Common use of Alcohol Abuse Clause in Contracts

Alcohol Abuse. Abuse of or addiction to alcohol. Alcohol Abuse does not include abuse of or addiction to drugs. Please see the definition of Substance Abuse. [ALLOWED CHARGE. An amount that is not more than the [lesser of: • the] allowance for the service or supply as determined by Us based on a standard approved by the Board[; or [• the negotiated fee schedule.] The Board will decide a standard for what is considered an Allowed Charge under this Contract. For charges that are not determined by a negotiated fee schedule, the [Member] may be billed for the difference between the Allowed Charge and the charge billed by the Provider. Please note: The Coordination of Benefits and Services provision includes a distinct definition of Allowed Charge.] AMBULANCE. A certified transportation vehicle for transporting Ill or Injured people that contains all life-saving equipment and staff as required by applicable state and local law. AMBULATORY SURGICAL CENTER. A Facility mainly engaged in performing Outpatient Surgery. It must: be staffed by Practitioners and Nurses, under the supervision of a Practitioner; have operating and recovery rooms; be staffed and equipped to give emergency care; and have written back-up arrangements with a local Hospital for emergency care. It must carry out its stated purpose under all relevant state and local laws and be either: accredited for its stated purpose by either the Joint Commission or the Accreditation Association for ambulatory care; or approved for its stated purpose by Medicare. A Facility is not an Ambulatory Surgical Center, for the purpose of this Contract, if it is part of a Hospital.

Appears in 3 contracts

Samples: www.state.nj.us, www.state.nj.us, www.state.nj.us

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