Common use of Aid Continuing Clause in Contracts

Aid Continuing. a) Contractor shall be required to continue the provision of services determined by the Contractor to be a Medicaid only benefit or a benefit under both Medicare and Medicaid that are the subject of the fair hearing to an Enrollee (hereafter referred to as "aid continuing") if so ordered by the OAH under the following circumstances: i) Contractor has or is seeking to reduce, suspend or terminate such service or treatment currently being provided; ii) Enrollee has filed a timely request for a fair hearing with OAH; and iii) There is a valid order for the service or treatment from a Participating Provider. b) Contractor shall provide aid continuing until the matter has been resolved to the Enrollee's satisfaction or until the administrative process is completed and there is a determination from OAH that Enrollee is not entitled to receive the service, the Enrollee withdraws the request for aid continuing and/or the fair hearing in writing, or the service or treatment originally ordered by the provider has been completed, whichever occurs first. c) If the services and/or benefits in dispute have been terminated, suspended or reduced and the Enrollee requests a fair hearing in a timely manner, Contractor shall, at the direction of either SDOH or LDSS, restore the disputed services and/or benefits consistent with the provisions of Section 24.4 of this Agreement.

Aid Continuing. a) Contractor shall be required to continue the provision of the Benefit Package services determined by the Contractor to be a Medicaid only benefit or a benefit under both Medicare and Medicaid that are the subject of the fair hearing to an Enrollee (hereafter referred to as "aid continuing") if so ordered by the OAH NYS Office of Administrative Hearings (OAH) under the following circumstances: i) Contractor has or is seeking to reduce, suspend or terminate such a treatment or Benefit Package service or treatment currently being provided; ii) Enrollee has filed a timely request for a fair hearing with OAH; and iii) There is a valid order for the treatment or service or treatment from a Participating Provider. b) Contractor shall provide aid continuing until the matter has been resolved to the Enrollee's satisfaction or until the administrative process is completed and there is a determination from OAH that Enrollee is not entitled to receive the service, ; the Enrollee withdraws the request for aid continuing and/or the fair hearing in writing, ; or the treatment or service or treatment originally ordered by the provider has been completed, whichever occurs first. c) If the services and/or benefits in dispute have been terminated, suspended or reduced and the Enrollee timely requests a fair hearing in a timely manner, hearing. Contractor shall, at the direction of either SDOH or LDSS, restore the disputed services and/or benefits consistent with the provisions of Section 24.4 25.4 (b) of this Agreement.

Aid Continuing. a) Contractor shall be required to continue the provision of the Benefit Package services determined by the Contractor to be a Medicaid only benefit or a benefit under both Medicare and Medicaid that are the subject of the fair hearing to an Enrollee (hereafter referred to as "aid continuing") if so ordered by the OAH under the following circumstances: i) Contractor has or is seeking to reduce, suspend or terminate such a treatment or Benefit Package service or treatment currently being provided; ii) Enrollee has filed a timely request for a fair hearing with OAH; and iii) There is a valid order for the treatment or service or treatment from a Participating Provider. b) participating provider. Contractor shall provide aid continuing until the matter has been resolved to the Enrollee's satisfaction or until the administrative process is completed and there is a determination from OAH that Enrollee is not entitled to receive the service, the Enrollee withdraws the request for aid continuing and/or the fair hearing in writing, or the treatment or service or treatment originally ordered by the provider has been completed, whichever occurs first. civ) If the services and/or benefits in dispute have been terminated, suspended or reduced and the Enrollee timely requests a fair hearing in a timely mannerhearing, Contractor shall, at the direction of either SDOH or LDSS, restore the disputed services and/or benefits consistent with the provisions of Section 24.4 25.4(iii) of this Agreement.

Aid Continuing. a) Contractor shall be required to continue the provision of the Benefit Package services determined by the Contractor to be a Medicaid only benefit or a benefit under both Medicare and Medicaid that are the subject of the fair hearing to an Enrollee (hereafter referred to as "aid continuing") if so ordered by the OAH NYS Office of Administrative Hearings (OAH) under the following circumstances: i) Contractor has or is seeking to reduce, suspend or terminate such a treatment or Benefit Package service or treatment currently being provided; ii) Enrollee has filed a timely request for a fair hearing with OAH; and iii) There is a valid order for the treatment or service or treatment from a Participating Provider. b) Contractor shall provide aid continuing until the matter has been resolved to the Enrollee's satisfaction or until the administrative process is completed and there is a determination from OAH that Enrollee is not entitled to receive the service, ; the Enrollee withdraws the request for aid continuing and/or the fair hearing in writing, ; or the treatment or service or treatment originally ordered by the provider has been completed, whichever occurs first. c) If the services and/or benefits in dispute have been terminated, suspended or reduced and the Enrollee timely requests a fair hearing in a timely mannerhearing, Contractor shall, at the direction of either SDOH or LDSS, restore the disputed services and/or benefits consistent with the provisions of Section 24.4 25.4 (b) of this Agreement.

Aid Continuing. a) Contractor shall be required to continue the provision of the Benefit Package services determined by the Contractor to be a Medicaid only benefit or a benefit under both Medicare and Medicaid that are the subject of the fair hearing to an Enrollee (hereafter referred to as "aid continuing") if so ordered by the OAH under the following circumstances: i) Contractor has or is seeking to reduce, suspend or terminate such a treatment or Benefit Package service or treatment currently being provided; ii) Enrollee has filed a timely request for a fair hearing with OAH; and iii) There is a valid order for the treatment or service or treatment from a Participating Provider. b) participating provider. Contractor shall provide aid continuing until the matter has been resolved to the Enrollee's satisfaction or until the administrative process is has been completed and there is a FHPlus - Section 23 -- Section 37 October 1, 2001 Page 2 of 11 determination from OAH that Enrollee is not entitled to receive the service, the Enrollee withdraws the request for aid continuing and/or the fair hearing in writing, or the treatment or service or treatment originally ordered by the provider has been completed, whichever occurs first. civ) If the services and/or benefits in dispute have been terminated, suspended or reduced and the Enrollee timely requests a fair hearing in a timely mannerhearing, Contractor shall, at the direction of either SDOH or LDSS, restore the disputed services Services and/or benefits consistent with the provisions of Section 24.4 25.4(iii) of this Agreement.

Aid Continuing. a) Contractor shall be required to continue the provision of the Benefit Package services determined by the Contractor to be a Medicaid only benefit or a benefit under both Medicare and Medicaid that are the subject of the fair hearing to an Enrollee (hereafter referred to as "“aid continuing"”) if so ordered by the OAH NYS Office of Administrative Hearings (OAH) under the following circumstances: i) Contractor has determined to uphold a decision of a PCP to deny a request for a referral, or is seeking to reducedeny or reduce a benefit or service, suspend or terminate such to authorize the service or treatment currently being providedfor less than requested; ii) Enrollee has filed a timely request for a fair hearing with OAH; and iii) There is a valid order for the treatment or service or treatment from a Participating Provider. b) Contractor shall provide aid continuing until the matter has been resolved to the Enrollee's ’s satisfaction or until the administrative process is completed and there is a determination from OAH that Enrollee is not entitled to receive the service, ; the Enrollee withdraws the request for aid continuing and/or the fair hearing in writing, ; or the treatment or service or treatment originally ordered by the provider has been completed, whichever occurs first. c) If the services and/or benefits in dispute have been terminated, suspended or reduced and the Enrollee timely requests a fair hearing in a timely mannerhearing, Contractor shall, at the direction of either SDOH or LDSS, restore the disputed services and/or benefits consistent with the provisions of Section 24.4 25.4 (b) of this Agreement.