Beneficiary Assistance Program Sample Clauses

Beneficiary Assistance Program. (PSNs only) - A state external conflict resolution program authorized under s. 409.91211(3)(q), F.S., similar to the Subscriber Assistance Program, available to Medicaid participants, that provides an additional level of appeal if the Health Plan’s process does not resolve the conflict. Benefit Maximum – (Reform only) - The point when the cost of covered services received by a non-pregnant enrollee, age 21 or older, reaches $550,000 in a Contract year, based on Medicaid fee-for-service payment levels. Care coordination services and emergency services and care must continue to be offered by the Health Plan, but the cost of additional services, excluding emergency services and care, will not be covered by the Medicaid program for the remainder of the Contract year in which the benefit maximum is met. In addition, the Health Plan shall provide benefit reporting in accordance with Attachment II, Section V, Covered Services, and Section XII, Reporting Requirements.

Beneficiary Assistance Program. A state external conflict resolution program authorized under s. 409.91211(3)(q), F.S., available to Medicaid participants, that provides an additional level of appeal if the Managed Care Plan’s process does not resolve the conflict.