CLINICAL SERVICE AND UTILIZATION MANAGEMENT Sample Clauses

CLINICAL SERVICE AND UTILIZATION MANAGEMENT. 6. Section 4.13.C is hereby amended by adding at the end therein the following language: “unless otherwise specified by EOHHS.”
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CLINICAL SERVICE AND UTILIZATION MANAGEMENT. Administrative Requirements Overview The Contractor shall: As of the Service Start Date, perform all clinical and Utilization Management (UM) functions and be responsible for the clinical management of Network Providers as described in this Contract. Develop the Clinical Criteria to govern the authorization of services provided under the Contract. As part of the development process, the Contractor shall consult with experts who are familiar with standards and practices of mental health and substance abuse treatment for adults and children and adolescents in Massachusetts. The Contractor shall: Submit the proposed Clinical Criteria to EOHHS for review and approval; and Annually review, and update as necessary, the Clinical Criteria and any other clinical protocols that have been developed, and submit any proposed changes to EOHHS for prior review and approval. Develop and maintain UM policies and procedures, including but not limited to policies and procedures for service authorizations that are consistent with the EOHHS-approved Clinical Criteria the Contractor has developed, and with the requirements set forth in Section 4.2. The Contractor shall: Initially, submit the UM policies and procedures to EOHHS for approval at least one month prior to the Service Start Date. Annually review, and update as necessary, the UM policies and procedures and submit any proposed changes to EOHHS for prior review and approval. The UM policies and procedures shall be conveyed through staff training and supervision, and shall: ensure that Covered Individuals receive the care that is Medically Necessary; and place emphasis on ensuring that BH Covered Services are not over-utilized or provided without a determination of Medical Necessity.
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CLINICAL SERVICE AND UTILIZATION MANAGEMENT. 4. Section 4.13 is hereby amended by adding at the end therein the following:
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CLINICAL SERVICE AND UTILIZATION MANAGEMENT. Section 4.3.A.2 is hereby amended by striking Subsections 4.3.A.2.(x-x) and adding at the end therein the following:
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CLINICAL SERVICE AND UTILIZATION MANAGEMENT. 1. Section 4.1.A.2 is hereby amended by striking the word “abuse”, and inserting the word “use”.
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Related to CLINICAL SERVICE AND UTILIZATION MANAGEMENT

  • Utilization Management Contractor shall maintain a utilization management program that complies with applicable laws, rules and regulations, including Health and Safety Code § 1367.01 and other requirements established by the applicable State Regulators responsible for oversight of Contractor.

  • Quality Management Grantee will:

  • Quality Management System Supplier hereby undertakes, warrants and confirms, and will ensue same for its subcontractors, to remain certified in accordance with ISO 9001 standard or equivalent. At any time during the term of this Agreement, the Supplier shall, if so instructed by ISR, provide evidence of such certifications. In any event, Supplier must notify ISR, in writing, in the event said certification is suspended and/or canceled and/or not continued.

  • STATEWIDE CONTRACT MANAGEMENT SYSTEM If the maximum amount payable to Contractor under this Contract is $100,000 or greater, either on the Effective Date or at any time thereafter, this section shall apply. Contractor agrees to be governed by and comply with the provisions of §§00-000-000, 00-000-000, 00-000-000, and 00- 000-000, C.R.S. regarding the monitoring of vendor performance and the reporting of contract information in the State’s contract management system (“Contract Management System” or “CMS”). Contractor’s performance shall be subject to evaluation and review in accordance with the terms and conditions of this Contract, Colorado statutes governing CMS, and State Fiscal Rules and State Controller policies.

  • AIN Selective Carrier Routing for Operator Services, Directory Assistance and Repair Centers 4.3.1 BellSouth will provide AIN Selective Carrier Routing at the request of <<customer_name>>. AIN Selective Carrier Routing will provide <<customer_name>> with the capability of routing operator calls, 0+ and 0- and 0+ NPA (LNPA) 555-1212 directory assistance, 1+411 directory assistance and 611 repair center calls to pre-selected destinations.

  • Project Management Plan 1 3.4.1 Developer is responsible for all quality assurance and quality control 2 activities necessary to manage the Work, including the Utility Adjustment Work.

  • Medical Services Plan 10.1.1 Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment.

  • Outpatient emergency and urgicenter services within the service area The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.

  • Configuration Management The Contractor shall maintain a configuration management program, which shall provide for the administrative and functional systems necessary for configuration identification, control, status accounting and reporting, to ensure configuration identity with the UCEU and associated cables produced by the Contractor. The Contractor shall maintain a Contractor approved Configuration Management Plan that complies with ANSI/EIA-649 2011. Notwithstanding ANSI/EIA-649 2011, the Contractor’s configuration management program shall comply with the VLS Configuration Management Plans, TL130-AD-PLN-010-VLS, and shall comply with the following:

  • Project Management Project Management Institute (PMI) certified project manager executing any or all of the following: • Development of Project Charter • Development of project plan and schedule • Coordination and scheduling of project activities across customer and functional areas • Consultation on operational and infrastructure requirements, standards and configurations • Facilitate project status meetings • Timely project status reporting • Address project issues with functional areas and management • Escalation of significant issues to customers and executive management • Manage project scope and deliverable requirements • Document changes to project scope and schedule • Facilitate and document project closeout

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