{"component": "clause", "props": {"groups": [{"samples": [{"hash": "7xpmkHORdE8", "uri": "/contracts/7xpmkHORdE8#practice-guidelines", "label": "Contract for Services", "score": 35.3246459961, "published": true}, {"hash": "lrPCEKRMpcM", "uri": "/contracts/lrPCEKRMpcM#practice-guidelines", "label": "Contract for Services", "score": 34.9988975525, "published": true}, {"hash": "jc0FRyqHfzq", "uri": "/contracts/jc0FRyqHfzq#practice-guidelines", "label": "Contract for Services", "score": 34.9195137024, "published": true}], "size": 30, "snippet": "37.1. CONTRACTOR shall adopt practice guidelines (or adopt COUNTY\u2019S practice guidelines) that meet the following requirements:\n37.1.1. They are based on valid and reliable clinical evidence or a consensus of health care professionals in the applicable field;\n37.1.2. They consider the needs of the clients;\n37.1.3. They are adopted in consultation with contracting health care professionals; and\n37.1.4. They are reviewed and updated periodically as appropriate (42 C.F.R.\u00a7 438.236(b) and CCR, Title 9, Section 1810.326).\n37.2. CONTRACTOR shall disseminate the guidelines to all affected providers and, upon request, to clients and potential clients (42 C.F.R. \u00a7 438.236(c)).", "snippet_links": [{"key": "contractor-shall", "type": "clause", "offset": [6, 22]}, {"key": "based-on", "type": "definition", "offset": [144, 152]}, {"key": "health-care-professionals", "type": "definition", "offset": [208, 233]}, {"key": "applicable-field", "type": "definition", "offset": [241, 257]}, {"key": "in-consultation-with", "type": "definition", "offset": [332, 352]}, {"key": "title-9", "type": "clause", "offset": [494, 501]}, {"key": "the-guidelines", "type": "clause", "offset": [557, 571]}, {"key": "upon-request", "type": "clause", "offset": [603, 615]}, {"key": "potential-clients", "type": "definition", "offset": [632, 649]}], "hash": "ec1289838e0c4696cca6e290d1387d50", "id": 1}, {"samples": [{"hash": "fDfXeISUrZK", "uri": "/contracts/fDfXeISUrZK#practice-guidelines", "label": "Professional Services", "score": 33.5590438843, "published": true}, {"hash": "6QRxvADNpKX", "uri": "/contracts/6QRxvADNpKX#practice-guidelines", "label": "Professional Services", "score": 33.4659729004, "published": true}, {"hash": "lHQUCINGHHs", "uri": "/contracts/lHQUCINGHHs#practice-guidelines", "label": "Professional Services", "score": 32.451423645, "published": true}], "size": 22, "snippet": "Contractor shall comply with and disseminate the Practice Guidelines to all affected staff and, upon request, to beneficiaries and potential beneficiaries. Practice Guidelines can be accessed at \u2587\u2587\u2587.\u2587\u2587\u2587\u2587\u2587\u2587\u2587\u2587\u2587.\u2587\u2587\u2587. [DMC-ODS IA, Exhibit A]", "snippet_links": [{"key": "contractor-shall", "type": "clause", "offset": [0, 16]}, {"key": "comply-with", "type": "clause", "offset": [17, 28]}, {"key": "the-practice", "type": "clause", "offset": [45, 57]}, {"key": "upon-request", "type": "clause", "offset": [96, 108]}, {"key": "exhibit-a", "type": "definition", "offset": [227, 236]}], "hash": "81cfc015101297fc6ac7e7f99632b41c", "id": 2}, {"samples": [{"hash": "axNrx1dAian", "uri": "/contracts/axNrx1dAian#practice-guidelines", "label": "Professional Services", "score": 33.597366333, "published": true}, {"hash": "bP0ChDTX2KQ", "uri": "/contracts/bP0ChDTX2KQ#practice-guidelines", "label": "Professional Services", "score": 33.4507141113, "published": true}, {"hash": "hBY51ykm9we", "uri": "/contracts/hBY51ykm9we#practice-guidelines", "label": "Professional Services", "score": 32.6201248169, "published": true}], "size": 16, "snippet": "22.1 Contractor shall adopt practice guidelines (or adopt MHP\u2019s practice guidelines) that meet the following requirements:\n22.1.1 They are based on valid and reliable clinical evidence or a consensus of health care professionals in the applicable field;\n22.1.2 They consider the needs of the beneficiaries;\n22.1.3 They are adopted in consultation with contracting health care professionals; and\n22.1.4 They are reviewed and updated periodically as appropriate (42 C.F.R.\u00a7 438.236(b) and CCR, Title 9, Section 1810.326).\n22.2 Contractor shall disseminate the guidelines to all affected providers and, upon request, to beneficiaries and potential beneficiaries (42 C.F.R. \u00a7 438.236(c)).\n22.3 Contractor shall take steps to assure that decisions for utilization management, beneficiary education, coverage of services, and any other areas to which the guidelines apply shall be consistent with the guidelines (42 C.F.R. \u00a7 438.236(d)).", "snippet_links": [{"key": "contractor-shall", "type": "clause", "offset": [5, 21]}, {"key": "based-on", "type": "definition", "offset": [139, 147]}, {"key": "health-care-professionals", "type": "definition", "offset": [203, 228]}, {"key": "applicable-field", "type": "definition", "offset": [236, 252]}, {"key": "the-beneficiaries", "type": "clause", "offset": [288, 305]}, {"key": "in-consultation-with", "type": "definition", "offset": [331, 351]}, {"key": "title-9", "type": "clause", "offset": [492, 499]}, {"key": "the-guidelines", "type": "clause", "offset": [554, 568]}, {"key": "upon-request", "type": "clause", "offset": [600, 612]}, {"key": "utilization-management", "type": "clause", "offset": [747, 769]}, {"key": "coverage-of-services", "type": "clause", "offset": [794, 814]}, {"key": "other-areas", "type": "clause", "offset": [824, 835]}, {"key": "consistent-with-the", "type": "clause", "offset": [875, 894]}], "hash": "721ec6d8f5d5cc00426bcd73d06a3f7e", "id": 3}, {"samples": [{"hash": "b0xuuLgxKv5", "uri": "/contracts/b0xuuLgxKv5#practice-guidelines", "label": "Service Agreement", "score": 34.2808456421, "published": true}, {"hash": "cQybtrdPzMV", "uri": "/contracts/cQybtrdPzMV#practice-guidelines", "label": "Service Agreement", "score": 33.8602142334, "published": true}, {"hash": "at7CxyDMftP", "uri": "/contracts/at7CxyDMftP#practice-guidelines", "label": "Standard Agreement", "score": 32.6392860413, "published": true}], "size": 15, "snippet": "A. The Contractor shall adopt practice guidelines. (42 C.F.R. \u00a7 438.236(b) and Cal. Code Regs., tit. 9, \u00a7 1810.326)", "snippet_links": [{"key": "the-contractor-shall", "type": "clause", "offset": [3, 23]}], "hash": "d8d8f68fb4fd8496683f9e4609e02116", "id": 4}, {"samples": [{"hash": "8RYZNe8oREv", "uri": "/contracts/8RYZNe8oREv#practice-guidelines", "label": "Contract Amendment", "score": 26.1704311371, "published": true}, {"hash": "7kQH6iej5rA", "uri": "/contracts/7kQH6iej5rA#practice-guidelines", "label": "Contract Amendment", "score": 24.1704311371, "published": true}, {"hash": "i5Y8cVus5QD", "uri": "/contracts/i5Y8cVus5QD#practice-guidelines", "label": "Contract Amendment", "score": 21.7200546265, "published": true}], "size": 10, "snippet": "2.10.12.1. The Contractor shall provide practice guidelines to the Department upon request within ten (10) Business Days, and at no cost to the Department.\n2.10.12.1.1. DELIVERABLE: Practice Guidelines.\n2.10.12.1.2. DUE: Within ten (10) Business Days of the Department\u2019s request.", "snippet_links": [{"key": "the-contractor-shall-provide", "type": "clause", "offset": [11, 39]}, {"key": "the-department", "type": "clause", "offset": [63, 77]}, {"key": "upon-request", "type": "clause", "offset": [78, 90]}, {"key": "at-no-cost", "type": "definition", "offset": [126, 136]}, {"key": "business-days-of", "type": "clause", "offset": [237, 253]}], "hash": "4ddf68e27dec0298910313b5212caa95", "id": 5}, {"samples": [{"hash": "keVdEnUn5G1", "uri": "/contracts/keVdEnUn5G1#practice-guidelines", "label": "Standard Agreement", "score": 26.5513820648, "published": true}, {"hash": "7A429jhXAHe", "uri": "/contracts/7A429jhXAHe#practice-guidelines", "label": "Standard Agreement", "score": 26.5513820648, "published": true}, {"hash": "boJ1RaUi3w0", "uri": "/contracts/boJ1RaUi3w0#practice-guidelines", "label": "Intergovernmental Agreement", "score": 25.5888442993, "published": true}], "size": 8, "snippet": "The Contractor shall comply with 42 CFR 438.236(b) which requires the adoption of practice guidelines. The Contractor shall comply with the practice guidelines established in Exhibit A, Attachment I Section 1.2(B).\nA. The Contractor\u2019s practice guidelines shall:\n1) be based on valid and reliable clinical evidence or a consensus of health care professionals in the applicable field;", "snippet_links": [{"key": "the-contractor-shall", "type": "clause", "offset": [0, 20]}, {"key": "the-practice", "type": "clause", "offset": [136, 148]}, {"key": "exhibit-a", "type": "definition", "offset": [175, 184]}, {"key": "attachment-i", "type": "clause", "offset": [186, 198]}, {"key": "based-on", "type": "definition", "offset": [268, 276]}, {"key": "health-care-professionals", "type": "definition", "offset": [332, 357]}, {"key": "applicable-field", "type": "definition", "offset": [365, 381]}], "hash": "9adc5e49e87ef088981ae720fdffb78b", "id": 6}, {"samples": [{"hash": "cZhDbP7a73a", "uri": "/contracts/cZhDbP7a73a#practice-guidelines", "label": "Specialty Mh Service Agreement", "score": 35.5454177856, "published": true}, {"hash": "4vVW6GGMA0n", "uri": "/contracts/4vVW6GGMA0n#practice-guidelines", "label": "Service Agreement", "score": 35.2752838135, "published": true}, {"hash": "5plmXvOqvoa", "uri": "/contracts/5plmXvOqvoa#practice-guidelines", "label": "Behavioral Health Specialty Mh Service Agreement", "score": 35.1166038513, "published": true}], "size": 8, "snippet": "A. Contractor shall adopt practice guidelines (or adopt County\u2019s practice guidelines) that meet the following requirements:\nI. They are based on valid and reliable clinical evidence or a consensus of health care professionals in the applicable field;\nII. They consider the needs of the clients;\nIII. They are adopted in consultation with contracting health care professionals; and\nIV. They are reviewed and updated periodically as appropriate (42 C.F.R.\u00a7 438.236(b) and CCR, Title 9, Section 1810.326).\nB. Contractor shall disseminate the guidelines to all affected providers and, upon request, to clients and potential clients (42 C.F.R. \u00a7 438.236(c)).", "snippet_links": [{"key": "contractor-shall", "type": "clause", "offset": [3, 19]}, {"key": "based-on", "type": "definition", "offset": [136, 144]}, {"key": "health-care-professionals", "type": "definition", "offset": [200, 225]}, {"key": "applicable-field", "type": "definition", "offset": [233, 249]}, {"key": "in-consultation-with", "type": "definition", "offset": [317, 337]}, {"key": "title-9", "type": "clause", "offset": [475, 482]}, {"key": "the-guidelines", "type": "clause", "offset": [535, 549]}, {"key": "upon-request", "type": "clause", "offset": [581, 593]}, {"key": "potential-clients", "type": "definition", "offset": [610, 627]}], "hash": "1ca3820feef193eca4e0d4c844641197", "id": 7}, {"samples": [{"hash": "kmXTPIBDYid", "uri": "/contracts/kmXTPIBDYid#practice-guidelines", "label": "Contract for Services (Amerigroup Corp)", "score": 18.0, "published": true}, {"hash": "bRpDgziHw5S", "uri": "/contracts/bRpDgziHw5S#practice-guidelines", "label": "Amendment to the Agreement for Health Services to the Medicaid Star Program (Centene Corp)", "score": 18.0, "published": true}, {"hash": "4W5mNUtglAP", "uri": "/contracts/4W5mNUtglAP#practice-guidelines", "label": "Contract for Services (Amerigroup Corp)", "score": 18.0, "published": true}], "size": 7, "snippet": "In accordance with 42 C.F.R. Section 438.236, HMO must adopt practice guidelines, that are based on valid & reliable clinical evidence or a consensus of health care professionals in the particular field; consider the needs of the HMO's Members; are adopted in consultation with contracting health care professionals; and are reviewed and updated periodically as appropriate. The HMO must disseminate the guidelines to all affected providers and, upon request to Members and potential Members. The HMO's decisions regarding utilization management, member education, coverage of services, and other areas included in the guidelines, must be consistent with the HMO's guidelines.\"", "snippet_links": [{"key": "in-accordance-with", "type": "clause", "offset": [0, 18]}, {"key": "based-on", "type": "definition", "offset": [91, 99]}, {"key": "health-care-professionals", "type": "definition", "offset": [153, 178]}, {"key": "in-consultation-with", "type": "definition", "offset": [257, 277]}, {"key": "the-guidelines", "type": "clause", "offset": [400, 414]}, {"key": "upon-request", "type": "clause", "offset": [446, 458]}, {"key": "to-members", "type": "clause", "offset": [459, 469]}, {"key": "potential-members", "type": "clause", "offset": [474, 491]}, {"key": "utilization-management", "type": "clause", "offset": [523, 545]}, {"key": "member-education", "type": "clause", "offset": [547, 563]}, {"key": "coverage-of-services", "type": "clause", "offset": [565, 585]}, {"key": "other-areas", "type": "clause", "offset": [591, 602]}, {"key": "consistent-with-the", "type": "clause", "offset": [639, 658]}], "hash": "9cd75ef6b531b971b4b4d6167ce8c06e", "id": 8}, {"samples": [{"hash": "sR478sxweY", "uri": "/contracts/sR478sxweY#practice-guidelines", "label": "Contract for Provision of Services", "score": 24.1704311371, "published": true}, {"hash": "jijP08Dmgxz", "uri": "/contracts/jijP08Dmgxz#practice-guidelines", "label": "Contract for Provision of Services (Wellcare Health Plans, Inc.)", "score": 24.1279945374, "published": true}], "size": 6, "snippet": "4.12.7.1 The Contractor shall adopt a minimum of three (3) evidence-based clinical practice guidelines. Such guidelines shall: \u2022 Be based on the health needs and opportunities for improvement identified as part of the QAPI program; \u2022 Be based on valid and reliable clinical evidence or a consensus of Health Care Professionals in the particular field; \u2022 Consider the needs of the Members; \u2022 Be adopted in consultation with network Providers; and \u2022 Be reviewed and updated periodically as appropriate.\n4.12.7.2 The Contractor shall submit all Practice Guidelines in use, which shall include a methodology for measuring and assessing compliance, to DCH for review and prior approval as part of the QAPI program plan as updated.\n4.12.7.3 The Contractor shall disseminate the guidelines to all affected Providers and, upon request, to Members.\n4.12.7.4 The Contractor shall ensure that decisions for Utilization Management, Member education, coverage of services, and other areas to which the guidelines apply are consistent with the guidelines.\n4.12.7.5 In order to ensure consistent application of the guidelines the Contractor shall encourage Providers to utilize the guidelines, and shall measure compliance with the guidelines, until ninety percent (90%) or more of the Providers are consistently in compliance. The Contractor may use Provider incentive strategies to improve Provider compliance with guidelines.", "snippet_links": [{"key": "the-contractor-shall", "type": "clause", "offset": [9, 29]}, {"key": "clinical-practice-guidelines", "type": "definition", "offset": [74, 102]}, {"key": "based-on", "type": "definition", "offset": [132, 140]}, {"key": "qapi-program", "type": "clause", "offset": [218, 230]}, {"key": "health-care-professionals", "type": "definition", "offset": [301, 326]}, {"key": "the-members", "type": "clause", "offset": [376, 387]}, {"key": "in-consultation-with", "type": "definition", "offset": [402, 422]}, {"key": "network-providers", "type": "clause", "offset": [423, 440]}, {"key": "for-review", "type": "clause", "offset": [651, 661]}, {"key": "prior-approval", "type": "definition", "offset": [666, 680]}, {"key": "program-plan", "type": "clause", "offset": [701, 713]}, {"key": "the-guidelines", "type": "clause", "offset": [768, 782]}, {"key": "upon-request", "type": "clause", "offset": [814, 826]}, {"key": "to-members", "type": "clause", "offset": [828, 838]}, {"key": "utilization-management", "type": "clause", "offset": [896, 918]}, {"key": "member-education", "type": "clause", "offset": [920, 936]}, {"key": "coverage-of-services", "type": "clause", "offset": [938, 958]}, {"key": "other-areas", "type": "clause", "offset": [964, 975]}, {"key": "consistent-with-the", "type": "clause", "offset": [1010, 1029]}, {"key": "in-order-to-ensure", "type": "clause", "offset": [1051, 1069]}, {"key": "application-of-the", "type": "clause", "offset": [1081, 1099]}, {"key": "compliance-with-the", "type": "clause", "offset": [1197, 1216]}, {"key": "the-providers", "type": "definition", "offset": [1267, 1280]}, {"key": "in-compliance", "type": "clause", "offset": [1298, 1311]}, {"key": "the-contractor-may", "type": "clause", "offset": [1313, 1331]}, {"key": "provider-incentive", "type": "definition", "offset": [1336, 1354]}, {"key": "compliance-with-guidelines", "type": "clause", "offset": [1386, 1412]}], "hash": "e726141b28390ec81b10e02ed9df2e38", "id": 9}, {"samples": [{"hash": "bNLWtTj3On5", "uri": "/contracts/bNLWtTj3On5#practice-guidelines", "label": "Health Care Services Contract (Wellcare Health Plans, Inc.)", "score": 21.0, "published": true}, {"hash": "AWXsCWLtSi", "uri": "/contracts/AWXsCWLtSi#practice-guidelines", "label": "Health Care Services Contract (Amerigroup Corp)", "score": 21.0, "published": true}, {"hash": "8J2mQVlUckt", "uri": "/contracts/8J2mQVlUckt#practice-guidelines", "label": "Health Care Services Contract (Wellcare Health Plans, Inc.)", "score": 21.0, "published": true}], "size": 5, "snippet": "a. The Health Plan shall adopt practice guidelines that meet the following requirements:\n(1) Are based on valid and reliable clinical evidence or a consensus of Health Care Professionals in a particular field;\n(2) Consider the needs of the Enrollees;\n(3) Are adopted in consultation with Providers; and\n(4) Are reviewed and updated periodically, as appropriate (See 42 CFR 438.236(b)).\nb. The Health Plan shall disseminate any revised practice guidelines to all affected Providers and, upon request, to Enrollees and Potential Enrollees.\nc. The Health Plan shall ensure consistency with regard to all decisions relating to UM, Enrollee education, Covered Services and other areas to which the practice guidelines apply.", "snippet_links": [{"key": "health-plan", "type": "clause", "offset": [7, 18]}, {"key": "based-on", "type": "definition", "offset": [97, 105]}, {"key": "health-care-professionals", "type": "definition", "offset": [161, 186]}, {"key": "with-providers", "type": "clause", "offset": [283, 297]}, {"key": "upon-request", "type": "clause", "offset": [486, 498]}, {"key": "with-regard-to", "type": "clause", "offset": [582, 596]}, {"key": "relating-to", "type": "definition", "offset": [611, 622]}, {"key": "enrollee-education", "type": "clause", "offset": [627, 645]}, {"key": "services-and", "type": "clause", "offset": [655, 667]}, {"key": "other-areas", "type": "clause", "offset": [668, 679]}, {"key": "the-practice", "type": "clause", "offset": [689, 701]}], "hash": "9e8b7c42c17f8cdaa2bb5cb32d3e2d99", "id": 10}], "next_curs": "ClwSVmoVc35sYXdpbnNpZGVyY29udHJhY3RzcjgLEhZDbGF1c2VTbmlwcGV0R3JvdXBfdjU2IhxwcmFjdGljZS1ndWlkZWxpbmVzIzAwMDAwMDBhDKIBAmVuGAAgAA==", "clause": {"size": 189, "parents": [["services", "Services"], ["quality-improvement-program", "Quality Improvement Program"], ["acknowledgement-of-exhibits", "ACKNOWLEDGEMENT OF EXHIBITS"], ["improvement-program", "Improvement Program"], ["outcomes-quality-assessment-and-performance-improvement", "OUTCOMES, QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT"]], "children": [["", ""], ["services", "SERVICES"], ["notices", "NOTICES"], ["termination", "TERMINATION"], ["general-requirements", "General Requirements"]], "title": "Practice Guidelines", "id": "practice-guidelines", "related": [["applicable-guidelines", "Applicable Guidelines", "Applicable Guidelines"], ["general-guidelines", "General Guidelines", "General Guidelines"], ["guidelines", "Guidelines", "Guidelines"], ["hot-weather-guidelines", "Hot Weather Guidelines", "Hot Weather Guidelines"], ["hiv-aids-model-workplace-guidelines", "HIV/AIDS Model Workplace Guidelines", "HIV/AIDS Model Workplace Guidelines"]], "related_snippets": [], "updated": "2025-07-24T06:49:03+00:00"}, "json": true, "cursor": ""}}