Mental Health and Substance Abuse Treatment Sample Clauses

The Mental Health and Substance Abuse Treatment clause establishes the terms under which mental health and substance abuse services are provided, accessed, or covered within an agreement. It typically outlines the scope of covered treatments, eligibility requirements, and any limitations or procedures for obtaining care, such as pre-authorization or provider networks. This clause ensures that parties understand their rights and obligations regarding mental health and substance abuse support, promoting access to necessary care while clarifying coverage boundaries and administrative processes.
Mental Health and Substance Abuse Treatment. The Empire Plan shall continue to provide comprehensive coverage for medically necessary mental health and substance abuse treatment services through a managed care network of preferred mental health and substance abuse care providers. In addition to the network care, limited non-network care will be available. Benefits shall be as follows:
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Mental Health and Substance Abuse Treatment. Network (a) Inpatient Mental Health Treatment (general acute or psychiatric hospital or clinic including inpatient and partial hospitalization, intensive outpatient and day treatment programs and 23 hour extended and 72 hour crisis beds) 1. Medically necessary inpatient mental health care is covered in full subject to a $200 copayment per person per admission. A new $200 copayment is required if the admission occurs more than 90 days after the previous admission. All elective admissions must be pre-certified. If pre-certification of an elective admission does not occur, the Plan payment equals 50 percent of the network allowance less the $200 copayment. (b) Inpatient Mental Health Treatment (residential treatment center, group home or halfway house) 1. Medically necessary inpatient mental health care in an approved facility is covered for up to 30 days per person per year. The Plan pays up to 80 percent of the network allowance less a $200 copayment. A new $200 copayment is required if the admission occurs more than 90 days after the previous admission. All elective admissions must be pre-certified. If pre-certification of an elective admission does not occur, the Plan pays up to 50 percent of the network allowance less the $200 copayment. (c) Outpatient Mental Health Treatment 1. Medically necessary outpatient mental health treatment is covered up to 15 visits per person per calendar year from a network practitioner subject to a $10 copayment per visit. Beginning with the sixteenth visit, the Plan pays up to 80 percent of the reasonable and customary allowance after the combined annual $100 per person deductible has been met. 2. Medically necessary treatment in a hospital emergency room is covered subject to a $25 copayment (waived if admitted as an inpatient directly from the emergency room).
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Mental Health and Substance Abuse Treatment. Non-Network (a) Inpatient Mental Health Treatment (general acute or psychiatric hospital or clinic including inpatient and partial hospitalization, intensive outpatient and day treatment programs and 23 hour extended and 72 hour crisis beds) 1. Medically necessary inpatient mental health care coverage at a non-network facility is available. The Plan pays up to 80 percent of the allowable amount less a $200 copayment. A new $200 copayment is required if the admission occurs more than 90 days after the previous admission. All elective admissions must be pre-certified. If pre- certification of an elective admission does not occur, the Plan pays up to 50 percent of the network allowance less the $200 copayment. (b) Inpatient Mental Health Treatment (residential treatment center, group home for halfway house) 1. Not a covered benefit.
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Mental Health and Substance Abuse Treatment. Denial and Limited Options
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Mental Health and Substance Abuse Treatment. (a) The Empire Plan shall continue to provide comprehensive coverage for medically necessary mental health and substance abuse treatment services through a managed care network of preferred mental health and substance abuse care providers. (1) Network benefits for Mental Health Coverage: Medically necessary hospital services and inpatient physician charges, provided by or arranged through the network shall be paid in full. (2) Effective April 1, 2010, outpatient care provided by, or arranged through the network, shall be covered subject to a $20 per visit copayment. Effective June 1, 2019 the copayment shall be $25. (3) Up to three visits for crisis intervention provided by, or arranged through the network, shall be covered without copay. (b) Medically necessary care for Alcohol and Other Substance Abuse Coverage, including hospitalization or alcohol/substance abuse facilities, that is provided by or arranged through the network, shall be paid in full. Outpatient care provided by or arranged through the network shall be subject to the participating provider office visit copayment.
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Mental Health and Substance Abuse Treatment. The Empire Plan shall continue to provide comprehensive coverage for medically necessary mental health and substance abuse treatment services through a managed care network of preferred mental health and substance abuse care providers. In addition to the in-network care, limited non-network care will be available. Benefits shall be as follows: a. IN-NETWORK BENEFIT • Mental Health Coverage • Paid-in-full medically necessary hospitalization services and inpatient physician charges when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be covered subject to a $15 per visit copayment. Effective March 31, 2007, outpatient care provided by, or arranged through, the network will be covered subject to an $18 per visit copayment. • Up to three visits for crisis intervention provided by, or arranged through, the network will be covered without copay. • Alcohol and Other Substance Abuse Coverage • Paid in full medically necessary care for hospitalization or alcohol/substance abuse facilities when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be subject to the participating provider office visit copayment. • Benefit Maximums • Annual and lifetime dollar maximums for covered expenses will be at the same level as the basic medical annual and lifetime dollar maximums; • Medically necessary inpatient alcohol and substance abuse treatment will be limited to three stays per lifetime. However, the managed care vendor will review on an individual, case by case, basis the appropriateness of additional treatment and may approve coverage for such treatment if it can be demonstrated that significant improvement will occur.
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Mental Health and Substance Abuse Treatment. The Empire Plan shall continue to provide comprehensive coverage for medically necessary mental health and substance abuse treatment services through a managed care network of preferred mental health and substance abuse care providers. In addition to the network care, limited non-network care will be available. Benefits shall be as follows: a. NETWORK BENEFIT • Mental Health Coverage • Paid-in-full medically necessary hospital services and inpatient physician charges when provided by, or arranged through, the network; • Effective April 1, 2010, outpatient care provided by, or arranged through, the network will be covered subject to a $20 per visit copayment; • Up to three visits for crisis intervention provided by, or arranged through, the network will be covered without copay. • Alcohol and Other Substance Abuse Coverage • Paid in full medically necessary care for hospitalization or alcohol/substance abuse facilities when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be subject to the participating provider office visit copayment. • Benefit Maximums • Effective January 1, 2010 medically necessary inpatient alcohol and substance abuse treatment will be unlimited. b. NON-NETWORK BENEFIT • Mental Health Coverage Medically necessary care rendered outside of the network will be subject to the following provisions: • Coincident with the increase in the Basic Medical deductible and coinsurance, the mental health basic medical deductible and coinsurance will increase accordingly; • The methodology for calculating non-network inpatient and outpatient reimbursement will be the same as the methodology for non-network hospital and medical services; • Substance Abuse • Medically necessary inpatient alcohol and substance abuse treatment will be unlimited effective January 1, 2010; • Coincident with the increase in the Basic Medical deductible and coinsurance, the substance abuse deductible and coinsurance will increase accordingly effective January 1, 2010; • Effective January 1, 2010 the methodology for calculating non-network inpatient and outpatient reimbursement will be the same as the methodology for non-network hospital and medical services; • Expenses applied against the deductible and coinsurance levels indicated above will not apply against any deductible or coinsurance maximums under the basic medical portion of the Plan. • Disease Management Under the Mental Health and Substance Abuse Prog...
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Related to Mental Health and Substance Abuse Treatment

  • Behavioral Health Services – Mental Health and Substance Use Disorder Inpatient - Unlimited days at a general hospital or a specialty hospital including detoxification or residential/rehabilitation per plan year. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Outpatient or intermediate careservices* - See Covered Healthcare Services: Behavioral Health Section for details about partial hospital program, intensive outpatient program, adult intensive services, and child and family intensive treatment. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Office visits - See Office Visits section below for Behavioral Health services provided by a PCP or specialist. Psychological Testing 0% - After deductible 40% - After deductible Medication-assisted treatment - whenrenderedby a mental health or substance use disorder provider. 0% - After deductible 40% - After deductible Methadone maintenance treatment - one copayment per seven-day period of treatment. 0% - After deductible 40% - After deductible Outpatient - Benefit is limited to 18 weeks or 36 visits (whichever occurs first) per coveredepisode. 0% - After deductible 40% - After deductible In a physician's office - limited to 12 visits per plan year. 0% - After deductible 40% - After deductible Emergency room - When services are due to accidental injury to sound natural teeth. 0% - After deductible The level of coverage is the same as network provider. In a physician’s/dentist’s office - When services are due to accidental injury to sound natural teeth. 0% - After deductible 40% - After deductible Services connected to dental care when performed in an outpatient facility * 0% - After deductible 40% - After deductible Inpatient/outpatient/in your home 0% - After deductible 40% - After deductible (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Outpatient durable medical equipment* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient medical supplies* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient diabetic supplies/equipment purchasedat licensed medical supply provider (other than a pharmacy). See the Summary of Pharmacy Benefits for supplies purchased at a pharmacy. 20% - After deductible 40% - After deductible Outpatient prosthesis* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Enteral formula delivered through a feeding tube. Must be sole source of nutrition. 20% - After deductible 40% - After deductible Enteral formula or food taken orally * 20% - After deductible The level of coverage is the same as network provider. Hair prosthesis (wigs) - The benefit limit is $350 per hair prosthesis (wig) when worn for hair loss suffered as a result of cancer treatment. 20% - After deductible The level of coverage is the same as network provider. Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% - After deductible The level of coverage is the same as network provider. Asthma management 0% - After deductible 40% - After deductible Hospital emergency room 0% - After deductible The level of coverage is the same as network provider.

  • Substance Abuse Treatment Information Substance abuse treatment information shall be maintained in compliance with 42 C.F.R. Part 2 if the Party or subcontractor(s) are Part 2 covered programs, or if substance abuse treatment information is received from a Part 2 covered program by the Party or subcontractor(s).

  • Substance Abuse The dangers and costs that alcohol and other chemical abuses can create in the electrical contracting industry in terms of safety and productivity are significant. The parties to this Agreement resolve to combat chemical abuse in any form and agree that, to be effective, programs to eliminate substance abuse and impairment should contain a strong rehabilitation component. The local parties recognize that the implementation of a drug and alcohol policy and program must be subject to all applicable federal, state, and local laws and regulations. Such policies and programs must also be administered in accordance with accepted scientific principles, and must incorporate procedural safeguards to ensure fairness in application and protection of legitimate interests of privacy and confidentiality. To provide a drug-free workforce for the Electrical Construction Industry, each IBEW local union and NECA chapter shall implement an area-wide Substance Abuse Testing Policy. The policy shall include minimum standards as required by the IBEW and NECA. Should any of the required minimum standards fail to comply with federal, state, and/or local laws and regulations, they shall be modified by the local union and chapter to meet the requirements of those laws and regulations.

  • Substance Abuse Testing The Parties agree that it is in the best interest of all concerned to promote a safe working environment. The Union has no objection to pre-employment substance abuse testing when required by the Employer and further, the Union has no objection to voluntary substance abuse testing to qualify for employment on projects when required by a project owner. The cost and scheduling of such testing shall be paid for and arranged by the Employer. The Union agrees to reimburse the Employer for any failed pre-access Alcohol and Drug test costs.

  • Substance Abuse Program The SFMTA General Manager or designee will manage all aspects of the FTA-mandated Substance Abuse Program. He/she shall have appointing and removal authority over all personnel working for the Substance Abuse Program personnel, and shall be responsible for the supervision of the SAP.