Covered Items and Services Clause Samples
The "Covered Items and Services" clause defines the specific goods, products, or services that are included under the terms of an agreement or contract. It typically lists or describes what the provider is obligated to supply and what the recipient is entitled to receive, such as particular medical treatments in a healthcare plan or specified deliverables in a service contract. By clearly outlining what is covered, this clause helps prevent misunderstandings and disputes about the scope of obligations, ensuring both parties have a shared understanding of what is included.
Covered Items and Services. Covered Items and Services must be available to all Participants twenty-four (24) hours a day, seven (7) days a week. All services must be provided, in accordance with the IDT policy.
Covered Items and Services. Payment by the Medicare Program currently includes payment for nursing services, certain therapies, use of a bed and the room in which the bed is located, linens, bedding, diapers and other incontinence supplies, routine laundry service, regular meals and snacks, certain equipment, social services, activities, and routine personal hygiene items which are required to meet your needs. Certain items and services are not covered in the Medicare daily rate. Extra charges for those non-covered items and services are set forth in Appendix A to this Admission Agreement. Certain other items and services are not included in our daily Medicaid rate (such as certain therapies, pharmacy services and dental services) but are covered by Medicaid and are billed directly to Medicaid by the provider. Future change in federal law may change the items and services which are included in payment by the Medicare Program to us.
Covered Items and Services. 2.4.1. Covered Items and Services must be available to all Participants twenty- four (24) hours a day, seven (7) days a week. All services must be provided, in accordance with the IDT policy.
2.4.2. Covered Items and Services will be managed and coordinated by the FIDA-IDD Plan through the Participant’s Care Manager.
2.4.3. Covered Items and Services shall be provided in the amount, duration and scope as set forth in this Contract, and shall be sufficient to achieve the purposes for which such Covered Items and Services are furnished. FIDA- IDD Plan shall, at all times, cover the appropriate level of service for all Emergency Services and non-Emergency Services in an appropriate setting.
2.4.4. The FIDA-IDD Plan must provide at least the full range of Behavioral Health Services covered by a Mainstream Managed Care Plan under the existing Partnership Plan demonstration under Social Security Act Section 1115(a).
2.4.5. The FIDA-IDD Plan must provide the full range of Covered Items and Services. If either Medicare or Medicaid provides more expansive services than the other program does for a particular condition, type of illness, or diagnosis, the FIDA-IDD Plan must provide the most expansive set of services required by either program. The FIDA-IDD Plan may not limit or deny services to Participants based on Medicare or Medicaid providing a more limited range of items and services than the other program.
2.4.6. As described herein and in the IDT Policy, many Covered Items and Services are authorized by the IDT through the Participant’s (LP).
2.4.7. Referrals from PCPs or other Providers are not necessary and may not be required by the FIDA-IDD Plan or any of its Participating Providers when a Participant is obtaining Covered Items or Services under the FIDA-IDD Demonstration.
Covered Items and Services. The set of items and services required to be offered by the FIDA Plans, as defined in Appendix A.
Covered Items and Services. Covered Items and Services must be available to all Participants twenty-four