Self-Referral Services Sample Clauses

Self-Referral Services. In accordance with state and federal requirements, some covered benefits are available to members on a self-referral basis. These services shall not require a physician’s referral or other authorization from the Contractor. The Contractor must include self-referral providers in its contracted network. The Contractor may direct members to seek the services of the self-referral providers contracted in the Contractor’s network. However, with the exception of behavioral health and routine dental services, the Contractor cannot require that the members receive such services from network providers. Members may self-refer to any IHCP provider qualified to provide the service(s). When members choose to receive self-referral services from IHCP-enrolled self- referral providers who do not have contractual relationships with the Contractor, the Contractor is responsible for payment to these providers up to the applicable benefit limits and at 98% of Indiana Medicaid fee-for-service (FFS) rates.  Chiropractic services may be provided by a licensed chiropractor, enrolled as an IHCP provider, when rendered within the scope of the practice of chiropractic as defined in IC 25-10-1-1 and 846 IAC 1-1.  Eye care services, except surgical services may be provided by any provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) or IC 25-24 (optometrist) who has entered into a provider agreement under IC 12-15-11.  Podiatric services may be provided by any provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) or IC 25-29 (doctor of podiatric medicine) who has entered into a provider agreement under IC 12-15-11.  Psychiatric services may be provided by any provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) who has entered into a provider agreement under IC 12-15-11.  Family planning services under federal regulation 42 CFR 431.51(b)(2) requires freedom of choice of providers and access to family planning services and supplies. Family planning services are those services provided to individuals of childbearing age to temporarily or permanently prevent or delay pregnancy. Family planning services also include sexually transmitted disease testing. Abortions and abortifacients are not covered family planning services, except as allowable under the federal Hyde Amendment. Members may self-refer to any IHCP provider qualified to provide the family planning service(s), including providers that are not in ...
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Self-Referral Services. In accordance with state and federal requirements, the Hoosier Healthwise program includes some benefits and services that are available to members on a self-referral basis. These self- referral services shall not require a referral from the member’s PMP or authorization from the Contractor. The Contractor shall include self-referral providers in its contracted network. The Contractor and its PMPs may direct members to seek the services of the self-referral providers contracted in the Contractor’s network. The Contractor cannot require that the members receive such services from network providers. Hoosier Healthwise members may self-refer to any IHCP provider qualified to provide the service(s). When Hoosier Healthwise members choose to receive self-referral services from IHCP-enrolled self-referral providers who do not have contractual relationships with the Contractor, the Contractor is responsible for payment to these providers up to the applicable benefit limits and at 98% of Indiana Medicaid FFS rates. Members may not self-refer to a provider who is not enrolled in IHCP. The following services are considered self-referral services. The Indiana Administrative Code 405 IAC 5 (Hoosier Healthwise) and provides further detail regarding these benefits.  Chiropractic services may be provided by a licensed chiropractor, enrolled as an Indiana Medicaid provider, when rendered within the scope of the practice of chiropractic as defined in IC 25-10-1-1 and 846 IAC 1-1.  Eye care services, except surgical services may be provided by any provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) or IC 25-24 (optometrist) who has entered into a provider agreement under IC 12-15-11.  Routine Dental services may be provided by any in-network licensed dental provider who has entered into a provider agreement under IC 12-15-11.  Podiatric services may be provided by any provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) or IC 25-29 (doctor of podiatric medicine) who has entered into a provider agreement under IC 12-15-11.  Psychiatric services may be provided by any provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) who has entered into a provider agreement under IC 12-15-11.  Family planning services under federal regulation 42 CFR 431.51(b)(2) require a freedom of choice of providers and access to family planning services and supplies. Family planning services are those services prov...
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Self-Referral Services. In accordance with state and federal requirements, some covered benefits are available to members on a self-referral basis. These services shall not require a physician’s referral or other authorization from the Contractor. The Contractor must include self-referral providers in its contracted network. Note that network is defined as a list of the doctors, other health care providers, and hospitals that the Contractor contracts with to provide medical care to its members. These providers are called “network providers” or “in-network providers.” A provider that isn’t contracted with the Contractor is called an “out-of-network provider.” The Contractor may direct members to seek the services of the self-referral providers contracted in the Contractor’s network. However, with the exception of behavioral health and routine dental services, the Contractor cannot require that the members receive such services from network providers. Members may self-refer to any IHCP provider qualified to provide the service(s). When members choose to receive self-referral services from IHCP- enrolled self-referral providers who do not have contractual relationships with the Contractor, the Contractor is responsible for payment to these providers up to the applicable benefit limits and at a rate not less than 100% of Indiana Medicaid fee-for- service (FFS) rates. ▪ Chiropractic services may be provided by a licensed chiropractor, enrolled as an IHCP provider, when rendered within the scope of the practice of chiropractic as defined in IC 25-10-1-1 and 846 IAC 1-1. ▪ Eye care services, except surgical services may be provided by any IHCP provider licensed under IC 25-22.5 (doctor of medicine or doctor of osteopathy) or IC 25-24 (optometrist) who has entered into a provider agreement under IC 12-15-11. ▪ Podiatric services may be provided by any IHCP provider licensed under IC 25-
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Self-Referral Services. In accordance with state and federal requirements, the Hoosier Healthwise program includes some benefits and services that are available to members on a self-referral basis. These self-referral services shall not require a referral from the member’s PMP or authorization from the Contractor. The Contractor shall include self-referral providers in its contracted network. The Contractor and its PMPs may direct members to seek the services of the self-referral providers contracted in the Contractor’s network. The Contractor cannot require that the members receive such services from network providers. Hoosier Healthwise members may self-refer to any IHCP provider qualified to provide the service(s). When Hoosier Healthwise members choose to receive self-referral services from IHCP-enrolled self-referral providers who do not have contractual relationships with the Contractor, the Contractor is responsible for payment to these providers up to the applicable benefit limits and at 98% of Indiana Medicaid FFS rates.
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Self-Referral Services. For Healthy Families Members, Self-Referral Services include acupuncture, chiropractic and sensitive services. -- A 0207 CENTRAL C O A S T A L L I A N C E F O R HEALTH
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Related to Self-Referral Services

  • Hosted Services We shall use commercially reasonable efforts to make the Hosted Services you have purchased available 24 hours a day, 7 days a week, except for: (a) planned downtime under our direct control (of which we shall give at least 8 hours notice via the Hosted Services and which we shall schedule to the extent practicable during the weekend hours from 6:00 p.m. Pacific time Friday to 3:00 a.m. Pacific time Monday), (b) to the extent we are notified by third party service providers of planned downtime (of which we shall provide such notice to you via the Hosted services as soon we can reasonably do so), or (c) any unavailability caused by circumstances beyond our reasonable control, including, without limitation, acts of God, acts of government, flood, fire, earthquakes, civil unrest, acts of terror, strikes or other labor problems, internet service or third party hosting provider failures or delays ("Force Majeure"). Hosted Services are provided in accordance with applicable laws and government regulations.

  • Contract for Professional Services of Physicians Optometrists, and Registered Nurses In accordance with Senate Bill 799, Acts 2021, 87th Leg., R.S., if Texas Government Code, Section 2254.008(a)(2) is applicable to this Contract, Contractor affirms that it possesses the necessary occupational licenses and experience.

  • Professional Services Fees You agree to pay us the professional services fees in the amounts set forth in the Investment Summary. Those amounts are payable in accordance with our Invoicing and Payment Policy. You acknowledge that the fees stated in the Investment Summary are good-faith estimates of the amount of time and materials required for your implementation. We will bill you the actual fees incurred based on the in-scope services provided to you. Any discrepancies in the total values set forth in the Investment Summary will be resolved by multiplying the applicable hourly rate by the quoted hours.

  • Educational Services Any service or supply for education, training or retraining services or testing including: special education, remedial education; cognitive remediation; wilderness/outdoor treatment, therapy or adventure programs (whether or not the program is part of a Residential Treatment facility or otherwise licensed institution); job training or job hardening programs; educational services and schooling or any such related or similar program including therapeutic programs within a school setting.

  • Medical Services Plan 10.1.1 Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment.

  • Approved Services; Additional Services Registry Operator shall be entitled to provide the Registry Services described in clauses (a) and (b) of the first paragraph of Section 2.1 in the Specification 6 attached hereto (“Specification 6”) and such other Registry Services set forth on Exhibit A (collectively, the “Approved Services”). If Registry Operator desires to provide any Registry Service that is not an Approved Service or is a material modification to an Approved Service (each, an “Additional Service”), Registry Operator shall submit a request for approval of such Additional Service pursuant to the Registry Services Evaluation Policy at xxxx://xxx.xxxxx.xxx/en/registries/rsep/rsep.html, as such policy may be amended from time to time in accordance with the bylaws of ICANN (as amended from time to time, the “ICANN Bylaws”) applicable to Consensus Policies (the “RSEP”). Registry Operator may offer Additional Services only with the written approval of ICANN, and, upon any such approval, such Additional Services shall be deemed Registry Services under this Agreement. In its reasonable discretion, ICANN may require an amendment to this Agreement reflecting the provision of any Additional Service which is approved pursuant to the RSEP, which amendment shall be in a form reasonably acceptable to the parties.

  • Professional Services Bodily injury" or "property damage" arising out of the rendering of or failure to render profes- sional services;

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.

  • Hosting Services 13.1 If Supplier or its subcontractor, affiliate or any other person or entity providing products or services under the Contract Hosts Customer Data in connection with an Acquisition, the provisions of Appendix 1, attached hereto and incorporated herein, apply to such Acquisition.

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