Covered Outpatient Drug definition

Covered Outpatient Drug shall have the meaning as set forth in Sections 1927(k)(2), (k)(3) and (k)(4) of the Act as implemented by 42 C.F.R. 447.502.
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Covered Outpatient Drug will have the meaning as set forth in Sectionsections 1927(k)(2), (k)(3) and (k)(4) of the Act, and with respect to the Manufacturer includes all such drug products meeting this definition. For purposes of coverage under this agreement, all of those Covered Outpatient Drugs are identified by the Manufacturer's labeler code segment of the NDC number. Certain Covered Outpatient Drugs, such as specified by Section 1927 (d) ( 1) (3) of the Act, may be restricted or excluded from Medicaid payment at State option but shall be included by the Manufacturer for purposes of this agreement. as implemented by 42 CFR 447.502.
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Covered Outpatient Drug means a drug that meets the Centers for Medicare and Medicaid Services (CMS) covered outpatient drug definition as outlined in 42 CFR 447.502. The following provisions also apply:
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Examples of Covered Outpatient Drug in a sentence

  • The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 defines a Specified Covered Outpatient Drug (SCOD) as a covered outpatient drug for which a separate APC has been established and that is either a radiopharmaceutical agent, or a drug or biological for which payment was made on a pass-through basis on or before December 31, 2002.

  • The Contractor shall comply with all requirements found in the Social Security Act section 1927 and all changes made to the Covered Outpatient Drug Section of the Patient Protection and Affordable Care Act (PPACA) found in 42 C.F.R. Part 447 [CMS 2345-FC].

  • In order to comply with CMS’s Medicare requirements in the Medicaid program, the plans shall substitute the terms, Medicaid Covered Outpatient Drug and MCP, for the terms, part D drug and plan sponsor, respectively, and are not required to include members who are experts regarding the care of elderly or disabled individuals.

  • Instilled Covered Outpatient Drug (COD) Status: A category that identifies how a product meets the statutory definition of a covered outpatient drug in accordance with sections 1927(k)(2) to 1927(k)(4) of the Social Security Act.

  • Covered Outpatient Drug — A brand name drug, a generic drug, or an OTC drug which: • Is approved by the FDA; • Is distributed by a manufacturer that entered into a Federal Drug Rebate Program Agreement with the CMS; • Is compensable under the MA Program; • May be dispensed only upon prescription in the MA Program; • Has been prescribed or ordered by a licensed prescriber within the scope of the prescriber’s practice; and • Is dispensed or administered in an outpatient setting.

  • The percentage of "working" patients who are "on sick leave" or "on disability" at one year and two years after implantation will be reported with the corresponding confidence interval.

  • Nevertheless, Defendants reported false information to CMS regarding these products, representing that they met the definition of a Covered Outpatient Drug to make them ostensibly eligible for Medicaid reimbursement.

  • A Covered Outpatient Drug must: (1) be a drug, (2) for which an NDC is required, (3) used for a medically accepted indication.

  • The Defendants’ submissions included a false representation that their levothyroxine drugs met the definition of a Covered Outpatient Drug, and in many instances contained a false FDA approval date.

  • Federal law enacted well before the Medicaid Rebate Program was established in 1990 expressly precludes payment for such DESI-LTE drugs (42 U.S.C. § 1396b (i)(5); 42 U.S.C. § 1395y(c); 42 C.F.R. §441.25) and the definition of Covered Outpatient Drug in the Medicaid Rebate Program legislation, 42 U.S.C. § 1396r-8(k)(2)(A)(iii), expressly excludes such drugs.


More Definitions of Covered Outpatient Drug

Covered Outpatient Drug will have the meaning as set forth in 42 U.S.C. 1396r-8(k)(2),(k)(3) and (k)(4) and regulations promulgated by CMS thereto, if any, as such statute or regulations may be amended from time to time.
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Covered Outpatient Drug has the same meaning as set forth in 42 U.S.C.§1396r-8 (k)(2)- (4), et seq., and with respect to the Manufacturer/Labeler includes all such drug products meeting this definition. For purposes of coverage under this Agreement, all of those Covered Outpatient Drugs are identified by the Manufacturer’s/Labeler’s labeler code segment of the NDC number. HHSC may restrict or exclude from payment certain Covered Outpatient Drugs.
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Covered Outpatient Drug means a drug approved for safety and effectiveness as a prescription drug under the federal Food, Drug, and Cosmetic Act, which is used for a medically accepted indication, and is not subject to the exceptions under WAC 388-530-1150, Noncovered drugs and pharmaceutical supplies.
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Covered Outpatient Drug will have the meaning as set forth in 42 U.S.C. § 1396r-8(k)(2),(k)(3) and (k)(4).
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Covered Outpatient Drug means a drug that meets all of the following criteria:
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Related to Covered Outpatient Drug

  • Substance abuse treatment means outpatient or inpatient services or participation in Alcoholics Anonymous or a similar program.

  • Outpatient means a person who is receiving care other than on an inpatient basis, such as: • in a provider’s office; • in an ambulatory surgical center or facility; • in an emergency room; or • in a clinic. .

  • Assisted outpatient treatment or "AOT" means the categories of outpatient services ordered by the court under section 468 or 469a. Assisted outpatient treatment may include a case management plan and case management services to provide care coordination under the supervision of a psychiatrist and developed in accordance with person-centered planning under section 712. Assisted outpatient treatment may also include 1 or more of the following categories of services: medication; periodic blood tests or urinalysis to determine compliance with prescribed medications; individual or group therapy; day or partial day programming activities; vocational, educational, or self-help training or activities; assertive community treatment team services; alcohol or substance use disorder treatment and counseling and periodic tests for the presence of alcohol or illegal drugs for an individual with a history of alcohol abuse or substance use disorder; supervision of living arrangements; and any other services within a local or unified services plan developed under this act that are prescribed to treat the individual's mental illness and to assist the individual in living and functioning in the community or to attempt to prevent a relapse or deterioration that may reasonably be predicted to result in suicide, the need for hospitalization, or serious violent behavior. The medical review and direction included in an assisted outpatient treatment plan shall be provided under the supervision of a psychiatrist.

  • Outpatient treatment means mental health or substance abuse treatment services rendered to a

  • Iatrogenic infertility means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.

  • Substance abuse means the consumption or use of any substance for purposes other than for the treatment of sickness or injury as prescribed or administered by a person duly authorized by law to treat sick and injured human beings.

  • Substance Abuse Professional (SAP) means a qualified person who evaluates employees who have violated a DOT drug and alcohol regulation and makes recommendations concerning education, treatment, follow-up testing, and aftercare.

  • Medical marijuana waste or "waste" means unused,

  • Preventive Care means certain Preventive Care services.

  • Inpatient treatment means twenty-four-hour-per-day mental

  • Hospice patient s family" means a hospice patient's immediate family members, including a spouse, brother, sister, child, or parent, and any other relative or individual who has significant personal ties to the patient and who is designated as a member of the patient's family by mutual agreement of the patient, the relative or individual, and the patient's interdisciplinary team.

  • Outpatient status means, with respect to a covered servicemember who is a current member of the Armed Forces, the status of a member of the Armed Forces assigned to:

  • Medical marijuana product means a product that contains cannabinoids that have been extracted from plant material or the resin therefrom by physical or chemical means and is intended for administration to a licensed patient, including but not limited to concentrates, oils, tinctures, edibles, pills, topical forms, gels, creams, and other derivative forms, except that this term does not include live plant forms.

  • Service Animal means an animal that is required by a person with a disability for assistance and is certified, in writing, as having been trained by a professional service animal institution to assist a person with a disability and which is properly harnessed in accordance with standards established by a professional service animal institution.

  • Outpatient hospital services means preventive, diagnostic, therapeutic, observation, rehabilitation, or palliative services provided to an outpatient by or under the direction of a physician, dentist, or other practitioner by an institution that:

  • Routine patient care costs means Covered Medical Expenses which are typically provided absent a clinical trial and not otherwise excluded under the Policy. Routine patient care costs do not include:

  • Medical marijuana means marijuana that is grown, processed, dispensed, tested, possessed, or used for a medical purpose.

  • Chemical dependency professional means a person certified as a chemical dependency professional by the department of health under chapter 18.205 RCW.

  • COVID-19 symptoms means fever of 100.4 degrees Fahrenheit or higher, chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea, unless a licensed health care professional determines the person’s symptoms were caused by a known condition other than COVID-19.

  • Inpatient care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.

  • Clinical nurse specialist means a registered nurse with relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field and who satisfies the local criteria.

  • Medically Necessary Services means those covered services that are, under the terms and conditions of the contract, determined through contractor utilization management to be:

  • Medical evaluation means the process of assessing an individual's health status that includes a medical history and a physical examination of an individual conducted by a licensed medical practitioner operating within the scope of his license.

  • Designated chemical dependency specialist means a person