Service Determination Sample Clauses
The Service Determination clause defines the process by which the specific services to be provided under an agreement are identified and confirmed. Typically, this clause outlines the criteria, procedures, or documentation required for both parties to agree on the scope and nature of services, such as through written statements of work or service orders. Its core practical function is to ensure clarity and mutual understanding regarding what services are included, thereby reducing the risk of disputes over service expectations.
Service Determination. (1) In determining services and supports to be provided to the child/adolescent and family, the choice of and admission to medically necessary services and supports are determined jointly by the child/adolescent and/or family/LAR and the Grantee.
(2) Criteria used to make these determinations are from the recommended LOC (LOC-R) of the individual, as derived from the UA, the needs of the individual, TRR UM Guidelines, and the availability of resources.
(3) Children/Youth authorized for care by Grantee through a clinical override are eligible for the duration of the authorization. A clinical override for ineligible children/youth may not exceed a maximum of two (2) consecutive authorizations.
Service Determination. (1) In determining services to be provided to the adult MH Priority Population, the choice of and admission to medically necessary services is determined jointly by the individual seeking service and Grantee.
(2) Criteria used to make these determinations are the Level of Care Recommended (i.e., LOC-R) of the individual as derived from the Uniform Assessment (UA), incorporated by reference and posted at ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇▇▇▇.▇▇▇/doing-business- hhs/provider-portals/behavioral-health-services-providers/local-mental-health- authorities/adult-needs-strengths-assessment, the needs of the individual, Texas Resiliency and Recovery (TRR) Utilization Management (UM) Guidelines, incorporated by reference and posted at ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇▇▇▇.▇▇▇/doing-business- hhs/provider-portals/behavioral-health-services-providers/behavioral-health-provider- resources/utilization-management-guidelines-manual, and the availability of resources. Clients authorized for care by Grantee through a clinical override are eligible for the duration of the authorization.
Service Determination. (1) In determining services to be provided to the priority population, the choice of and admission to medically necessary services is determined jointly by the individual seeking service and Contractor.
(2) Criteria used to make these determinations are the Level of Care Recommended (i.e., LOC-R) of the individual as derived from the Uniform Assessment (UA), the needs of the individual, Texas Resiliency and Recovery (TRR) Utilization Management (UM) Guidelines, and the availability of resources. Clients authorized for care by Contractor through a clinical override are eligible for the duration of the authorization.
Service Determination. The number of points an employee earns for service will be calculated as one per year for each year of service.