In Lieu of Service definition

In Lieu of Service. (ILOS) means a setting or service determined by the Authority to be a medically appropriate and cost-effective substitute for a Covered Services consistent with provisions in OAR 410-141- 3820. The utilization and actual cost of an ILOS is included in developing the components of the Capitation Payment. In lieu of services must meet the requirements of 42 CFR 438.3(e)(2).¶

In Lieu of Service means an alternative service or setting that DHHS has approved as medically appropriate and cost-effective substitute for a Covered Service or setting under the Medicaid State Plan. A Member cannot be required by the MCO to use the alternative service or setting. Any In Lieu Of service must be authorized by DHHS, either via DHHS’s issuance prospective identification of approved In Lieu of Services or through an agreement reached between DHHS and the MCO. The utilization and actual cost of In Lieu Of Services will be taken into account in developing the component of the capitation rates that represents the Medicaid State Plan Covered Services, unless a statute or regulation explicitly requires otherwise.

In Lieu of Service means an alternative service or setting that the Department has approved as medically appropriate and cost-effective substitute for a Covered Service or setting under the Medicaid State Plan. A Member cannot be required by the DO to use the alternative service or setting. Any In Lieu Of Service shall be authorized by the Department, either via the Department’s issuance of prospective identification of approved In Lieu of Services or through an agreement reached between the Department and the DO. The utilization and actual cost of In Lieu Of Services shall be taken into account in developing the component of the capitation rates that represents the Medicaid State Plan Covered Services, unless a statute or regulation explicitly requires otherwise.

Examples of In Lieu of Service in a sentence

• With regard to AmerenCILCO's bond issuance in December 2008, in Docket Nos.

• NCDHHS will make guidance and technical assistance available to providers of ADVP Services and Day Components of ICF IID In Lieu of Service In ADVP Settings, through nationally recognized experts, to assist them with transforming their program and business models to become providers of, or to increase capacity within their existing, Integrated Employment Services resulting in CIE.

• The PHP shall monitor the cost-effectiveness of each approved In Lieu of Service by tracking utilization and expenditures (see Attachment J.

• He indicated that an example might help to clarify the need for periodic updates to the Secretariat paper.

• See the In Lieu of Service or Settings section herein for conditions under which inpatient psychiatric services may also be provided in an Institution for Mental Diseases (IMD).

• The implementation of the Customs Union remains the cornerstone of bilateral relations.

• Establishing Partnerships for Enhanced Case Management (ECM) and In Lieu of Service (ILOS) benefits Member InputMember input is obtained from member experience surveys, member focus and engagement groups, member complaint/grievance data, CAC feedback, FAC feedback, PCP/specialist access and availability data, Member Services telephone access reports, member suggestions, and member requests for PCP transfers.

• In Lieu of Service (ILS) – Under the federal Medicaid managed care rules (42 CFR 438.3[e][2]), ILS substitute for services or settings covered in a state plan because they are a cost-effective alternative.

• Are there other in lieu of services that ODM should consider for approval that would be cost effective alternatives to the current service array?AmeriHealth Caritas supports ODM in recognizing Institutions for Mental Disease as an In Lieu of Service (ILOS).

• The Payment In Lieu of Service shall be for the prior month and calculated based on a capacity charge of $3/Kw-mth, utilizing the demands shown on the riser diagram submitted to the City in the one-year notice of the Required Service Date.