Necessary service definition
Necessary service means appropriate to participant’s current medical, physical, emotional, and social needs; and follow current clinical practice guidelines and professional standards of care applicable to the particular service Nursing home means a health facility licensed as either an Intermediate Care Facility or a Skilled Nursing Facility by the Department of Health Care Services. Out-of-area is any area beyond GMWP’s service area. (See below for definition of service area). PACE is the acronym for the Program of All-Inclusive Care for the Elderly. PACE is the comprehensive service plan which integrates acute and long-term care for older people with serious health problems. Payments for services are on a monthly capitation basis, combining both state and federal dollars through Medicare and Medi-Cal. Individuals not eligible for these programs pay privately. ▇▇▇▇ arranges for participants to come to the GMWP Center to receive individualized care from doctors, nurses and other health and social service providers. The goal is to help participants stay independent in the community for as long as safely possible. GMWP Health Care Provider includes (a) GMWP; (b) any clinic, health dispensary, or health facility, licensed pursuant to Division 2 (commencing with Section 1200) of the Health and Safety Code, that is owned, operated by, or contracted with, GMWP; and (c) any person licensed or certified pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or licensed pursuant to the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or licensed pursuant to Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code, who is lawfully employed by, or contracted with, GMWP to provide services to PACE participants. GMWP Physician is a doctor who is either employed by GMWP or has a contract with GMWP to provide primary care medical services to participants.
Necessary service means any of the following: —