In Lieu of Service definition

In Lieu of Service. (ILOS) means a setting or service determined by the Authority to be a medically appropriate and cost-effective substitute for a Covered Services consistent with provisions in OAR 410-141- 3820. The utilization and actual cost of an ILOS is included in developing the components of the Capitation Payment. In lieu of services must meet the requirements of 42 CFR 438.3(e)(2).¶
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In Lieu of Service means an alternative service or setting that DHHS has approved as medically appropriate and cost-effective substitute for a Covered Service or setting under the Medicaid State Plan. A Member cannot be required by the MCO to use the alternative service or setting. Any In Lieu Of service must be authorized by DHHS, either via DHHS’s issuance prospective identification of approved In Lieu of Services or through an agreement reached between DHHS and the MCO. The utilization and actual cost of In Lieu Of Services will be taken into account in developing the component of the capitation rates that represents the Medicaid State Plan Covered Services, unless a statute or regulation explicitly requires otherwise.
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Examples of In Lieu of Service in a sentence

  • As defined in 42 CFR 441.301(c)(4) In Lieu of Service — As defined in 42 CFR 438.3(e)(2) Incentive — Related to an MMA Healthy Behaviors Program, something offered to an enrollee that encourages or motivates him or her to take action.

  • NCDHHS will make guidance and technical assistance available to providers of ADVP Services and Day Components of ICF IID In Lieu of Service In ADVP Settings, through nationally recognized experts, to assist them with transforming their program and business models to become providers of, or to increase capacity within their existing, Integrated Employment Services resulting in CIE.

  • The PHP shall monitor the cost-effectiveness of each approved In Lieu of Service by tracking utilization and expenditures (see Attachment J.

  • See the In Lieu of Service or Settings section herein for conditions under which inpatient psychiatric services may also be provided in an Institution for Mental Diseases (IMD).

  • In Lieu of Service (ILS) – Under the federal Medicaid managed care rules (42 CFR 438.3[e][2]), ILS substitute for services or settings covered in a state plan because they are a cost-effective alternative.

  • DHHS approved an IMD In Lieu of Service (ILOS) for use by the LME/MCOs effective beginning July 1, 2017.

  • Are there other in lieu of services that ODM should consider for approval that would be cost effective alternatives to the current service array?AmeriHealth Caritas supports ODM in recognizing Institutions for Mental Disease as an In Lieu of Service (ILOS).

  • Establishing Partnerships for Enhanced Case Management (ECM) and In Lieu of Service (ILOS) benefits Member InputMember input is obtained from member experience surveys, member focus and engagement groups, member complaint/grievance data, CAC feedback, FAC feedback, PCP/specialist access and availability data, Member Services telephone access reports, member suggestions, and member requests for PCP transfers.

  • Please articulate the final In Lieu of Service (ILOS) selection and the specific date by which those services will be available in the county using the following template.

  • This could include endorsement of the CalAIM 2020 proposal to include Meals/Medically Tailored Meals as an In Lieu of Service benefit and a recommendation that all Medicaid managed care plans offer this benefit.

Related to In Lieu of Service

  • Level of service has the meaning set forth in Section 2.02(c).

  • Period of Service means the aggregate of all periods of service commencing with an Employee's first day of employment or reemployment with the Employer or an Affiliated Employer and ending on the first day of a Period of Severance, or for benefit accrual purposes, ending on the severance from service date. The first day of employment or reemployment is the first day the Employee performs an Hour of Service. An Employee who incurs a Period of Severance of twelve (12) months or less will also receive service-spanning credit by treating any such period as a Period of Service for purposes of eligibility and vesting (but not benefit accrual). For purposes of benefit accrual, a Participant's whole year Periods of Service is equal to the sum of all full and partial periods of service, whether or not such service is continuous or contiguous, expressed in the number of whole years represented by such sum. For this purpose, fractional periods of a year will be expressed in terms of days.

  • Vesting Service of an employee means the period or periods of service credited to him under the provisions of Article II for purposes of determining his vested interest in his Employer Contributions Sub-Account, if Employer Contributions are provided for under either Article VI or Article XXII.

  • Date of Service means the date on which the client receives medical services or items, unless otherwise specified in the appropriate provider rules. For items that are mailed or shipped by the provider, the date of service is the date on which the order was received, the date on which the item was fabricated, or the date on which the item was mailed or shipped.

  • Years of Service means the total number of full years in which a Participant has been employed by one or more Employers. For purposes of this definition, a year of employment shall be a 365 day period (or 366 day period in the case of a leap year) that, for the first year of employment, commences on the Employee's date of hiring and that, for any subsequent year, commences on an anniversary of that hiring date. Any partial year of employment shall not be counted.

  • Month of Service means a calendar month in which an employee is in receipt of full salary or wages in respect of the prescribed number of working hours in each working day in the month and includes a calendar month in which an employee is absent on special leave without pay not in excess of twenty (20) working days.

  • Class of Service means the various categories of service generally available to customers, such as business or residence.

  • Termination of Service means:

  • Unit of service means a half day which shall be up to 5 hours of service per 24-hour period.

  • Year of Service means the computation period of twelve (12) consecutive months, herein set forth, during which an Employee has at least 1000 Hours of Service.

  • Out of service means that process established under the motor carrier safety act of 1963, 1963 PA 181, MCL 480.11 to 480.25.

  • Length of Service means total length of time within the Agency. For the purpose of this definition any service prior to a break-in-service with the Agency of more than ninety (90) days shall not be computed in determining length of service. (This will not preclude a reinstatement of a former Agency employee who has been separated from state service for ninety (90) days or less.)

  • Credited Service means the member's total period of service

  • Minimum Period of Service means a period of 12 consecutive months beginning on the Service Start Date, unless set out otherwise in any applicable Order.

  • Termination of Services means Participant’s Termination of Consultancy, Termination of Directorship or Termination of Employment, as applicable.

  • CMU Service means the Central Moneymarkets Unit Service, operated by the Hong Kong Monetary Authority;

  • Terms of Service means those Support Services and Professional Services terms posted at xxxx://xxx.XXXXXXX.xxx/terms-of-service/, which are incorporated herein. Client acknowledges and agrees it has read, understands and agrees to be bound by the Terms of Service.

  • Eligibility Service of an employee means the period or periods of service credited to him under the provisions of Article II for purposes of determining his eligibility to participate in the Plan as may be required under Article III or Article VI.

  • Point of Service means the point at which FortisAlberta’s service conductors are connected to the conductors or apparatus of a Customer;

  • Separates from Service or “Separation from Service” means the Participant’s termination of service as a non‑employee director and as an employee of UGI for any reason other than death and shall be determined in accordance with section 409A of the Code.

  • Hours of Service means hours to be credited to an Employee under the following rules:

  • contract of service means any agreement, whether oral or in writing and whether express or implied, whereby one person agrees to employ another as an employee and that other agrees to serve his employer as an employee and includes an apprenticeship contract;

  • COMMENCEMENT OF SERVICE means the actual date of placement of the first Vehicle(s) under this Agreement.

  • STIPULATED HOURS OF SERVICE PER DAY means hours of duty per day, normal hours/timings of duty whereof shall be determined by the Company's Engineer for which fixed charge shall be payable.

  • Testing service means a national testing service selected by the board.

  • completed year of service means continuous service for one year;