Common use of Nutritional Counseling Clause in Contracts

Nutritional Counseling. Skilled behavioral health care services provided in the home by a behavioral health provider when ordered by a physician and directly related to an active treatment plan of care established by the physician. All of the following must be met: − The skilled behavioral health care is appropriate for the active treatment of a condition, sickness or disease to avoid placing the covered person at risk for serious complications. − The services are in lieu of a continued confinement in a hospital or residential treatment facility, or receiving outpatient services outside of the home. − The covered person is homebound because of sickness or injury. − The services provided are not primarily for comfort or convenience or custodial in nature. − The services are intermittent or hourly in nature. − The services are not for Applied Behavior Analysis. Benefits for home health care visits are payable up to the home health care maximum. Each visit by a nurse, In figuring the policy year maximum visits, each visit of a: • nurse or therapist, of up to 4 hours, is one visit and • behavioral health provider, of up to 1 hour, is one visit. This maximum will not apply to care given by an R.N. or L.P.N. when: • Care is provided within 7 days of discharge from a hospital or skilled nursing facility as a full-time inpatient; and • Care is needed to transition from the hospital or skilled nursing facility to home care. When the above criteria are met, covered medical expenses include up to 12 hours of continuous care by an R.N. or L.P.N. per day. Whether or not someone is available to give care does not determine whether the services are covered for home health care. The absence of a person to perform a non-skilled or custodial care service does not cause the service to become covered. If the covered person is a minor or an adult who is dependent upon others for non-skilled care (e.g., bathing, eating, toileting), home health care services will only be covered during times when: • there is a family member or caregiver present in the home, and • the family member or caregiver can meet the covered person’s non-skilled needs.