Common use of Care Services Clause in Contracts

Care Services. Home Health Care provides a program for the Member’s care and treatment in the home. Your coverage is outlined in the Summary of Benefits and Coverage’s. A visit consists up to four hours of care. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the Member’s attending Physician. Some special conditions apply:  The Physician’s statement and recommended program must be Pre-Certified.  Claims will be reviewed to verify that services consist of skilled care that is medically consistent with the diagnosis. Note:  Covered Services available under Home Health Care do NOT reduce outpatient benefits available under the Physical Therapy section shown in this Contract.  A Member must be essentially confined at home. Covered Services:  Visits by an RN or LPN-Benefits cannot be provided for services if the nurse is related to the Member.  Visits by a qualified physiotherapist or speech therapist and by an inhalation therapist certified by the National Board of Respiratory Therapy.  Visits by a Home Health Nursing Aide when rendered under the direct supervision of an RN.  Administration of prescribed drugs.  Oxygen and its administration. Covered Services for Home Health do not include: Food, housing, homemaker services, sitters, home-delivered meals; Home Health Care services which are not Medically Necessary or of a non-skilled level of care. Services and/or supplies which are not included in the Home Health Care plan as described.  Services of a person who ordinarily resides in the patient’s home or is a member of the family of either the patient or patient’s spouse.  Any services for any period during which the Member is not under the continuing care of a Physician.  Convalescent or Custodial Care where the Member has spent a period of time for recovery of an illness or surgery and where skilled care is not required or the services being rendered are only for aid in daily living, i.e., for the convenience of the patient.  Any services or supplies not specifically listed as Covered Services.  Routine care of a newborn child.  Dietitian services.  Maintenance therapy.  Private duty nursing care. Hospice Care Services Hospice benefits cover inpatient and outpatient services for patients certified by a Physician as terminally ill.

Care Services. The services of a Home Health Care provides a program for Agency in the Member’s care home are covered when provided by a registered nurse or licensed vocational nurse and treatment /or licensed physical, occupational, speech therapist or respiratory therapist. These services are in the form of visits that may include, but are not limited to, skilled nursing services, medical social services, rehabilitation therapy (including physical, speech and occupation- al), pulmonary rehabilitation therapy and cardiac rehabilitation therapy. Home Health Care Services must be ordered by your Physician, approved by your Physician Group or Health Plan and provided under a treatment plan describing the length, type and frequency of the visits to be provided. The following conditions must be met in order to receive Home Health Care Services: • The skilled nursing care is appropriate for the medical treatment of a condition, illness, disease or injury; • The Member is homebound because of illness or injury (this means that the Member is normally unable to leave home unassisted, and, when the Member does leave home, it must be to obtain medical care, or for short, infrequent non-medical reasons such as a trip to get a haircut, or to attend religious services or adult day care); • The Home Health Care Services are part-time and intermittent in nature; a visit lasts up to 4 hours in duration in every 24 hours; and • The services are in place of a continued hospitalization, confinement in a Skilled Nursing Facility, or outpatient services provided outside of the Member's home. Your coverage Additionally, Home Infusion Therapy is outlined in the Summary of Benefits and Coverage’salso covered. A visit consists up provider of infusion therapy must be a licensed pharmacy. Home nursing services are also provided to four hours ensure proper patient education, training, and monitoring of carethe administration of prescribed home treatments. Home treatments may be provided directly by infusion pharmacy nursing staff or by a qualified home health agency. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with patient does not need to be homebound to be eligible to receive Home Infusion Therapy. See the diagnosis, established and approved in writing by the Member’s attending Physician. Some special conditions apply:  The Physician’s statement and recommended program must be Pre-Certified.  Claims will be reviewed to verify that services consist of skilled care that is medically consistent with the diagnosis"Definitions" section. Note:  Covered Services Diabetic supplies covered under medical supplies include blood glucose monitors and insulin pumps. Custodial Care services and Private Duty Nursing, as described in the "Definitions" section and any other types of services primarily for the comfort or convenience of the Member, are not covered even if they are available under through a Home Health Care Agency. Home Health Care Services do NOT reduce outpatient benefits not include Private Duty Nursing or shift care. Private Duty Nursing (or shift care, including any portion of shift care services) is not a covered benefit under this plan even if it is available under the Physical Therapy section shown in this Contract.  A Member must be essentially confined at home. Covered Services:  Visits by an RN or LPN-Benefits cannot be provided for services if the nurse is related to the Member.  Visits by a qualified physiotherapist or speech therapist and by an inhalation therapist certified by the National Board of Respiratory Therapy.  Visits by through a Home Health Nursing Aide when rendered under the direct supervision of an RN.  Administration of prescribed drugs.  Oxygen and its administration. Covered Services for Home Health do not include: Food, housing, homemaker services, sitters, home-delivered meals; Home Health Care services which are not Medically Necessary or of a non-skilled level of care. Services and/or supplies which are not included in the Home Health Care plan as described.  Services of a person who ordinarily resides in the patient’s home Agency or is a member of determined to be Medically Necessary. See the family of either the patient or patient’s spouse.  Any services for any period during which the Member is not under the continuing care of a Physician.  Convalescent or Custodial Care where the Member has spent a period of time for recovery of an illness or surgery and where skilled care is not required or the services being rendered are only for aid in daily living, i.e., for the convenience of the patient.  Any services or supplies not specifically listed as Covered Services.  Routine care of a newborn child.  Dietitian services.  Maintenance therapy.  Private duty nursing care. Hospice Care Services Hospice benefits cover inpatient and outpatient services for patients certified by a Physician as terminally ill"Definitions" section.

Care Services. The services of a Home Health Care provides a program for Agency in the Member’s care home are covered when provided by a registered nurse or licensed vocational nurse and treatment /or licensed physical, occupational, speech therapist or respiratory therapist. These services are in the form of visits that may include, but are not limited to, skilled nursing services, medical social services, rehabilitation therapy (including physical, speech and occupation- al), pulmonary rehabilitation therapy and cardiac rehabilitation therapy. Home Health Care Services must be ordered by your Physician, approved by your Physician Group or Health Plan and provided under a treatment plan describing the length, type and frequency of the visits to be provided. The following conditions must be met in order to receive Home Health Care Services: The skilled nursing care is appropriate for the medical treatment of a condition, illness, disease or injury; The Member is homebound because of illness or injury (this means that the Member is normally unable to leave home unassisted, and, when the Member does leave home, it must be to obtain medical care, or for short, infrequent non-medical reasons such as a trip to get a haircut, or to attend religious services or adult day care); The Home Health Care Services are part-time and intermittent in nature; a visit lasts up to 4 hours in duration in every 24 hours; and Covered Services and Supplies Page 49 The services are in place of a continued hospitalization, confinement in a Skilled Nursing Facility, or outpatient services provided outside of the Member's home. Your coverage Additionally, Home Infusion Therapy is outlined in the Summary of Benefits and Coverage’salso covered. A visit consists up provider of infusion therapy must be a licensed pharmacy. Home nursing services are also provided to four hours ensure proper patient education, training, and monitoring of carethe administration of prescribed home treatments. Home treatments may be provided directly by infusion pharmacy nursing staff or by a qualified home health agency. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with patient does not need to be homebound to be eligible to receive Home Infusion Therapy. See the diagnosis, established and approved in writing by the Member’s attending Physician. Some special conditions apply:  The Physician’s statement and recommended program must be Pre-Certified.  Claims will be reviewed to verify that services consist of skilled care that is medically consistent with the diagnosis"Definitions" section. Note:  Covered Services Diabetic supplies covered under medical supplies include blood glucose monitors and insulin pumps. Custodial Care services and Private Duty Nursing, as described in the "Definitions" section and any other types of services primarily for the comfort or convenience of the Member, are not covered even if they are available under through a Home Health Care Agency. Home Health Care Services do NOT reduce outpatient benefits not include Private Duty Nursing or shift care. Private Duty Nursing (or shift care, including any portion of shift care services) is not a covered benefit under this plan even if it is available under the Physical Therapy section shown in this Contract.  A Member must be essentially confined at home. Covered Services:  Visits by an RN or LPN-Benefits cannot be provided for services if the nurse is related to the Member.  Visits by a qualified physiotherapist or speech therapist and by an inhalation therapist certified by the National Board of Respiratory Therapy.  Visits by through a Home Health Nursing Aide when rendered under the direct supervision of an RN.  Administration of prescribed drugs.  Oxygen and its administration. Covered Services for Home Health do not include: Food, housing, homemaker services, sitters, home-delivered meals; Home Health Care services which are not Medically Necessary or of a non-skilled level of care. Services and/or supplies which are not included in the Home Health Care plan as described.  Services of a person who ordinarily resides in the patient’s home Agency or is a member of determined to be Medically Necessary. See the family of either the patient or patient’s spouse.  Any services for any period during which the Member is not under the continuing care of a Physician.  Convalescent or Custodial Care where the Member has spent a period of time for recovery of an illness or surgery and where skilled care is not required or the services being rendered are only for aid in daily living, i.e., for the convenience of the patient.  Any services or supplies not specifically listed as Covered Services.  Routine care of a newborn child.  Dietitian services.  Maintenance therapy.  Private duty nursing care. Hospice Care Services Hospice benefits cover inpatient and outpatient services for patients certified by a Physician as terminally ill"Definitions" section.

Care Services. The services of a Home Health Care provides a program for Agency in the Member’s care home are covered when provided by a registered nurse or licensed vocational nurse and treatment /or licensed physical, occupational, speech therapist or respiratory therapist. These services are in the form of visits that may include, but are not limited to, skilled nursing services, medical social services, rehabilitation therapy (including physical, speech and occupational), pulmonary rehabilita- tion therapy and cardiac rehabilitation therapy. Home Health Care Services must be ordered by your Physician, approved by your Physician Group or Health Plan and provided under a treatment plan describing the length, type and frequency of the visits to be provided. The following conditions must be met in order to receive Home Health Care Services: • The skilled nursing care is appropriate for the medical treatment of a condition, illness, disease or injury; • The Member is homebound because of illness or injury (this means that the Member is normally unable to leave home unassisted, and, when the Member does leave home, it must be to obtain medical care, or for short, infrequent non-medical reasons such as a trip to get a haircut, or to attend religious services or adult day care); • The Home Health Care Services are part-time and intermittent in nature; a visit lasts up to 4 hours in duration in every 24 hours; and • The services are in place of a continued hospitalization, confinement in a Skilled Nursing Facility, or outpa- tient services provided outside of the Member's home. Your coverage Additionally, Home Infusion Therapy is outlined in the Summary of Benefits and Coverage’salso covered. A visit consists up provider of infusion therapy must be a licensed pharmacy. Home nursing services are also provided to four hours ensure proper patient education, training, and monitoring of carethe administration of prescribed home treatments. Home treatments may be provided directly by infusion pharmacy nursing staff or by a qualified home health agency. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the Member’s attending Physicianpatient does not need to be homebound to be eligible to receive Home Infusion Therapy. Some special conditions apply:  The Physician’s statement and recommended program must be Pre-Certified.  Claims will be reviewed to verify that services consist of skilled care that is medically consistent with the diagnosisSee "Definitions," Section 900. Note:  Covered Services Diabetic supplies covered under medical supplies include blood glucose monitors and insulin pumps. Custodial Care services and Private Duty Nursing, as described in "Definitions," Section 900 and any other types of services primarily for the comfort or convenience of the Member, are not covered even if they are available under through a Home Health Care Agency. Home Health Care Services do NOT reduce outpatient benefits not include Private Duty Nursing or shift care. Private Duty Nursing (or shift care, including any portion of shift care services) is not a covered benefit under this Plan even if it is available under the Physical Therapy section shown in this Contract.  A Member must be essentially confined at home. Covered Services:  Visits by an RN or LPN-Benefits cannot be provided for services if the nurse is related to the Member.  Visits by a qualified physiotherapist or speech therapist and by an inhalation therapist certified by the National Board of Respiratory Therapy.  Visits by through a Home Health Nursing Aide when rendered under the direct supervision of an RN.  Administration of prescribed drugs.  Oxygen and its administration. Covered Services for Home Health do not include: Food, housing, homemaker services, sitters, home-delivered meals; Home Health Care services which are not Medically Necessary or of a non-skilled level of care. Services and/or supplies which are not included in the Home Health Care plan as described.  Services of a person who ordinarily resides in the patient’s home Agency or is a member of the family of either the patient or patient’s spousedetermined to be Medically Necessary.  Any services for any period during which the Member is not under the continuing care of a Physician.  Convalescent or Custodial Care where the Member has spent a period of time for recovery of an illness or surgery and where skilled care is not required or the services being rendered are only for aid in daily living, i.e., for the convenience of the patient.  Any services or supplies not specifically listed as Covered Services.  Routine care of a newborn child.  Dietitian services.  Maintenance therapy.  Private duty nursing care. Hospice Care Services Hospice benefits cover inpatient and outpatient services for patients certified by a Physician as terminally illSee "Definitions," Section 900.