An Evaluation of Contracts Between Managed Care Organizations and Community Mental Health and Substance Abuse Treatment and Prevention Agencies, Volume 2U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 1997 - Community mental health services - 60 pages |
Common terms and phrases
50 contracts 50 Percent Contract American Health clinical community MH/SA agencies contracts reviewed contracts specified coverage Covered Person Covered Services criteria contractual language definition Emergency definition No definition definition Table 17-Medical determined by Plan diagnosis and treatment DSM-IV emergency criteria contractual Facility fee-for-service financial risk furnished group purchasers group sponsor health and substance health care provider Health Care System HMOs immediate medical inpatient Jonathan Weiner managed care organization MCO's Medicaid medical emergency criteria Medical Necessity Medically medical practice Medicare Member's condition ment Mental Health Services MH/SA providers necessity and medical Necessity Medically Necessary negotiation onset outpatient patient payment physician Plan's prior authorization professional provider contracts provider manuals provider networks provider's psychiatric quality management system referrals safely provided service agreements services or supplies stop-loss substance abuse treatment substance-related disorders Table 17-Medical necessity termination tion tracts treatment obligations treatment time lines Unclear Not addressed utilization review vider