132 Intensive Outpatient Therapy means distinct levels or phases of treatment that are provided by a certified/licensed Mental Health or Substance Use Disorder Treatment program. Intensive Outpatient Therapy programs typically provide a combination of individual, family, and/or group therapy in a day, totaling nine (9) or more hours in a week. Medically Necessary/Medical Necessity with respect to each service or supply means that the service or supply meets all of the following tests: • It is rendered for the treatment or diagnosis of an injury or illness, including premature birth, congenital defects, and birth defects; • It is appropriate for the symptoms, consistent with the diagnosis, and is otherwise in accordance with generally accepted medical practice and Professionally Recognized Standards; • It is not mainly for the convenience of the participant or the participant’s physician or other provider; • It is the most appropriate supply or level of service needed to provide safe and adequate care. When applied to confinement in a hospital or other facility, this test means that the participant needs to be confined as an inpatient due to the nature of the services rendered or due to the participant’s condition and that the participant cannot receive safe and adequate care through Outpatient treatment. Medicare means the health insurance benefits provided under Title XVIII of the Social Security Act, as amended in 1965. Mental Health Services are the services that are required to treat a disorder that impairs behavior, emotional reaction, or thought processes, but not including substance use disorder, and not including learning, behavioral, and developmental disorders except for ABA therapy for the treatment of autism spectrum disorder. In determining benefits payable, charges made for the treatment of any physiological conditions related to mental health will not be considered to be charges made for the treatment of mental health. Mental Health Residential Treatment Center means a facility that meets all of the tests of the Acute Care Hospital definition or that is licensed in accordance with the laws of the appropriate legally authorized agency as a residential treatment center for Mental Health Services. No Surprises Act means the federal No Surprises Act (Public Law 116-260, Division BB). Non-PPO emergency facility means an emergency department of a hospital, or an independent freestanding emergency department (or a hospital, with respect to Emergency Services as defined), that does not have a contractual relationship directly or indirectly with a group health plan or group health insurance coverage offered by a health insurance issuer, with respect to the furnishing of an item or service under the plan or coverage respectively. Non-PPO Provider means a health care provider who does not have a contractual relationship directly or indirectly with the Plan with respect to the furnishing of an item or service under the Plan. Out-of-Network Rate with respect to items and services furnished by a Non-PPO Provider, Non- Network emergency facility, or Non-PPO Provider of ambulance services, means one of the following: • the amount the parties negotiate; • the amount approved under the independent dispute resolution (“IDR”) process; or