Coordinated Services Program (CSP) Sample Clauses

Coordinated Services Program (CSP). The MCP shall develop and submit for prior approval, a CSP as defined in OAC rule 5160-20-01 to address the overuse or misuse of all services. The MCP shall, at a minimum, follow all provisions set forth in OAC rule 5160-20-01 for initial and continued enrollment. The MCP shall offer to provide care management services to any member who is enrolled in the CSP.
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Coordinated Services Program (CSP). The MCP shall develop and submit for prior approval a CSP as defined in OAC rule 5160-20-01 to address the utilization or pattern of receiving medications at a frequency or in an amount that exceeds medical necessity. 1. The MCP shall, at a minimum, issue a notice of enrollment in CSP to members whose pattern of utilization, of controlled substances, exceeds medical necessity and follow all provisions of OAC rule 5160-20-01 for initial and continued enrollment. The MCP shall offer to provide care management services to any member who is enrolled in the CSP. Exceeding medical necessity may include: a. Receiving prescriptions for 12 or more controlled substances in 90 calendar days; or b. Receiving controlled substance prescriptions from 4 or more pharmacies in 90 calendar days; or c. Receiving controlled substance prescriptions from 4 or more prescribers in 90 calendar days; or d. Receiving medical services for diagnoses including substance abuse, or poisoning, or that indicates a pattern of using services to obtain controlled substances not medically necessary or are a result of substances being used in a way not medically necessary. 2. The MCP shall issue a notice of enrollment in CSP to members who, during a 90 calendar day period: a. Received four or more abuse potential drugs, as defined by ODM; b. Have a history of addiction and/or drug dependence with abuse potential drugs, as defined by ODM; and c. Obtained prescriptions for abuse potential drugs, as defined by ODM, from four or more prescribers. For the purposes of this requirement, any 90 calendar day period shall include up to July 1, 2018 and beyond (e.g. April 2, 2018 through July 1, 2018).
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Related to Coordinated Services Program (CSP)

  • Program Services a) Personalized Care Practice agrees to provide to Program Member certain enhancements and amenities to professional medical services to be rendered by Personalized Care Practice to Program Member, as further described in Schedule 1 to these Terms. Upon prior written notice to Program Member, Personalized Care Practice may add or modify the Program Services set forth in Schedule 1, as reasonably necessary, and subject to such additional fees and/or terms and conditions as may be reasonably necessary. b) Program Member acknowledges that the Program Services are services that are not covered services under any insurance contract to which Program Member may be a party, including, without limitation, Medicare, and are not reimbursable by Program Member’s insurer, health plan or any governmental entity, including Medicare. Program Member agrees to bear sole financial responsibility for the Member Amenities Fee and agrees not to submit to Program Member’s insurer, health plan or governmental entity any ▇▇▇▇, invoice or claim for payment or reimbursement of such Member Amenities Fee. c) Personalized Care Practice or its designated affiliate will separately charge Program Member or Program Member’s insurer, health plan or governmental entity for medical, clinical, diagnostic or therapeutic services rendered by Personalized Care Practice or its designated affiliate to Program Member, and Program Member may seek payment or reimbursement from Program Member’s insurer or health plan for any such service to the extent covered by Program Member’s insurer, health plan or governmental entity. d) Program Member understands, agrees and covenants that this Agreement is a service contract, and not a contract for insurance.

  • Related Services Licensee shall be responsible for obtaining and installing all proper hardware and support software (including operating systems) and for proper installation and implementation of and training concerning the Licensed Software. In the event that Licensee retains Licensor to perform any services with respect to the Licensed Software (for example: installation, implementation, maintenance, consulting and/or training services), Licensee and Licensor agree that such services shall be subject to Licensor’s then current standard terms, conditions and rates for such services unless otherwise agreed in writing by Licensor.

  • Marketing Services The Manager shall provide advice and assistance in the marketing of the Vessels, including the identification of potential customers, identification of Vessels available for charter opportunities and preparation of bids.

  • Technical Support Services 2.1 The technical support services (the "Services"): Party A agrees to provide to Party B the relevant services requested by Party B, which are specified in Exhibit 1 attached hereto ("Exhibit 1").

  • Medical Services Plan 10.1.1 Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. 10.1.2 The City shall pay one hundred percent (100%) of the premiums required by the Plan.