Treatment Decisions. No Company or Payor is liable for, nor will it exercise control over, the manner or method by which a Contracted Provider provides items or services under this Agreement. Provider and Contracted Providers understand that determinations of Company or Payor that certain items or services are not Covered Services or have not been provided or billed in accordance with the requirements of this Agreement or the Provider Manual are administrative decisions only. Such decisions do not absolve the Contracted Provider of its responsibility to exercise independent judgment in treatment decisions relating to Covered Persons. Nothing in this Agreement (i) is intended to interfere with Contracted Provider’s relationship with Covered Persons, or (ii) prohibits or restricts a Contracted Provider from disclosing to any Covered Person any information that the Contracted Provider deems appropriate regarding health care quality, medical treatment decisions or alternatives.
Treatment Decisions. Provider shall be familiar with the package of benefits offered by DHH set forth in the State Contract and DHH’s requirement that providers make treatment decisions based upon individual medical needs. Provider must comply with DHH’s requirements governing Member rights and responsibilities as set forth in State Contract, Company Policies and applicable state and federal law.
Treatment Decisions. Neither Company, Payor, nor CCHN shall be liable for, or exercise control over, the manner or method by which a Contracted Provider provides items or services under this Agreement. Provider and Contracted Providers understand that determinations of Company, Payor, or CCHN that certain items or services are not Covered Services or have not been provided or billed in accordance with the requirements of this Agreement or the Provider Manual are administrative decisions only. Such decisions do not absolve the Contracted Provider of its responsibility to exercise independent judgment in treatment decisions relating to Covered Persons. Nothing in this Agreement (i) is intended to interfere with Contracted Provider’s relationship with Covered Persons, or (ii) prohibits or restricts a Contracted Provider from disclosing to any Covered Person any information that the Contracted Provider deems appropriate regarding health care quality, medical treatment decisions or alternatives.
Treatment Decisions. A. Procedure #3.6.19, Clinical Decision Making System and Procedure #3.2.4B, Clinical Review and Resolution Process, addresses how employees with concerns regarding treatment decisions and safety may resolve disputes.
Treatment Decisions. Resident shall be provided with adequate and appropriate medical care, and will be fully informed by a physician of his or her total health status, including but not limited to, his or her medical condition including diagnosis, prognosis and treatment plan options. Resident will be fully informed and provided with all information concerning his or her rights, when permitted by applicable law and regulations, to consent to or refuse treatment, and/or to execute an advance directive such as a living will, Health Care Proxy, or Do Not Resuscitate (DNR) Order.
Treatment Decisions. MCO shall not be liable for, nor will it exercise control over, the manner or method by which Provider provides or arranges for Covered Services. Provider understands that MCO’s determinations, if any, to deny payments for services which MCO does not deem to constitute Covered Services or which were not provided in accordance with the requirements of this Agreement, the Attachments or the Provider Manual, are administrative decisions only. Such a denial does not absolve Provider of Provider’s responsibility to exercise independent judgment in Covered Person treatment decisions. Nothing in this Agreement is intended to interfere with Provider’s provider- patient relationship with Covered Person(s).
Treatment Decisions. MCNA shall not be liable for, nor will it exercise control over, the manner or method by which Provider provides or arranges for Covered Services. Provider may not refuse to provide medically necessary or Covered Services to Covered Persons specified in the State Contract for non-medical reasons, except those services allowable under federal law for religious and moral objections. However, the Provider is not required to accept or continue treatment of a patient with whom the Provider determines a professional relationship cannot be maintained/established. The Provider understands that MCNA’s determinations, if any, to deny payments for services which MCNA does not deem to constitute Covered Services or which were not provided in accordance with the requirements of this Agreement, the Attachments or the Provider Manual, are administrative decisions only. Such a denial does not absolve Provider of Provider’s responsibility to exercise independent judgment in Covered Person treatment decisions. Nothing in this Agreement is intended to interfere with Provider’s provider-patient relationship with Covered Person(s).
Treatment Decisions. You have the right to: • Participate in the development and implementation of your Plan of Care. A Participant may also designate a health spokesperson. • Have all treatment options explained to you in a respectful manner and acknowledge this explanation in writing. • Make your own health care decisions. • Refuse treatment and be informed of the consequences. • Request and receive complete information about your health and functional status by the {PACE Program} Interdisciplinary Team. • Request a reassessment by the {PACE Program} Interdisciplinary Team. • Receive reasonable advance notice, in writing, if you are to be transferred to another treatment setting for medical reasons or for your welfare or the welfare of other Participants. Any such actions will be documented in your health record. • Have our staff explain Advance Health Care Directives to you and to establish one on your behalf, if you desire. Exercising Your Rights You have the right to: • Assistance to exercise civil, legal and Participant rights, including {PACE Program} grievance process, the Medi-Cal fair hearing process and the Medicare and Medi-Cal appeals processes. • Voice your complaints and recommend changes in policies and services to our staff and to outside representatives of your choice. There will be no restraint, interference, coercion, discrimination or reprisal by our staff if you do so. • Appeal any treatment decision made by {PACE Program} or our contractors through our appeals process and to have a fair hearing. If you feel any of your rights have been violated or you are dissatisfied and want to file a grievance or an appeal, please report this immediately to your Social Worker or call our office during regular business hours at {telephone #} or our toll free line at {telephone #}. Please refer to other sections of your {PACE Program} Participant Enrollment Agreement Terms and Conditions booklet for details about {PACE Provider} as your sole provider; a description of {PACE Program} services and how they are obtained; how you may obtain emergency and urgently needed services outside {PACE Program’s} network; the grievance and appeals procedure; conditions for disenrollment; and a description of premiums, if any, and payment of these. Participant Responsibilities We believe that you and your caregiver play crucial roles in the delivery of your care. To assure that you remain as healthy and independent as possible, please establish an open line of communication with those...
Treatment Decisions. MCNA shall not be liable for, nor will it exercise control over, the manner or method by which Provider provides or arranges for Covered Services. Provider understands that MCNA’s determinations, if any, to deny payments for services which MCNA does not deem to constitute Covered Services or which were not provided in accordance with the requirements of this Agreement, the Attachments or the Provider Manual, are administrative decisions only. Such a denial does not absolve Provider of Provider’s responsibility to exercise independent judgment in Covered Person treatment decisions. Nothing in this Agreement is intended to interfere with Provider’s provider-patient relationship with Covered Person(s).
Treatment Decisions. Subject to Client’s Plan Guidelines and the Prior Authorization process set forth in this Agreement, the decisions, in all circumstances, to prescribe and dispense any prescription drug shall be made solely by the prescribing physician or health care provider and the dispensing pharmacist, respectively. A Participating Pharmacy will not be deemed to be a representative, subcontractor, or agent of Navitus or Client based solely on this Agreement.
