Additional Transition of Care Requirements Sample Clauses

Additional Transition of Care Requirements. The CONTRACTOR shall be responsible for the cost of the continuation of services to a newly enrolled Medicaid Managed Care Members including the following: 5.6.6.1. For a new Medicaid Managed Care Member entering the CONTRACTOR’s Health Plan. The CONTRACTOR shall: 5.6.6.1.1. Continue authorized services without requiring Prior Authorization for up to ninety (90) Calendar Days, 5.6.6.1.2. Continue authorized services regardless if the service is provided by an in-network or out of network Provider, Or, 5.6.6.1.3. Until the CONTRACTOR has performed appropriate clinical review(s) and arranged for the provision of medically necessary services without disruption. And, 5.6.6.1.4. At its discretion, the CONTRACTOR may require Prior Authorization for continuation of services beyond ninety
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Additional Transition of Care Requirements. The CONTRACTOR shall be responsible for the cost of the continuation of services to newly enrolled Medicaid Managed Care Members entering the CONTRACTOR’s Health Plan. The CONTRACTOR shall: 5.6.6.1.1. Continue authorized services without requiring Prior Authorization for up to ninety (90) Days, 5.6.6.1.2. Continue authorized services regardless if the service is provided by an in-network or out of network Provider, Or, 5.6.6.1.3. Until the CONTRACTOR has performed appropriate clinical review(s) and arranged for the provision of medically necessary services without disruption. And, 5.6.6.1.4. At its discretion, the CONTRACTOR may require Prior Authorization for continuation of services beyond ninety (90) Days; however, the CONTRACTOR is prohibited from denying authorization solely on the basis that the Provider is out-of-network.
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Additional Transition of Care Requirements. 5.6.7.1 The CONTRACTOR shall be responsible for the cost of the continuation of services to newly enrolled Medicaid Managed Care Members entering the CONTRACTOR’s Health Plan. The CONTRACTOR shall: 5.6.7.1.1 Continue authorized services without requiring Prior Authorization for up to ninety (90) Days, 5.6.7.1.2 Continue authorized services regardless if the service is provided by an in-network or out of network Provider, Or, 5.6.7.1.3 Until the CONTRACTOR has performed appropriate clinical review(s) and arranged for the provision of medically necessary services without disruption. And, 5.6.7.1.4 At its discretion, the CONTRACTOR may require Prior Authorization for continuation of services beyond ninety (90) Days; however, the CONTRACTOR is prohibited from denying authorization solely on the basis that the Provider is out-of-network. 5.6.7.2 Inpatient in Hospital at Time of Enrollment For a Member who is in an inpatient hospital setting at the time of Enrollment in the CONTRACTOR’s Health Plan, the member’s facility charges shall be the responsibility of the payor at admission. 5.6.7.3 Pregnant at Time of Enrollment The CONTRACTOR shall provide transition of care for Members who are pregnant or receiving inpatient care. This requirement applies to the following stages of pregnancy: 5.6.7.3.1 Furnish Core Benefits and services in accordance with Medical Necessity and in an amount, duration, and scope that is no less than the amount, duration, and scope for the same services furnished to beneficiaries up to the limits as specified in the Medicaid FFS Program as defined in the State Plan, administrative rule and Managed Care Process and Procedure Manual.
Sample 1Sample 2
Additional Transition of Care Requirements. The CONTRACTOR shall be responsible for the cost of the continuation of services to a newly enrolled Medicaid Managed Care Member including the following: For a new Medicaid Managed Care Member entering the CONTRACTOR’s Health Plan. The CONTRACTOR shall: 5.6.6.1.1. Continue authorized services without requiring Prior Authorization for up to ninety (90) calendar days, 5.6.6.1.2. Continue authorized services regardless if the service is provided by an in-network or out of network provider, Or, 5.6.6.1.3. Until the CONTRACTOR has performed appropriate clinical review(s) and arranged for the provision of medically necessary services without disruption. And, 5.6.6.1.4. At its discretion, the CONTRACTOR may require Prior Authorization for continuation of services beyond ninety (90) calendar days; however, the CONTRACTOR is prohibited from denying authorization solely on the basis that the Provider is out-of-network. Inpatient at Time of Enrollment For a Member who is an Inpatient at the time of enrollment in the CONTRACTOR’s Health Plan, the member’s facility charges shall be the responsibility of the payor at admission. Pregnant at Time of Enrollment The CONTRACTOR shall provide transition of care for Members who are pregnant or receiving inpatient care. This requirement applies to the following stages of pregnancy:
Sample 1
Additional Transition of Care Requirements. The CONTRACTOR shall be responsible for the cost of the continuation of services to a newly enrolled Medicaid Managed Care Member including the following: 5.6.6.1. For a new Medicaid Managed Care Member entering the CONTRACTOR’s Health Plan. The CONTRACTOR shall: 5.6.6.1.1. Continue authorized services without requiring Prior Authorization for up to ninety (90) calendar days, 5.6.6.1.2. Continue authorized services regardless if the service is provided by an in-network or out of network provider, Or, And, 5.6.6.1.3. Until the CONTRACTOR has performed appropriate clinical review(s) and arranged for the provision of medically necessary services without disruption. 5.6.6.1.4. At its discretion, the CONTRACTOR may require Prior Authorization for continuation of services beyond ninety (90) calendar days; however, the CONTRACTOR is prohibited from denying authorization solely on the basis that the Provider is out-of-network. 5.6.6.2. Inpatient in Hospital at Time of Enrollment For a Member who is in an inpatient hospital setting at the time of enrollment in the CONTRACTOR’s Health Plan, the member’s facility charges shall be the responsibility of the payor at admission. 5.6.6.3. Pregnant at Time of Enrollment The CONTRACTOR shall provide transition of care for Members who are pregnant or receiving inpatient care. This requirement applies to the following stages of pregnancy:
Sample 1

Related to Additional Transition of Care Requirements

  • Training Requirements Grantee will: A. Authorize and require staff (including volunteers) to attend training, conferences, and meetings as directed by DSHS. B. Appropriately budget funds to meet training requirements in a timely manner, and ensure staff and volunteers are trained as specified in the training requirements listed at xxxxx://xxx.xxxx.xxxxx.xxx/hivstd/training/ and as otherwise specified by DSHS. Grantee shall document that these training requirements are met. C. Follow the appropriate DSHS POPS by funding opportunity (as per Section I: General Requirements for All Grantees) for training and observation requirements.

  • Certification Regarding Termination of Contract for Non-Compliance (Tex Gov. Code 552.374)

  • Additional Compliance If any Proposed Key Holder Transfer is not consummated within forty-five (45) days after receipt of the Proposed Transfer Notice by the Company, the Key Holders proposing the Proposed Key Holder Transfer may not sell any Transfer Stock unless they first comply in full with each provision of this Section 2. The exercise or election not to exercise any right by any Investor hereunder shall not adversely affect its right to participate in any other sales of Transfer Stock subject to this Section 2.2.

  • Additional Remedy for Non-Compliance with Superannuation If the Employer does not contribute the amounts in accordance with this Agreement, the relevant Trust Deed and the Fund or scheme the Employer shall be liable to make the appropriate contributions immediately upon notification of the non compliance. Further, the Employer shall pay the earnings on the relevant Trust Deed and the Fund or scheme that would have accrued during the period of non-payment. The requirement for the Employer to make retrospective payments shall not limit any common law action which may be available in relation to death, disablement or any other cover existing within the terms of a relevant fund.

  • ORDERING REQUIREMENTS Eligible Purchasers shall order Goods and/or Services from this Contract, consistent with the terms hereof and by using any ordering mechanism agreeable both to Contractor and Purchaser but including, at a minimum, a purchase order. When practicable, Contractor and Purchaser also shall use telephone orders, email orders, web- based orders, and similar procurement methods (collectively “Purchaser Order”). All Purchase Orders must reference the Contract number. The terms of this Contract shall apply to any Purchase Order and, in the event of any conflict, the terms of this Contract shall prevail. Notwithstanding any provision to the contrary, in no event shall any ‘click-agreement,’ software or web-based application terms and conditions, or any other agreement modify the terms and conditions of this Contract.

  • Performance of Services in Accordance with Regulatory Requirements; Furnishing of Books and Records In performing the services set forth in this Agreement, the Manager: A. shall conform with the 1940 Act and all rules and regulations thereunder, with all other applicable federal, state and foreign laws and regulations, with any applicable procedures adopted by the Trust’s Board of Trustees, and with the provisions of the Trust’s Registration Statement filed on Form N-1A as supplemented or amended from time to time; B. will make available to the Trust, promptly upon request, any of the Fund’s books and records as are maintained under this Agreement, and will furnish to regulatory authorities having the requisite authority any such books and records and any information or reports in connection with the Manager’s services under this Agreement that may be requested in order to ascertain whether the operations of the Trust are being conducted in a manner consistent with applicable laws and regulations.

  • Filing Requirements Escrow securities will not be released under this Part until the Issuer does the following: (a) at least 20 days before the date of the first release of escrow securities under the new release schedule, files with the securities regulators in the jurisdictions in which it is a reporting issuer (i) a certificate signed by a director or officer of the Issuer authorized to sign stating (A) that the Issuer has become an established issuer by satisfying one of the conditions in section 3.1 and specifying the condition, and (B) the number of escrow securities to be released on the first release date under the new release schedule, and (ii) a copy of a letter or other evidence from the exchange or quotation service confirming that the Issuer has satisfied the condition to become an established issuer; and (b) at least 10 days before the date of the first release of escrow securities under the new release schedule, issues and files with the securities regulators in the jurisdictions in which it is a reporting issuer a news release disclosing details of the first release of the escrow securities and the change in the release schedule, and sends a copy of such filing to the Escrow Agent.

  • Staffing Requirements Licensee will be in full compliance with the main studio staff requirements as specified by the FCC.

  • Additional Requirements As a condition precedent to the execution and Delivery, the registration of issuance, transfer, split-up, combination or surrender, of any ADS, the delivery of any distribution thereon, or the withdrawal of any Deposited Property, the Depositary or the Custodian may require (i) payment from the depositor of Shares or presenter of ADSs or of an ADR of a sum sufficient to reimburse it for any tax or other governmental charge and any stock transfer or registration fee with respect thereto (including any such tax or charge and fee with respect to Shares being deposited or withdrawn) and payment of any applicable fees and charges of the Depositary as provided in Section 5.9 and Exhibit B, (ii) the production of proof reasonably satisfactory to it as to the identity and genuineness of any signature or any other matter contemplated by Section 3.1, and (iii) compliance with (A) any laws or governmental regulations relating to the execution and Delivery of ADRs or ADSs or to the withdrawal of Deposited Securities and (B) such reasonable regulations as the Depositary and the Company may establish consistent with the provisions of the representative ADR, if applicable, the Deposit Agreement and applicable law.

  • Child Abuse Reporting Requirements A. Grantees shall comply with child abuse and neglect reporting requirements in Texas Family Code Chapter 261. This section is in addition to and does not supersede any other legal obligation of the Grantee to report child abuse. B. Grantee shall use the Texas Abuse Hotline Website located at xxxxx://xxx.xxxxxxxxxxxxxx.xxx/Login/Default.aspx as required by the System Agency. Grantee shall retain reporting documentation on site and make it available for inspection by the System Agency.

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