Adjustments in Service Area or Enrollment Sample Clauses

Adjustments in Service Area or Enrollment a. If Contractor experiences a Material Change, or is engaged in the termination or loss of a Provider or group or affected by other factors which have significant impact on access in that Service Area and which may result in transferring a substantial number of Members to other Providers employed or subcontracted with Contractor, Contractor shall provide OHA with a (1) If a Provider or group terminates its subcontract or employment with Contractor or if Contractor is affected by circumstances beyond Contractor’s control and the Contractor cannot reasonably provide the required 90 day notice, less than the required notice to OHA may be provided with the approval of OHA. (2) If Contractor cannot demonstrate sufficient Provider capacity, OHA may seek other avenues to provide services to Members. If OHA determines that some or all of the affected Members must be disenrolled from Contractor, the applicable provisions of this Section shall apply. b. If Contractor experiences a Material Change, or is engaged in the termination or loss of a Provider or group or affected by other factors which has significant impact on access in that Service Area and which may result in reducing or terminating Contractor’s Service Area or disenrolling a substantial number of Members from Contractor, Contractor shall provide OHA with a written notice and a plan for implementation (which may include an intent to transfer its Members in the Service Area to a Contractor designated by OHA) at least 90 days prior to the date of such action. Contractor shall remain responsible for providing all Covered Services through the end of the 90 day period, without limitation, for all Members for which the Contractor received a CCO Payment. (1) If Contractor must terminate a Provider or group due to circumstances that could compromise Member care, less than the required notice to OHA may be provided with the approval of OHA. (2) If a Provider or group terminates its Subcontract or employment with Contractor or Contractor is affected by other circumstances beyond Contractor’s control and the Contractor cannot reasonably provide the required 90 day notice, less than the required notice to OHA may be provided with the approval of OHA. (3) If Contractor provides OHA with the required 90 day notice but provides no Letter of Intent to transfer its Members to a designated Contractor within 30 days of the 90 day notice, Members in the affected Service Area will be disenrolled from Contractor and will be ...
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Adjustments in Service Area or Enrollment. The terms and conditions of Section 14, Exhibit B, Part 4 in the Medicaid Contract are incorporated by reference and have the same force and effect as though they are fully set forth herein.
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Adjustments in Service Area or Enrollment a. If Contractor experiences a Material Change, or is engaged in the termination or loss of a Provider or group or affected by other factors which have significant impact on access in that Service Area and which may result in transferring a substantial number of Members to other Providers employed or subcontracted with Contractor, Contractor shall provide OHA with a written plan for transferring the Members and an updated Provider Report, Exhibit G, at least 90 days prior to the date of such action, notwithstanding the Contract renewal date. Contractor shall remain responsible for maintaining sufficient capacity and solvency, and providing all Coordinated Care Services through the end of the 90-day period. (1) If Contractor must terminate a Provider or group due to circumstances that could compromise Member care, less than the required notice to OHA may be provided with the approval of OHA. (2) If a Provider or group terminates its subcontract or employment with Contractor or if Contractor is affected by circumstances beyond Contractor’s control and the Contractor cannot reasonably provide the required 90 days notice, less than the required notice to OHA may be provided with the approval of OHA. (3) If Contractor cannot demonstrate sufficient Provider capacity, OHA may seek other avenues to provide services to Members. If OHA determines that some or all of the affected Members must be disenrolled from Contractor, the applicable provisions of this Section shall apply. b. If Contractor experiences a Material Change, or is engaged in the termination or loss of a Provider or group or affected by other factors which has significant impact on access in that Service Area and which may result in reducing or terminating Contractor’s Service Area or disenrolling a substantial number of Members from Contractor, Contractor shall provide OHA (1) If Contractor must terminate a Provider or group due to circumstances that could compromise Member care, less than the required notice to OHA may be provided with the approval of OHA. (2) If a Provider or group terminates their Subcontract or employment with Contractor or Contractor is affected by other circumstances beyond Contractor’s control and the Contractor cannot reasonably provide the required 90 days notice, less than the required notice to OHA may be provided with the approval of OHA. (3) If Contractor provides OHA with the required 90-day notice but provides no Letter of Intent to transfer its Members to a designated...
Sample 1
Adjustments in Service Area or Enrollment a. If RAE reasonably anticipates losing a substantial number of Members from its enrollment, or experiencing a reduction in its network or capacity due to: (i) the occurrence of a Material Change or other significant change; (ii) engaging in the termination or loss of Participating Providers; or (iii) decreased access in RAE’s Service Area, RAE shall notify TCMC at least 120 days, or as soon as reasonably practicable, prior to the date of such anticipated loss or reduction. b. In such an event, RAE shall cooperate with and assist TCMC to develop a written plan for removing or reassigning the Members, and to cooperate and assist in the preparation of any written reports required by the Core Contract or the OHA related to the removal or reassignment. x. XXX shall remain responsible for maintaining sufficient capacity and solvency, and providing Covered Care Services through such 120-day period, without limitation, for all Members for which RAE received Compensation. d. If RAE cannot demonstrative sufficient capacity to provide Covered Services to Members during such 120-day period, TCMC may seek other avenues to provide Covered Services to Members. Part 5 – Health Equity and Elimination Health Disparities
Sample 1
Adjustments in Service Area or Enrollment a. If Contractor is engaged in the termination or loss of a Provider or group or affected by other factors which have significant impact on access in that Service Area and which may result in transferring a substantial number of Members to other Providers employed or subcontracted with Contractor, Contractor shall provide OHA with a written plan for transferring the Members and an updated DSN Provider Report, Exhibit G, at least 90 days prior to the date of such action. b. If Contractor experiences a change which may result in the reduction or termination of any portion of Contractor’s Service Area or may result in the disenrollment of a substantial number c. OHA will not approve a transfer of Members if the Provider’s contract with the transferring Contractor is terminated for reasons related to quality of care, competency, Fraud or other reasons described in OAR 410-141-3080. d. OHA reserves the right to waive the required notice period in certain circumstances, including but not limited to: (1) i. If Contractor must terminate a Provider or group due to circumstances that could compromise Member care; (2) ii. If a Provider or group terminates its subcontract or employment with Contractor or if Contractor is affected by circumstances beyond Contractor’s control and the Contractor cannot reasonably provide the required 90 day notice; or,
Sample 1

Related to Adjustments in Service Area or Enrollment

  • Payment and Year-End Adjustment Amounts accrued pursuant to this Agreement shall be payable to the Adviser as of the last day of each month. If necessary, on or before the last day of the first month of each fiscal year, an adjustment payment shall be made by the appropriate party in order that the actual Fund Operating Expenses of a Fund for the prior fiscal year (including any reimbursement payments hereunder with respect to such fiscal year) do not exceed the Maximum Annual Operating Expense Limit.

  • Enrollment Requirements You must maintain with Blue Cross and Blue Shield a current and updated listing of covered employees. You will be responsible for all claims costs and expenses associated with failure to maintain an accurate and current listing with Blue Cross and Blue Shield, unless such claims costs and expenses are due to an error on Blue Cross and Blue Shield’s part. In order to maintain health care coverage with Blue Cross and Blue Shield, an employee must meet the written eligibility requirements (such as length of service, active employment and number of hours worked) you impose as long as they do not conflict with Blue Cross and Blue Shield’s eligibility requirements. An eligible employee as defined by Blue Cross and Blue Shield means: • A permanent full-time employee regularly working 30 hours or more each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A permanent part-time employee regularly working at least 20 hours but less than 30 hours each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A disabled permanent full-time or part-time employee who is actively working despite the disability (including one who is engaged in a trial work period) and a disabled employee who is not actively working but whom the employer treats as an employee; or • A former employee (or a former covered dependent of the employee of the group) who qualifies for continued group coverage under federal or state law, but only if the employer maintains Blue Cross and Blue Shield group coverage for permanent full-time employees as defined in (a) above; or • A retired employee of the employer. Newly hired employees who are eligible for group benefits can enroll in the benefits plan according to your eligibility requirements for coverage, provided that your requirements comply with Blue Cross and Blue Shield’s eligibility and enrollment requirements. The effective date of an eligible employee’s (or his or her dependent’s) membership in the benefits plan may be the Member’s initial eligibility date or your subsequent anniversary/renewal date, as long as: (a) Blue Cross and Blue Shield receives your written notice no later than 30 days after the Member’s enrollment notification period applicable to membership modifications (as described in the Subscriber Certificate for your benefits plan); and (b) you pay the applicable premium charges.

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • Disenrollment The Contractor shall: Have a mechanism for receiving timely information about all disenrollments from the Contractor’s One Care Plan, including the effective date of disenrollment, from CMS and MassHealth systems. All enrollments and disenrollment‑related transactions will be performed by the EOHHS customer service vendor. Subject to 42 C.F.R. § 423.100, § 423.38 and § 438.56. Enrollees can elect to disenroll from the One Care Plan or the Demonstration at any time and enroll in another One Care Plan, a Medicare Advantage plan, PACE, or Senior Care Options (if they meet applicable eligibility requirements); or may elect to receive services through Medicare fee‑for‑service and a prescription drug plan and to receive Medicaid services in accordance with the Commonwealth’s State plan and any waiver programs. Disenrollments received by MassHealth or the Contractor, or by CMS or its contractor by the last calendar day of the month will be effective on the first calendar day of the following month; Be responsible for ceasing the provision of Covered Services to an Enrollee upon the effective date of disenrollment; Notify EOHHS of any individual who is no longer eligible to remain enrolled in the One Care Plan per CMS enrollment guidance, in order for EOHHS to disenroll the individual. This includes where an Enrollee remains out of the Service Area or for whom residence in the One Care Plan Service Area cannot be confirmed for more than six (6) consecutive months; Not interfere with the Enrollee’s right to disenroll through threat, intimidation, pressure, or otherwise; Not request the disenrollment of any Enrollee due to an adverse change in the Enrollee’s health status or because of the Enrollee’s utilization of treatment plan, medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs. The Contractor, however, may submit a written request, accompanied by supporting documentation, to the Contract Management Team (CMT) to disenroll an Enrollee, for cause, for the following reason: The Enrollee’s continued enrollment seriously impairs the Contractor’s ability to furnish services to either this Enrollee or other Enrollees, provided the Enrollee’s behavior is determined to be unrelated to an adverse change in the Enrollee's health status, or because of the Enrollee's utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs.

  • What Forms of Distribution Are Available from a Xxxxxxxxx Education Savings Account Distributions may be made as a lump sum of the entire account, or distributions of a portion of the account may be made as requested.

  • Special Enrollment a. KFHPWA will allow special enrollment for persons: 1) Who initially declined enrollment when otherwise eligible because such persons had other health care coverage and have had such other coverage terminated due to one of the following events: • Cessation of employer contributions. • Exhaustion of COBRA continuation coverage. • Loss of eligibility, except for loss of eligibility for cause. 2) Who initially declined enrollment when otherwise eligible because such persons had other health care coverage and who have had such other coverage exhausted because such person reached a lifetime maximum limit. KFHPWA or the Group may require confirmation that when initially offered coverage such persons submitted a written statement declining because of other coverage. Application for coverage must be made within 31 days of the termination of previous coverage. b. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their Dependents (other than for nonpayment or fraud) in the event one of the following occurs: 1) Divorce or Legal Separation. Application for coverage must be made within 60 days of the divorce/separation. 2) Cessation of Dependent status (reaches maximum age). Application for coverage must be made within 30 days of the cessation of Dependent status. 3) Death of an employee under whose coverage they were a Dependent. Application for coverage must be made within 30 days of the death of an employee. 4) Termination or reduction in the number of hours worked. Application for coverage must be made within 30 days of the termination or reduction in number of hours worked. 5) Leaving the service area of a former plan. Application for coverage must be made within 30 days of leaving the service area of a former plan. 6) Discontinuation of a former plan. Application for coverage must be made within 30 days of the discontinuation of a former plan. c. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their Dependents in the event one of the following occurs: 1) Marriage. Application for coverage must be made within 31 days of the date of marriage. 2) Birth. Application for coverage for the Subscriber and Dependents other than the newborn child must be made within 60 days of the date of birth. 3) Adoption or placement for adoption. Application for coverage for the Subscriber and Dependents other than the adopted child must be made within 60 days of the adoption or placement for adoption. 4) Eligibility for premium assistance from Medicaid or a state Children’s Health Insurance Program (CHIP), provided such person is otherwise eligible for coverage under this EOC. The request for special enrollment must be made within 60 days of eligibility for such premium assistance. 5) Coverage under a Medicaid or CHIP plan is terminated as a result of loss of eligibility for such coverage. Application for coverage must be made within 60 days of the date of termination under Medicaid or CHIP. 6) Applicable federal or state law or regulation otherwise provides for special enrollment.

  • Early and Safe Return to Work The Hospital and the Union are committed to a consistent, fair approach to meeting the needs of disabled workers, to restoring them to work which is meaningful for them and valuable to the Hospital, and to meeting the parties’ responsibilities under the law. To that end, the Hospital and the Union agree to cooperate in facilitating the return to work of disabled employees. The Employer and the Union agree that ongoing and timely communication by all participants in this process is essential to the success of the process. (a) At the regular HAC meeting or at least bi-monthly the Employer will provide an updated list of information to the bargaining unit president including the following: i) Nurses absent from work because of disability who are in receipt of Workplace Safety and Insurance Board benefits; ii) Nurses absent from work because of disability who are in receipt of Long Term Disability benefits including the last day worked; iii) Nurses who have been absent from work because of disability for more than twenty-four (24) months; iv) Nurses who are currently on a temporary modified work program; v) Nurses who are currently permanently accommodated in the workplace; vi) Nurses awaiting temporary modified work; vii) Nurses awaiting permanent accommodation in the workplace. (b) A disabled nurse returning to work from a disability including WSIB to a modified/light/alternative work program, will have a joint Return to Work Team (RTW) attend a return to work meeting. The RTW team will be comprised of the Bargaining Unit President or designate, the Occupational Health representative, the manager and Human Resources. If the Bargaining Unit President or designate attends RTW meetings on her day off, she / he will receive pay at straight time or time in lieu where possible for hours spent in RTW meetings. Such hours are invisible for the purposes of determining premium. L-2 The nurse will advise her manager and Occupational Health Services that she wishes to return to work. A disabled nurse who is ready to return to work will provide the Occupational Health Service with medical verification of her ability to return to work including information regarding any restrictions.

  • Adjustment of Minimum Quarterly Distribution and Target Distribution Levels (a) The Minimum Quarterly Distribution, First Target Distribution, Second Target Distribution, Third Target Distribution, Common Unit Arrearages and Cumulative Common Unit Arrearages shall be proportionately adjusted in the event of any distribution, combination or subdivision (whether effected by a distribution payable in Units or otherwise) of Units or other Partnership Securities in accordance with Section 5.10. In the event of a distribution of Available Cash that is deemed to be from Capital Surplus, the then applicable Minimum Quarterly Distribution, First Target Distribution, Second Target Distribution and Third Target Distribution, shall be adjusted proportionately downward to equal the product obtained by multiplying the otherwise applicable Minimum Quarterly Distribution, First Target Distribution, Second Target Distribution and Third Target Distribution, as the case may be, by a fraction of which the numerator is the Unrecovered Capital of the Common Units immediately after giving effect to such distribution and of which the denominator is the Unrecovered Capital of the Common Units immediately prior to giving effect to such distribution. (b) The Minimum Quarterly Distribution, First Target Distribution, Second Target Distribution and Third Target Distribution, shall also be subject to adjustment pursuant to Section 6.9.

  • Enrollment The Competitive Supplier shall be responsible for enrolling all Eligible Consumers through EDI transactions submitted to the LDC for all enrollments of Eligible Consumers during the term of this Agreement.

  • Other Payroll Deductions Upon appropriate written authorization from the employee, the Board shall deduct from the salary of any employee and make appropriate remittance for annuities, credit union, savings bonds, insurance, or any other plans or programs approved by the parties.

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