Benefit Maximum. The point when the cost of Covered Services received by a non-pregnant Enrollee, ages 21 and older reaches $550,000 in a state fiscal year, based on Medicaid Fee-for-Service payment levels. Care coordination services must continue to be offered by the Health Plan but the cost of additional services will not be covered by the Medicaid program for the remainder of the Contract Year in which the Benefit Maximum is met.
Appears in 2 contracts
Samples: Standard Contract (Wellcare Health Plans, Inc.), Standard Contract (Wellcare Health Plans, Inc.)
Benefit Maximum. The point when the cost of Covered Services received by a non-pregnant Enrollee, ages 21 and older older, reaches $550,000 in a state fiscal year, based on Medicaid Fee-for-for- Service payment levels. Care coordination services and Emergency Services and Care must continue to be offered by the Health Plan PSN but the cost of additional services 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 PSN shall provide benefit reporting in accordance with Section XII.V.
Appears in 2 contracts
Samples: Provider Service Network Model Contract, Provider Service Network Model Contract
Benefit Maximum. The point when the cost of Covered Services received by a non-pregnant Enrollee, ages 21 and older older, reaches $550,000 in a state fiscal year, based on Medicaid Fee-for-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 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.
Appears in 1 contract
Samples: Ahca Contract
