Common use of Beneficiary Liability for Payment Clause in Contracts

Beneficiary Liability for Payment. A. Pursuant to 42 CFR 438.106, the Contractor or an affiliate, vendor, contractor, or sub- subcontractor of the Contractor shall not submit a claim to, or demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any SUD or related administrative services provided under this Intergovernmental Agreement, except to collect other health insurance coverage, share of cost, and co-payments. Consistent with 42 CFR 438.106, the Contractor or an affiliate, vendor, contractor, or sub-subcontractor of the Contractor shall not hold beneficiaries liable for debts in the event that the Contractor becomes insolvent, for costs of covered services for which DHCS does not pay the Contractor, for costs of covered services for which DHCS or the Contractor does not pay the Contractor's providers, for costs of covered services provided under an Intergovernmental Agreement, referral or other arrangement rather than from the Contractor, or for payment of subsequent screening and treatment needed to diagnose the specific condition of or stabilize a beneficiary with an emergency condition. B. Pursuant to 42 CFR 438.6(l) and 438.230 the Contractor and subcontractor shall not bill beneficiaries for covered services, any amount greater than would be owed if the Contractor provided the services directly. C. Pursuant to 438.108, Contractor shall provide that any cost sharing imposed on beneficiaries is in accordance with Medicaid fee for service requirements (Section 447.50 – 447.60)

Beneficiary Liability for Payment. A. Pursuant to 42 CFR 438.106, the Contractor or an affiliate, vendor, contractor, or sub- subcontractor of the Contractor shall not submit a claim to, or demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any SUD or related administrative services provided under this Intergovernmental Agreement, except to collect other health insurance coverage, share of cost, and co-payments. Consistent with 42 CFR 438.106, the Contractor or an affiliate, vendor, contractor, or sub-subcontractor of the Contractor shall not hold beneficiaries liable for debts in the event that the Contractor becomes insolvent, for costs of covered services for which DHCS does not pay the Contractor, for costs of covered services for which DHCS or the Contractor does not pay the Contractor's providers, for costs of covered services provided under an Intergovernmental Agreement, referral or other arrangement rather than from the Contractor, or for payment of subsequent screening and treatment needed to diagnose the specific condition of or stabilize a beneficiary with an emergency condition. B. Pursuant to 42 CFR 438.6(l) and 438.230 the Contractor and subcontractor shall not bill xxxx beneficiaries for covered services, any amount greater than would be owed if the Contractor provided the services directly. C. Pursuant to 438.108, Contractor shall provide that any cost sharing imposed on beneficiaries is in accordance with Medicaid fee for service requirements (Section 447.50 – 447.60)

Beneficiary Liability for Payment. A. Pursuant to 42 CFR 438.106, the Contractor or an affiliate, vendor, contractor, or sub- subcontractor of the Contractor shall not submit a claim to, or demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any SUD or related administrative services provided under this Intergovernmental Agreement, except to collect other health insurance coverage, share of cost, and co-payments. Consistent with 42 CFR 438.106, the Contractor or an affiliate, vendor, contractor, or sub-subcontractor of the Contractor shall not hold beneficiaries liable for debts in the event that the Contractor becomes insolvent, for costs of covered services for which DHCS does not pay the Contractor, for costs of covered services for which DHCS or the Contractor does not pay the Contractor's providers, for costs of covered services provided under an Intergovernmental Agreement, referral or other arrangement rather than from the Contractor, or for payment of subsequent screening and treatment needed to diagnose the specific condition of or stabilize a beneficiary with an emergency condition. B. Pursuant to 42 CFR 438.6(l) and 438.230 the Contractor and subcontractor shall not bill beneficiaries for covered services, any amount greater than would be owed if the Contractor provided the services directly. C. Pursuant to 438.108, Contractor shall provide that any cost sharing imposed on beneficiaries is in accordance with Medicaid fee for service requirements (Section 447.50 – 447.60)

Beneficiary Liability for Payment. ‌ A. Pursuant to 42 CFR 438.106, the Contractor or an affiliate, vendor, contractor, or sub- subcontractor of the Contractor shall not submit a claim to, or demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any SUD or related administrative services provided under this Intergovernmental Agreement, except to collect other health insurance coverage, share of cost, and co-payments. Consistent with 42 CFR 438.106, the Contractor or an affiliate, vendor, contractor, or sub-subcontractor of the Contractor shall not hold beneficiaries liable for debts in the event that the Contractor becomes insolvent, for costs of covered services for which DHCS does not pay the Contractor, for costs of of‌ covered services for which DHCS or the Contractor does not pay the Contractor's providers, for costs of covered services provided under an Intergovernmental Agreement, referral or other arrangement rather than from the Contractor, or for payment of subsequent screening and treatment needed to diagnose the specific condition of or stabilize a beneficiary with an emergency condition.condition.‌ B. Pursuant to 42 CFR 438.6(l) and 438.230 the Contractor and subcontractor shall not bill beneficiaries for covered services, any amount greater than would be owed if the Contractor provided the services directly.directly.‌ C. Pursuant to 438.108, Contractor shall provide that any cost sharing imposed on beneficiaries is in accordance with Medicaid fee for service requirements (Section 447.50 – 447.60)447.60)‌