Care Services. The MCO must implement procedures to:
Care Services. 4.1 It is a requirement of this Agreement that the parties to it have also entered into a Care Agreement.
Care Services. The MCO must implement procedures to: Ensure that each member has an ongoing source of primary care appropriate to his/her needs and a person or entity formally designated as primarily responsible for coordinating the health care services furnished to the member. Coordinate the services the MCO furnishes to the member with the services the member receives from any other provider of health care or insurance plan, including mental health and substance abuse services. Share with other agencies serving the member the results of its identification and assessment of special health care needs so that those activities need not be duplicated.
Care Services. The care services to be delivered by the Provider pursuant to the Care Plan as determined and assessed from time to time pursuant to clause 2, provided that unless and until otherwise determined and assessed from time to time pursuant to clause 2, Care Package Band A will apply. Care Package Band A comprises up to 1 hour per day of a non-nurse carer or up to 30 minutes per day of a carer who is a nurse, or a proportionate blend thereof (for example, up to 30 minutes per day of a non-nurse carer plus up to 15 minutes per day of a carer who is a nurse) • Care Staff available 24 hours a day • Emergency call system in suites • Activities as organised by the Provider’s Activity Team • Scheduled transportation arranged by the Provider in the Provider’s minibus with wheelchair access • Housekeeping services for infection control purposes which are more frequent or otherwise additional to those provided under the Residence Agreement, and provision of related cleaning materials
Care Services. Home Health Care provides a program for the Member’s care and treatment in the home. Your coverage is outlined in the Summary of Benefits and Coverage’s. A visit consists up to four hours of care. The program consists of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the Member’s attending Physician. Some special conditions apply: The Physician’s statement and recommended program must be Pre-Certified. Claims will be reviewed to verify that services consist of skilled care that is medically consistent with the diagnosis. Note: Covered Services available under Home Health Care do NOT reduce outpatient benefits available under the Physical Therapy section shown in this Contract. A Member must be essentially confined at home. Covered Services: Visits by an RN or LPN-Benefits cannot be provided for services if the nurse is related to the Member. Visits by a qualified physiotherapist or speech therapist and by an inhalation therapist certified by the National Board of Respiratory Therapy. Visits by a Home Health Nursing Aide when rendered under the direct supervision of an RN. Administration of prescribed drugs. Oxygen and its administration. Covered Services for Home Health do not include: Food, housing, homemaker services, sitters, home-delivered meals; Home Health Care services which are not Medically Necessary or of a non-skilled level of care. Services and/or supplies which are not included in the Home Health Care plan as described. Services of a person who ordinarily resides in the patient’s home or is a member of the family of either the patient or patient’s spouse. Any services for any period during which the Member is not under the continuing care of a Physician. Convalescent or Custodial Care where the Member has spent a period of time for recovery of an illness or surgery and where skilled care is not required or the services being rendered are only for aid in daily living, i.e., for the convenience of the patient. Any services or supplies not specifically listed as Covered Services. Routine care of a newborn child. Dietitian services. Maintenance therapy. Private duty nursing care. Hospice Care Services Hospice benefits cover inpatient and outpatient services for patients certified by a Physician as terminally ill.
Care Services. 1.1 Prior to admission the Home’s General Manager or another member of the Home’s team will carry out an assessment of the care needs of the Resident. From this assessment a Service Fee will be calculated based on the needs of the Resident.
Care Services. The care services to be delivered by the Provider pursuant to the Care Plan as determined and assessed from time to time pursuant to clause 2, provided that unless and until otherwise determined and assessed from time to time pursuant to clause 2, Dementia Care Package Band A will apply. Dementia Care Package Band A comprises up to 3 hours 30 minutes per day of a non-nurse carer or up to 1 hour 45 minutes per day of a carer who is a nurse, or a proportionate blend thereof (for example, up to 3 hours per day of a non-nurse carer plus up to 15 minutes per day of a carer who is a nurse) • Care Staff available 24 hours a day • Emergency call system in suites • Activities as organised by the Provider’s Activity Team • Scheduled transportation arranged by the Provider in the Provider’s minibus with wheelchair access • Housekeeping services for infection control purposes which are more frequent or otherwise additional to those provided under the Residence Agreement, and provision of related cleaning materials
Care Services. Covered services, related to an emergency medical condition that are provided after a member is stabilized in order to maintain the stabilized condition, or, under the circumstances described in 42 CFR 438.114(e), to improve or resolve the member’s condition. Prepaid Limited Health Service Organization (PLHSO) – An entity certified by TDCI under applicable provisions of TCA Title 56, Chapter 51.
Care Services. The PO must implement procedures to: Ensure that each member has an ongoing source of primary care appropriate to his/her needs and a person or entity formally designated as primarily responsible for coordinating the health care services furnished to the member. Coordinate the services the PO furnishes to the member with the services the member receives from any other provider of health care or insurance plan, including mental health and substance abuse services. Share with other agencies serving the member the results of its identification and assessment of special health care needs so that those activities need not be duplicated.
Care Services. If You are admitted as an Inpatient to a Hospital, You or Your Practitioner needs to notify Us as soon as possible so we can review Your Hospital stay. We will approve or deny coverage of post stabilization care as requested by Your treating Practitioner within the appropriate time, depending on the services requested and Your condition, but in no more one hour from the time of the request. We will not deny a claim for Emergency Care Services when You are sent to the emergency room by Your PCP or by Our representative. If Your Emergency Care Services results in a hospitalization directly from the emergency room, You are responsible for paying the Inpatient Hospital Cost Sharing amounts rather than the emergency room visit Copayment. Read to Your Schedule of Benefits for the Cost Sharing amount. For Emergency Care Services received from a Non-Participating Provider and/or outside of Texas, You may seek Emergency Care Services from the nearest appropriate facility where Emergency Care Services can be rendered. Non-emergency follow-up care received outside of Texas for Your convenience or preference is not a Covered Benefit. Follow-up care from a Non-Participating Provider needs Preauthorization. You must pay for charges that We do not authorize. Whether You require hospitalization or not, You should notify Your PCP or Physician within 48 hours, or as soon as reasonably possible, of any emergency medical treatment so he can recommend the continuation of any necessary medical services.
