Outpatient Health Services Sample Clauses

Outpatient Health Services. Eligible costs are for the direct outpatient treatment of medical conditions and are provided by licensed medical professionals. Emergency Solutions Grant (ESG) funds may be used only for these services to the extent that other appropriate health services are unavailable within the community. Eligible treatment consists of assessing a program participant’s health problems and developing a treatment plan; assisting program participants to understand their health needs; providing directly or assisting program participants to obtain appropriate medical treatment, preventive medical care, and health maintenance services, including emergency medical services; providing medication and follow-up services; and providing preventive and non-cosmetic dental care.
Sample 1Sample 2
AutoNDA by SimpleDocs
Outpatient Health Services.  General medical and specialist care, including consultation, routine care, and periodic physical examinations, including but not limited to, anesthesiology, cardiology, dermatology, gastroenterology, gynecology, internal medicine, nephrology, neurology, neurosurgery, oncology, ophthalmology, oral surgery, orthopedic surgery, otorhinolaryngology, plastic surgery, pulmonary disease, psychiatry, radiology, rheumatology, general surgery, thoracic and vascular surgery, and urology  Nursing care  Medical social service (social work)  Physical, occupational, speech, and respiratory therapies  Nutrition counseling, education, and support, including tube feedings, total parenteral nutrition, or peripheral parenteral nutrition  Laboratory tests, X-rays, and other diagnostic proceduresPrescription drugs and over the counter drugs and items as ordered by a network physician and obtained through a network pharmacy—Note: if you have Medicare Part D plan, Fallon Health Xxxxxxxx-XXXX now becomes your prescription drug plan; if after enrolling in Fallon Health Xxxxxxxx-XXXX, you choose to enroll in another Part D plan, you will be automatically disenrolled from Fallon Health Xxxxxxxx-XXXX  Pharmacy consulting services  Prostheses, orthotics, and durable medical equipment (per Medicare and Medicaid guidelines) and repairs and maintenance  Podiatry, including routine foot careVision care, including periodic examinations, treatment and corrective vision devices such as eyeglasses and lenses, and repairs and maintenance  Mental health servicesSubstance abuse services  Audiology, including evaluation, hearing aids, repairs and maintenance  Recreational therapy  Dentistry, including dentures, repair and maintenance
Sample 1
Outpatient Health Services. Eligible costs are for the direct outpatient treatment of medical conditions and are provided by licensed medical pro- fessionals. Emergency Solutions Grant (ESG) funds may be used only for these services to the extent that other appro- priate health services are unavailable within the community. Eligible treat- ment consists of assessing a program participant’s health problems and de- veloping a treatment plan; assisting program participants to understand their health needs; providing directly or assisting program participants to obtain appropriate medical treatment, preventive medical care, and health maintenance services, including emer- gency medical services; providing medication and follow-up services; and providing preventive and noncosmetic dental care.
Sample 1
Outpatient Health Services. Physician Specialists services including, but not limited to, services such as gastroenterology, oncology, urology, rheumatology and dermatology • Nursing care • Home Health Care • Laboratory tests, X-rays and other diagnostic services • Physical therapy, speech therapy and occupational therapy • Prosthetics and Orthotics • Personal Care Attendant services • Prescription drugs (only if obtained from a pharmacy designated by EB ESP except when provided for emergency services or authorized post emergency or urgent care services) • Durable medical equipment • Podiatry • Vision care, including examinations, treatment and corrective devices such as eyeglasses • Psychiatry, including evaluation, consultation, diagnostic and treatment service • Audiology evaluation, hearing aids, repairs and maintenance • Non-emergency ambulance transportation, if medically necessary
Sample 1
Outpatient Health Services. General medical and specialist care, including consultation, routine care, and periodic physical examinations (included but not limited to Anesthesiology, Cardiology, Dermatology, Gastroenterology, Gynecology, Internal Medicine, Nephrology, Neurology, Neurosurgery, Oncology, Ophthalmology, Oral surgery, Orthopedic surgery, Otorhinolaryngology, Plastic surgery, Pulmonary disease, Psychiatry, Radiology, Rheumatology, General Surgery, Thoracic and Vascular Surgery, Urology) Nursing care Medical social service (social work) Physical, Occupational, Speech, and Respiratory therapies Nutrition counseling, education, and support, including tube feedings, total parenteral nutrition, or peripheral parenteral nutrition Laboratory tests, x-rays and other diagnostic procedures Prescription and over the counter drugs as ordered by a network physician and obtained through a network pharmacy – Note: if you have Medicare Part D plan, PACE CNY now becomes your Prescription Drug Plan. And, after enrolling in PACE CNY, if you choose to enroll in another Part D Plan, you will be automatically disenrolled from PACE CNY. Pharmacy consulting services Prostheses, orthotics, and durable medical equipment (per Medicare and Medicaid guidelines) and repairs and maintenance Podiatry, including routine foot care Vision care, including periodic examinations, treatment and corrective vision devices such as eyeglasses and lenses, and repairs and maintenance Mental health services Substance abuse services Audiology, including evaluation, hearing aids, repairs and maintenance Recreational Therapy Dentistry, including dentures and repair and maintenance
Sample 1

Related to Outpatient Health Services

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. Inpatient This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. Residential Treatment Facility This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. Intermediate Care Services This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Health Services At the time of employment and subject to (b) above, full credit for registered professional nursing experience in a school program shall be given. Full credit for registered professional nursing experience may be given, subject to approval by the Human Resources Division. Non-degree nurses shall be placed on the BA Track of the Teachers Salary Schedule and shall be ineligible for movement to any other track.

  • Mental Health Services This agreement covers medically necessary services for the treatment of mental health disorders in a general or specialty hospital or outpatient facilities that are: • reviewed and approved by us; and • licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a general or specialty hospital or outpatient facility. We review network and non-network programs, hospitals and inpatient facilities, and the specific services provided to decide whether a preauthorization, hospital or inpatient facility, or specific services rendered meets our program requirements, content and criteria. If our program content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below.

  • Outpatient Services The following services are covered only at the Primary Care Provider’s office[selected by a [Member], or elsewhere [upon prior written Referral by a [Member]'s Primary Care Provider ]:

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. Preauthorization may be required for certain surgical services. Reconstructive Surgery for a Functional Deformity or Impairment This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia. Preauthorization may be required for these services.

  • Radiation Therapy/Chemotherapy Services This plan covers chemotherapy and radiation services. Respiratory Therapy This plan covers respiratory therapy services. When respiratory services are provided in your home, as part of a home care program, durable medical equipment, supplies, and oxygen are covered as a durable medical equipment service.

  • Inpatient Services Hospital This plan covers services provided while inpatient in a general or specialty hospital including, but not limited to the following: • anesthesia; • diagnostic tests and lab services; • dialysis; • drugs; • intensive care/coronary care; • nursing care; • physical, occupational, speech and respiratory therapies; • physician’s services while hospitalized; • radiation therapy; • surgery related services; and • room and board. Notify us if you are admitted from the emergency room to a hospital that is not in our network. Our Customer Service Department can assist you with any questions you may have about your coverage. Rehabilitation Facility This plan covers rehabilitation services received in a general hospital or specialty hospital. Coverage is limited to the number of days shown in the Summary of Medical Benefits.

Time is Money Join Law Insider Premium to draft better contracts faster.