Mental Health and Substance Use Disorder Sample Clauses

POPULAR SAMPLE Copied 1 times
Mental Health and Substance Use Disorder. Parity‌ Insurer shall comply with the requirements of 42 CFR 457.496. Insurer shall assist and cooperate with FHKC as needed to ensure the Program is in compliance with parity requirements. In the event Insurer is directly or indirectly preventing the Program from meeting parity requirements, Insurer shall implement appropriate, timely changes to allow the Program to become compliant.
View SourceView Similar (6)
Mental Health and Substance Use Disorder. The Plan provides Benefits for Mental Health and Substance Use Disorder services when they are for the active treatment of Mental Health and Substance Use Disorders. An established plan of treatment may be required. This includes Inpatient (Inpatient and Residential Treatment), and Outpatient (Outpatient and Day Treatment Program), services for Mental Health and Substance Use Disorder when you receive them from a Provider. If you receive services from a Community Mental Health Center or Substance Use Disorder Treatment Facility, services must be: 1. Supervised by a licensed Physician, licensed psychologist, or licensed clinical social worker; and 2. Part of a plan of treatment for furnishing such services established by the appropriate staff member. The Plan provides Benefits for only the following mental health and substance use disorder treatment services when Medically Necessary: 1. Applied behavioral health services; 2. Room and board, including general nursing for inpatients; 3. Prescription drugs, biologicals, and solutions administered to inpatients; 4. Supplies and use of equipment required for medical withdrawal monitoring and management; 5. Diagnostic and evaluation services; 6. Intervention and assessment; 7. Facility‐based professional and ancillary services; 8. Individual, group, couple and/or family psychotherapy and professional counseling services; 9. Medication checks; 10. Individual or group alcohol and drug counseling services; 11. Psychological and Neuropsychological testing; 12. Emergency treatment for the sudden onset of a mental health or substance use condition requiring immediate and acute treatment. Outpatient visits for substance use disorder conditions may be furnished during the acute withdrawal management stage of treatment or during stages of early recovery and maintenance. .
View SourceView Similar (5)
Mental Health and Substance Use Disorder. The Plan provides Benefits for Mental Health and Substance Use Disorder services when they are for the active treatment of Mental Health and Substance Use Disorder. An established plan of treatment may be required. This includes Inpatient, Outpatient, residential, and Day Treatment Program services for Mental Health and Substance Use Disorder when you receive them from a Provider. If you receive services from a Community Mental Health Center or Substance Use Disorder Treatment Facility, services must be: a. Supervised by a licensed Physician, licensed psychologist, or licensed clinical social worker; and b. Part of a plan of treatment for furnishing such services established by the appropriate staff member. The Plan provides Benefits for only the following mental health and Substance Use Disorder treatment services when Medically Necessary: a. Applied behavioral health services b. Room and board, including general nursing; c. Prescription drugs, biologicals, and solutions administered to inpatients; d. Supplies and use of equipment required for detoxification and rehabilitation; e. Diagnostic and evaluation services; f. Intervention and assessment; g. Facility-based professional and ancillary services; h. Individual, group, and family therapy and counseling; i. Medication checks; j. Psychological and Neuropsychological testing; and k. Emergency treatment for the sudden onset of a mental health or Substance Use Disorder condition requiring immediate and acute treatment. Outpatient visits for Substance Use Disorder conditions may be furnished during the acute detoxification stage of treatment or during stages of rehabilitation. The Member cost-sharing will be waived for the first 3 outpatient office visits in the Plan Year to an In- Network mental health or Substance Use Disorder provider.
View SourceView Similar (4)
Mental Health and Substance Use Disorder. The Plan provides Benefits for Mental Health and Substance Use Disorder services when they are for the active treatment of Mental Health and Substance Use Disorder. An established plan of treatment may be required. This includes Inpatient, Outpatient, residential, and Day Treatment Program services for Mental Health and Substance Use Disorder when you receive them from a Provider. If you receive services from a Community Mental Health Center or Substance Use Disorder Treatment Facility, services must be: a. Supervised by a licensed Physician, licensed psychologist, or licensed clinical social worker; and b. Part of a plan of treatment for furnishing such services established by the appropriate staff member. The Plan provides Benefits for only the following mental health and Substance Use Disorder treatment services when Medically Necessary: a. Applied behavioral health services such as, but not limited to electroconvulsive treatment (ECT), transcranial magnetic stimulation (TMS), assertive community team (ACT), Applied Behavioral Analysis (ABA), multi-systemic therapy and psychiatric supports (MST-Psychiatric),. Functional Family Therapy (FFT) and health behavior assessment intervention. b. Room and board, including general nursing; c. Prescription drugs, biologicals, and solutions administered to inpatients; d. Supplies and use of equipment required for medical withdrawal monitoring and management; e. Diagnostic and evaluation services; f. Intervention and assessment; g. Facility-based professional and ancillary services; h. Individual, group, couple and/or family psychotherapy professional counseling services; i. Medication checks; j. Individual or group alcohol and drug counseling services; k. Psychological and Neuropsychological testing; and l. Emergency treatment for the sudden onset of a mental health or Substance Use Disorder condition requiring immediate and acute treatment. Outpatient visits for Substance Use Disorder conditions may be furnished during the acute detoxification stage of treatment or during stages of rehabilitation.
View SourceView Similar (4)
Mental Health and Substance Use Disorder. The Plan provides Benefits for Mental Health and Substance Use Disorder services when they are for the active treatment of Mental Health and Substance Use Disorders. An established plan of treatment may be required. This includes Inpatient (Inpatient and Residential Treatment), and Outpatient (Outpatient and Day Treatment Program) services for Mental Health and Substance Use Disorder when you receive them from a Provider. If you receive services from a Community Mental Health Center or Substance Use Disorder Treatment Facility, services must be: a. Supervised by a licensed Physician, licensed psychologist, or licensed clinical social worker; and b. Part of a plan of treatment for furnishing such services established by the appropriate staff member. The Plan provides Benefits for only the following mental health and substance use disorder treatment services when Medically Necessary: a. Applied Behavioral health services, b. Room and board, including general nursing for inpatients; c. Prescription drugs, biologicals, and solutions administered to inpatients; d. Supplies and use of equipment required for medical withdrawal monitoring and management; e. Diagnostic and evaluation services; f. Intervention and assessment; g. Facility‐based professional and ancillary services; h. Individual, group, couple and/or family psychotherapy and professional counseling services; i. Medication checks; j. Individual or group alcohol and drug counseling services; k. Psychological and Neuropsychological testing; l. Emergency treatment for the sudden onset of a mental health or substance use disorder condition requiring immediate and acute treatment. m. Consultation services Outpatient visits for substance use disorder conditions may be furnished during the acute withdrawal management stage of treatment or during stages of early recovery and maintenance.
View Source
Mental Health and Substance Use Disorder. Inpatient* – Services are considered inpatient when you are admitted to a facility. Refer to your Schedule of Benefits for Cost Share information. Mental Health and Substance Use Disorder: Outpatient – Covered Services are paid according to the plan based on place of service, provider type, and provider billing. Refer to your Schedule of Benefits for Cost Share information. Mental Health and Substance Use Disorder Services* – The Plan covers Medically Necessary treatment of Mental Health conditions and Substance Use Disorders. Refer to the Benefit Exclusions section for more information on Services not covered by this Plan. Samaritan Health Plans covers Services and treatment for those Mental Health and Substance Use Disorder diagnoses covered under the Mental Health and Addiction Equity Act of 2008. Samaritan Health Plans is compliant with state and federal Mental Health parity. Multidisciplinary Programs* – Include, but are not limited to, pain management, and child development and rehabilitation center (CDRC) programs. Services usually consist of a team of providers coordinating and working for the benefit of one Member. These programs do not Nursery Care* – Routine nursery care of eligible newborns, while the mother is hospitalized and eligible for maternity benefits under the Plan, are covered. Newborn stays less than 5 days do not require Prior Authorization. Nutritional Therapy and/or Counseling – Covered Services of a registered and licensed dietician for the treatment of celiac sprue, hyperlipidemia, eating disorders, obesity, or otherwise stated as Medically Necessary by a provider are covered and paid based on place of service, provider type, and provider billing. Registered and licensed dieticians are considered Specialists. Occupational Therapy* – Covered Services are paid according to the plan. Services must be prescribed by a Professional Provider. The written prescription must include site, modality, duration, and frequency of treatment. Occupational, physical, and Speech Therapy are covered up to a combined maximum of 30 visits per Calendar Year. We cover Medically Necessary therapy and Services for the treatment of traumatic brain injury. These Services can be provided in both inpatient and outpatient settings and are referred to as Rehabilitative and Habilitative Services. Refer to your Schedule of Benefits for Cost Share information. Osteopathic Manipulation – Covered Services are paid according to the plan only for the treatment of dis...
View Source

Related to Mental Health and Substance Use Disorder

  • Behavioral Health Services – Mental Health and Substance Use Disorder Inpatient - Unlimited days at a general hospital or a specialty hospital including detoxification or residential/rehabilitation per plan year. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Outpatient or intermediate careservices* - See Covered Healthcare Services: Behavioral Health Section for details about partial hospital program, intensive outpatient program, adult intensive services, and child and family intensive treatment. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Office visits - See Office Visits section below for Behavioral Health services provided by a PCP or specialist. Psychological Testing 0% - After deductible 40% - After deductible Medication-assisted treatment - whenrenderedby a mental health or substance use disorder provider. 0% - After deductible 40% - After deductible Methadone maintenance treatment - one copayment per seven-day period of treatment. 0% - After deductible 40% - After deductible Outpatient - Benefit is limited to 18 weeks or 36 visits (whichever occurs first) per coveredepisode. 0% - After deductible 40% - After deductible In a physician's office - limited to 12 visits per plan year. 0% - After deductible 40% - After deductible Emergency room - When services are due to accidental injury to sound natural teeth. 0% - After deductible The level of coverage is the same as network provider. In a physician’s/dentist’s office - When services are due to accidental injury to sound natural teeth. 0% - After deductible 40% - After deductible Services connected to dental care when performed in an outpatient facility * 0% - After deductible 40% - After deductible Inpatient/outpatient/in your home 0% - After deductible 40% - After deductible (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Outpatient durable medical equipment* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient medical supplies* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient diabetic supplies/equipment purchasedat licensed medical supply provider (other than a pharmacy). See the Summary of Pharmacy Benefits for supplies purchased at a pharmacy. 20% - After deductible 40% - After deductible Outpatient prosthesis* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Enteral formula delivered through a feeding tube. Must be sole source of nutrition. 20% - After deductible 40% - After deductible Enteral formula or food taken orally * 20% - After deductible The level of coverage is the same as network provider. Hair prosthesis (wigs) - The benefit limit is $350 per hair prosthesis (wig) when worn for hair loss suffered as a result of cancer treatment. 20% - After deductible The level of coverage is the same as network provider. Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% - After deductible The level of coverage is the same as network provider. Asthma management 0% - After deductible 40% - After deductible Hospital emergency room 0% - After deductible The level of coverage is the same as network provider.

  • Substance Abuse The dangers and costs that alcohol and other chemical abuses can create in the electrical contracting industry in terms of safety and productivity are significant. The parties to this Agreement resolve to combat chemical abuse in any form and agree that, to be effective, programs to eliminate substance abuse and impairment should contain a strong rehabilitation component. The local parties recognize that the implementation of a drug and alcohol policy and program must be subject to all applicable federal, state, and local laws and regulations. Such policies and programs must also be administered in accordance with accepted scientific principles, and must incorporate procedural safeguards to ensure fairness in application and protection of legitimate interests of privacy and confidentiality. To provide a drug-free workforce for the Electrical Construction Industry, each IBEW local union and NECA chapter shall implement an area-wide Substance Abuse Testing Policy. The policy shall include minimum standards as required by the IBEW and NECA. Should any of the required minimum standards fail to comply with federal, state, and/or local laws and regulations, they shall be modified by the local union and chapter to meet the requirements of those laws and regulations.

  • Substance Abuse Program The SFMTA General Manager or designee will manage all aspects of the FTA-mandated Substance Abuse Program. He/she shall have appointing and removal authority over all personnel working for the Substance Abuse Program personnel, and shall be responsible for the supervision of the SAP.

  • Workplace Violence Prevention and Crisis Response (applicable to any Party and any subcontractors and sub-grantees whose employees or other service providers deliver social or mental health services directly to individual recipients of such services): Party shall establish a written workplace violence prevention and crisis response policy meeting the requirements of Act 109 (2016), 33 VSA §8201(b), for the benefit of employees delivering direct social or mental health services. Party shall, in preparing its policy, consult with the guidelines promulgated by the U.S. Occupational Safety and Health Administration for Preventing Workplace Violence for Healthcare and Social Services Workers, as those guidelines may from time to time be amended. Party, through its violence protection and crisis response committee, shall evaluate the efficacy of its policy, and update the policy as appropriate, at least annually. The policy and any written evaluations thereof shall be provided to employees delivering direct social or mental health services. Party will ensure that any subcontractor and sub-grantee who hires employees (or contracts with service providers) who deliver social or mental health services directly to individual recipients of such services, complies with all requirements of this Section.

  • Substance Abuse Treatment Information Substance abuse treatment information shall be maintained in compliance with 42 C.F.R. Part 2 if the Party or subcontractor(s) are Part 2 covered programs, or if substance abuse treatment information is received from a Part 2 covered program by the Party or subcontractor(s).