Delegated Services Clause Samples

Delegated Services. Plans and Provider shall comply with their respective obligations set forth in the Agreement, including the exhibits hereto, with respect to performance and oversight of delegated services.
Delegated Services. Pursuant to the Vendor Agreement and this Attachment, Health Plan hereby delegates to Vendor the activities set forth in Exhibit B-1 to this Attachment. All Vendor’s programs, work plans, and policies and procedures shall be in accordance with the most current Health Plan standards and guidelines, as applicable, and shall comply with all Regulatory Requirements. The following services may be delegated hereunder, as applicable (such services to be referred to as “Delegated Services”). For the purposes of this Attachment, all attachments, exhibits, schedules and addenda that are referenced herein and attached hereto are hereby incorporated in this Attachment. Services below are “applicable” to Vendor to the extent indicated in Exhibit B-1 to this Attachment. A. Quality Improvement (“QI”). If applicable, Vendor shall perform all quality management functions as delegated by Health Plan and detailed in Exhibit B-3.
Delegated Services. As of the Effective Date of this agreement, the following affiliates are providing services pursuant to a delegation in accordance with Section 1 hereof: A. THE MANUFACTURERS LIFE INSURANCE COMPANY ("MANULIFE") Manulife performs the following services relating to the Company's products SERVICES PROVIDED ON A COMPANY-WIDE BASIS: NONE SERVICES PROVIDED TO A BUSINESS UNIT OR ON A PARTIAL BASIS: 1. Underwriting and policy issuance pursuant to Section 5(a), except for individual annuity products. 2. Policyowner services pursuant to Section 5(b), except for individual annuity products. 3. Claim services pursuant to Section 5(c) except for individual annuity products. 4. Marketing services pursuant to Section 5(d) in connection with Group Pension products.
Delegated Services. The administrative services, including but not limited to, services provided under the Utilization Management Program, the credentialing of RPO Providers, and claims processing and payment to RPO Providers performed by RPO or RPO's designee. RPO shall perform Delegated Services on behalf of Texas HealthSpring as required to provide or arrange for the provision of Covered Medical Services in accordance with this Agreement, a delegation services agreement of even date herewith by and between Texas HealthSpring and RPO (the "Delegated Services Agreement"), as amended from time to time, and the HMO Laws.
Delegated Services. In the event that any services under the Program Contract are delegated, Anthem must; (a) Monitor Subcontractor’s performance on an ongoing basis and conduct a formal review at least annually to identify any deficiencies or areas for improvement; (b) Communicate the results of the performance review to the Subcontractor and impose corrective action on the Subcontractor as necessary; (c) Notify ODM and submit a corrective action plan to ODM if at any time the Subcontractor is found to be in noncompliance with Anthem's delegated contractual obligations; (d) Report the results of the annual performance review and any corrective action plan to ODM; and (e) Ensure there is no disruption in meeting t▇▇ ▇▇▇▇▇▇’▇ contractual obligations to ODM, if Subcontractor or Anthems terminates the Agreement. D.l SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIRED SUBCONTRACT BOILERPLATE The following language is required by the South Carolina Department of Health and Human Services (SCDHHS, hereafter referred to as the Department) as a condition of participation in the Medicaid program as a subcontractor of a Managed Care Organization (MCO). To the extent that any provision of this subcontract conflicts with any provision or requirement set forth within this Section, the Department required language shall be controlling. Any other provision in this agreement notwithstanding, in the event that the Department shall modify, amend, or otherwise change the required subcontract language, as set forth in the MCO Contract between the Department and the MCO, Subcontractor understands and agrees that the Department required subcontract boilerplate shall be amended to conform to the Department's requirements and standards, without the need for a signed, written amendment.
Delegated Services. NHS England delegates to the ICB the statutory function for commissioning the Specialised Services set out in this Schedule 2 (Delegated Services) subject to the reservations set out in Schedule 4 (Retained Functions) and the provisions of any Developmental Arrangements set out in Schedule 9. The following Specialised Services were delegated to the ICB on 1 April 2024. 2 Adult congenital heart disease services 13X Adult congenital heart disease services (non-surgical) 13Y Adult congenital heart disease services (surgical) 3 Adult specialist pain management services 31Z Adult specialist pain management services 4 Adult specialist respiratory services 29M Interstitial lung disease (adults) 29S Severe asthma (adults) 29L Lung volume reduction (adults) 5 Adult specialist rheumatology services 26Z Adult specialist rheumatology services 7 Adult Specialist Cardiac Services 13A Complex device therapy 13B Cardiac electrophysiology & ablation 13C Inherited cardiac conditions 13E Cardiac surgery (inpatient) 13F PPCI for ST- elevation myocardial infarction 13H Cardiac magnetic resonance imaging 13T Complex interventional cardiology (adults) 13Z Cardiac surgery (outpatient) 9 Adult specialist endocrinology services 27E Adrenal Cancer (adults) 27Z Adult specialist endocrinology services 11 Adult specialist neurosciences services 08O Neurology (adults) 08P Neurophysiology (adults) 08R Neuroradiology (adults) 08S Neurosurgery (adults) 08T Mechanical Thrombectomy 58A Neurosurgery LVHC national: surgical removal of clival chordoma and chondrosarcoma 58B Neurosurgery LVHC national: EC-IC bypass (complex/high flow) 58C Neurosurgery LVHC national: transoral excision of dens 58D Neurosurgery LVHC regional: anterior skull based tumours 58E Neurosurgery LVHC regional: lateral skull based tumours 58F Neurosurgery LVHC regional: surgical removal of brainstem lesions 58G Neurosurgery LVHC regional: deep brain stimulation 58H Neurosurgery LVHC regional: pineal tumour surgeries - resection 58I Neurosurgery LVHC regional: removal of arteriovenous malformations of the nervous system 58J Neurosurgery LVHC regional: epilepsy 58K Neurosurgery LVHC regional: insula glioma’s/ complex low grade glioma’s 58L Neurosurgery LVHC local: anterior lumbar fusion Adult specialist neurosciences services (continued) 58M Neurosurgery LVHC local: removal of intramedullary spinal tumours 58N Neurosurgery LVHC local: intraventricular tumours resection 58O Neurosurgery LVHC local: surgical repair of aneurysm...
Delegated Services. In the event that any services under the Program Contract are delegated, Anthem must;13.1
Delegated Services. The supervisory agreement shall include a provision which addresses the services the supervising physician delegates to the physician assistant. The medical services and medical tasks delegated to and provided by the physician assistant shall be in compliance with 645—subrule 327.1 (1). All delegated medical services shall be within the scope of practice of the supervising physician and the physician assistant. The supervising physician and the physician assistant shall have the education, training, skills, and relevant experience necessary to perform the delegated services prior to delegation.
Delegated Services. NHS England delegates to the ICB the statutory function for commissioning the Specialised Services set out in this Schedule 2 (Delegated Services) subject to the reservations set out in Schedule 4 (Reserved Functions) and the provisions of any Developmental Arrangements set out in Schedule 9. The list of Delegated Services set out in Schedule 2 of this Agreement contains two categories of service: the first is drawn from the Prescribed Specialised Services (PSS) Manual and aligns to Schedule 4 of the 2012 Standing Rules Regulations; the second is the sub-service line codes that NHS England has introduced over time to assist in the commissioning of Specialised Services. From time-to- time, NHS England will amend the list of sub-service line codes, either to repurpose, remove or add a code. This is done to support in the management of finances, activity or for other administrative reasons; or to support transformational work that may be ongoing in the service area that requires a sub-service line code to track and manage funding and activity. The intention is that any changes will be supportive of ICBs’ commissioning responsibilities, and that there will be a small number of changes in the Delegated Services sub-service line codes in any one year. All future changes to sub-service line codes relating to Delegated Services will be developed with ICBs. ICBs will be engaged and have the opportunity to provide comment on the proposed change before it is made. Changes to the sub-service line codes will be discussed at and agreed by the Delegated Commissioning Group, hosted by NHS England and attended by ICB representatives. If changes are agreed, the latest lists will be made available on the NHS England website here [NHS England » NHS England service codes by year 2024/25] and a more detailed version on the Future NHS site here [Service Portfolio Analysis - Integrating specialised services within Integrated Care Systems - FutureNHS Collaboration Platform]. The PSS Manual Lines in Schedule 2 of the Agreement, which derive from the 2012 Standing Rules Regulations, will not be altered unless there is a decision of the NHS England Board, which will necessitate wider engagement with ICBs and stakeholders. The following Specialised Services through this agreement will be delegated to the ICB: 2 Adult congenital heart disease services 13X Adult congenital heart disease services (non-surgical) 13Y Adult congenital heart disease services (surgical) 3 Adult specialist pai...

Related to Delegated Services

  • 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.

  • Administration Services When a medical prescription drug is administered by infusion, the administration of the prescription drug may be covered separately from the prescription drug. See Infusion Therapy - Administration Services in the Summary of Medical Benefits for benefit limits and the amount you pay. Prescription drugs that are self-administered are not covered as a medical benefit but may be covered as a pharmacy benefit. Please see Pharmacy Prescription Drugs and Diabetic Equipment or Supplies – Pharmacy Benefits section above for additional information. For some medical prescription drugs, after the first administration, coverage may be limited to certain locations (for example, a designated outpatient or ambulatory service facility, physician’s office, or your home), provided the location is appropriate based on your medical status. For a list of medical prescription drugs that are subject to this Site of Care Program, visit our website. Preauthorization may be required to determine medical necessity as well as appropriate site of care. If we deny your request for preauthorization, or you disagree with our determination for the appropriate site of care, you can submit a medical appeal. See Appeals in Section 5 for information on how to file a medical appeal.

  • Autism Services This plan covers the following services for the treatment of autism spectrum disorders. • Applied behavior analysis when provided and/or supervised by an individual licensed by the state in which the service is rendered. See the Summary of Medical Benefits for the amount that you pay. • Physical therapy, occupational therapy, and speech therapy services when rendered as part of the treatment of autism spectrum disorder. A benefit limit will not apply to these services. • Psychological and psychiatric services, and prescription drugs are also covered. See Behavioral Health Services and Prescription Drugs and Diabetic Equipment or Supplies for additional information. Coverage for autism spectrum disorders does not affect any obligation of a school district, a state or other governmental entity to provide services to an individual under an individualized family service plan, an individualized education program, or similar services required under state or federal law. Services related to autism that are furnished by school personnel are not covered under this plan.

  • 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.

  • Services FASC agrees to provide to the Adviser the services indicated in Exhibit A to this Agreement (the “Services”).