor’s Medical Necessity criteria will be transparent and meet all relative documentation requirements as required by the Department, the Kentucky Department of Insurance, CMS or other relevant regulatory agencies. Criteria shall be readily available for review by DMS or the public by request and on the Contractor’s website. The Contractor and Subcontractors responsible for service authorization decisions shall have in place written policies, procedures and mechanisms to ensure consistent application of review criteria for the processing of requests for initial and continuing authorization of services. The written clinical criteria and protocols shall provide for mechanisms to obtain all necessary information, including pertinent clinical information, and consultation with the attending physician or other health care provider as appropriate. The Contractor shall have a review body that includes representation by Kentucky licensed health care professionals that review Medical Necessity criteria at least annually. The Contractor shall annually attest to the criteria being used by the Contractor and Subcontractors for Medical Necessity decisions. The Contractor shall resubmit criteria approved under a prior contract, if applicable, to the Department for review and approval to ensure compliance with the requirements of this Contract.
Approval of Department. The Contractor shall have in place mechanisms to check the consistency of application of review criteria. The written clinical criteria and protocols shall provide for mechanisms to obtain all necessary information, including pertinent clinical information, and consultation with the attending physician or other health care provider as appropriate. The Medical Director and Behavioral Health Director shall supervise the UM program and shall be accessible and available for consultation as needed. Contractor will have until April 1, 2017 to implement any change required in this section. Criteria approved under a prior contract must be resubmitted to ensure it meets the requirements of this contract. Decisions to deny a service authorization request or to authorize a service in an amount, duration, or scope that is less than requested, must be made by a physician who has appropriate clinical expertise in treating the Member’s condition or disease. The clinical reason for the denial, in whole or in part, specific to the Member shall be cited. Physician consultants from appropriate medical, surgical and psychiatric specialties shall be accessible and available for consultation as needed. The Medical Necessity review process shall be completed within two (2) business days of receiving the request and shall include a provision for expedited reviews in urgent decisions. Post-service review requests shall be completed within thirty (30) days.
Approval of Department. The Provider Manual and updates shall serve as a source of information to Providers regarding Covered Services, Contractor’s Policies and Procedures, provider credentialing and recredentialing, including Member Grievances and Appeals, claims submission requirements, reporting fraud and abuse, prior authorization procedures, Medicaid laws and regulations, telephone access, the QAPI program, standards for preventive health services and other requirements when identified by the Contractor.
Approval of Department. Care coordination shall be linked to other Contractor systems, such as QI, Member Services and Grievances.
Approval of Department. The Department’s subcontract review shall assure that all Subcontracts:
Approval of Department. The plan shall include the frequency of activities, the staff person responsible for the activities and how the activities will be documented and evaluated for effectiveness and need for change.