Carved-out Services Sample Clauses

Carved-out Services. Some services are not included in the Contractor’s capitation rates for the Hoosier Healthwise populations and, therefore, are not the responsibility of the Contractor. These services are referred to as “carved-out” services. The State fiscal agent pays on a FFS basis for carved-out services rendered to the Contractor’s members. However, under some circumstances, services related to the carved-out services are the responsibility of the Contractor for reimbursement. Listed below are the carved-out services in the Hoosier Healthwise program and the conditions under which related services are the Contractor’s responsibility. The Hoosier Healthwise MCE Policies and Procedures Manual describes these carved-out services in greater detail.
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Carved-out Services. Some services are not included in the Contractor’s capitation rates for the HIP populations and, therefore, are not the responsibility of the Contractor. These services are referred to as “carved-out” services. The State fiscal agent pays on a FFS basis for carved-out services rendered to the Contractor’s members. However, under some circumstances, services related to the carved-out services are the responsibility of the Contractor for reimbursement. Listed below are the carved-out services in the HIP program and the conditions under which related services are the Contractor’s responsibility. The HIP MCE Policies and Procedures Manual describes these carved-out services in greater detail.
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Carved-out Services. The services described in this section are excluded from the Contractor’s capitation rate; these are referred to as “carved-out” services. The State’s fiscal agent pays claims for carved-out services on a fee-for-service basis for the Contractor’s members. While these services are not the financial responsibility of the Contractor, the Contractor shall ensure coordination of all Medicaid covered services and implement strategies to prevent duplication and fragmentation of care across the healthcare delivery system. Respondents shall describe strategies proposed to ensure coordination for carved-out services.
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Carved-out Services. Some services are not included in the Contractor’s capitation rates for the Hoosier Healthwise populations and, therefore, are not the responsibility of the Contractor. These services are referred to as “carved-out” services. Carved-out services, as defined by the State, include services that are carved out of managed care program coverage, meaning that they are the financial responsibility of the State to provide to managed care members via fee- for-service (FFS) Medicaid benefits. This definition also includes services that could potentially require a managed care member to be disenrolled from a managed care plan and instead be reenrolled into traditional Medicaid to obtain the FFS benefit. The State fiscal agent pays on a FFS basis for carved-out services rendered to the Contractor’s members. However, under some circumstances, services related to the carved- out services are the responsibility of the Contractor for reimbursement. Listed below are the carved-out services in the Hoosier Healthwise program and the conditions under which related services are the Contractor’s responsibility. The Hoosier Healthwise MCE Policies and Procedures Manual describes these carved-out services in greater detail.
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Carved-out Services. The services described in this section are excluded from the Contractor’s capitation rate; these are referred to as “carved-out” services. The State’s fiscal agent pays claims for carved-out services on a fee-for-service basis for the Contractor’s members. While these services are not the financial responsibility of the Contractor, the Contractor shall ensure coordination of all Medicaid covered services and implement strategies to prevent duplication and fragmentation of care across the healthcare delivery system, including as may result from new initiatives. The Contractor shall maintain strategies to ensure coordination for carved-out services. 3.13.1 Medicaid Rehabilitation Option (MRO) Services MRO services are intensive community-based behavioral health services delivered exclusively by CMHCs. Medicaid members requiring MRO services are assigned a service package based on qualifying diagnosis and level of need, as determined by an individualized assessment conducted by CMHCs. The Contractor is not responsible for claims reimbursement for MRO services but is responsible for ensuring coordination of care for members receiving MRO services. The State shall provide data to the Contractor identifying members receiving MRO services. A complete listing of carved-out MRO services is provided in Contract Exhibit 3 Program Description and Covered Benefits. Further information on the behavioral health services which are the financial responsibility of the Contractor are described in Section 3.10. 3.13.2 1915(i) State Plan Home and Community-Based Services The State has three (3) 1915(i) State Plan Home and Community-Based services programs: Behavioral and Primary Healthcare Coordination (BPHC), Adult Mental Health Habilitation (AMHH) and Child Mental Health Wraparound (CMHW). These services are carved-out of the Contractor’s financial responsibility. The Contractor shall coordinate with 1915(i) service providers to prevent duplication and fragmentation of services. A listing of carved-out 1915(i) services is provided in Contract Exhibit 3 Program Description and Covered Benefits. 3.13.3 Individualized Family Services Plan (IFSP) IFSP services provided under the FSSA First Steps program are carved-out from the Contractor’s financial responsibility. 3.13.4 Individualized Education Plan (IEP) Services IEP services provided by a school are carved-out from the Contractor’s responsibility. The Contractor shall communicate and coordinate with the school to ensure cont...
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Carved-out Services. The subset of Medicaid and Medicare Covered Services for which the STAR+PLUS MMP will not be responsible under this Contract. Refer to Appendix A for the list of Carved-Out Services. Also referred to as “Non-Capitated Services.”
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Carved-out Services. The services described in this section are excluded from the Contractor’s capitation rate; these are referred to as “carved-out” services. Carved-out services, as defined by the State, include services that are carved out of managed care program coverage, meaning that they are the financial responsibility of the State to provide to managed care members via fee-for- service (FFS) Medicaid benefits. This definition also includes services that could potentially require a managed care member to be disenrolled from a managed care plan and instead be reenrolled into traditional Medicaid to obtain the FFS benefit. The State’s fiscal agent pays claims for carved-out services on a fee-for-service basis for the Contractor’s members. While these services are not the financial responsibility of the Contractor, the Contractor shall ensure coordination of all Medicaid covered services and implement strategies to prevent duplication and fragmentation of care across the healthcare delivery system, including as may result from new initiatives. The Contractor shall maintain strategies to ensure coordination for carved-out services.
Sample 1Sample 2Sample 3
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Carved-out Services. The services described in this section are excluded from the Contractor’s capitation rate; these are referred to as “carved-out” services. The State’s fiscal agent pays claims for carved-out services on a fee-for-servic e basis for the Contractor’s members. While these services are not the financial responsibility of the Contractor, the Contractor shall ensure coordination of all Medicaid covered services and implement strategies to prevent duplication and fragmentation of care across the healthcare delivery system, including as may result from new initiatives. The Contractor shall maintain strategies to ensure coordination for carved-out services. 3.13.1 Medicaid Rehabilitation Option (MRO) Services MRO services are intensive community-based behavioral health services delivered exclusively by CMHCs. Medicaid members requiring MRO services are assigned a service package based on qualifying diagnosis and level of need, as determined by an individualized assessment conducted by CMHCs. The Contractor is not responsible for claims reimbursement for MRO services but is responsible for ensuring coordination of care for members receiving MRO services. The State shall provide data to the Contractor identifying members receiving MRO services. A complete listing of carved-out MRO services is provided in Contract Exhibit 3 Program Description and Covered Benefits. Further information on the behavioral health services which are the financial responsibility of the Contractor are described in Section 3.10. 3.13.2 1915(i) State Plan Home and Community-Based Services
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Related to Carved-out Services

  • PROJECT SERVICES Landlord shall furnish services as follows:

  • Autism Services This plan covers the following services for the treatment of autism spectrum disorders. • Applied behavior analysis when provided and/or supervised by an individual licensed by the state in which the service is rendered. See the Summary of Medical Benefits for the amount that you pay. • Physical therapy, occupational therapy, and speech therapy services when rendered as part of the treatment of autism spectrum disorder. A benefit limit will not apply to these services. • Psychological and psychiatric services, and prescription drugs are also covered. See Behavioral Health Services and Prescription Drugs and Diabetic Equipment or Supplies for additional information. Coverage for autism spectrum disorders does not affect any obligation of a school district, a state or other governmental entity to provide services to an individual under an individualized family service plan, an individualized education program, or similar services required under state or federal law. Services related to autism that are furnished by school personnel are not covered under this plan.

  • OVERSIGHT SERVICES Oversight services for the Fund provided by Price Associates shall include all oversight of BNY Mellon, Delegates and service providers that provide accounting, administrative, and tax support services and not specifically provided for under each Fund’s Investment Management Agreement. Price Associates provides all accounting, administrative, tax and oversight services to the Funds listed on Exhibit A2, including the below. Accounting Services provided by Price Associates shall include, among other things: · oversight of quality control, including processing results related to fund accounting services provided by Delegates or other third party service providers relating to pricing. Such oversight includes, but is not limited to, review of (a) NAV calculations and fund valuations, (b) securities pricing and resolution of pricing exceptions, and (c) calculation and preparation of any financial information or schedules; · end-of-day INAV oversight for ETFs that provide INAV · determining accounting and valuation policies, instructing Delegates and/or other service providers, and/or providing it with such advice that may be reasonably necessary, to properly account for all financial transactions and to maintain the Fund’s accounting procedures and records so as to ensure compliance with generally accepted accounting principles and tax practices and rules; and · calculating and authorizing expense accruals and payments; annual fund expense budgets; accrual analysis; rollforward calculations; payment of expenses; fees for payment to service providers; · facilitating on behalf of the Fund resolution and remediation of fund accounting issues escalated by Delegates and/or other service providers; · preparing daily NAV calculations, including all necessary component services such as valuation and particularly private company investment valuation, corporate actions processing, trade processing, and performing month-end and fiscal-period-end close processes; · recordkeeping as required; and · such other accounting services as agreed to by the parties not otherwise performed by Price Associates under the Investment Management Agreement. Administrative Services provided by Price Associates shall include, among other things: · ensuring maintenance for the Fund of all records that may be reasonably required in connection with the audit performed by the Fund’s independent registered public accountants, or by the Securities and Exchange Commission (“SEC”), the Internal Revenue Service (“IRS”) or such other Federal or state regulatory agencies; · cooperating with the Fund’s independent registered public accountants and taking all reasonable action in the performance of its obligations under the Agreement to assure that the necessary information is made available to such accountants for the expression of their opinion without any qualification as to the scope of their examination including, but not limited to, their opinion included in the Fund’s annual report on Form N-CSR and annual amendment to Form N-1A; · implementing and maintaining the systems, data storage and reporting necessary to perform services outlined herein; · all efforts concerning financial reporting services, including shareholder reports and financial information in regulatory filings; N-PORT and N-CEN; and other financial reporting services as necessary; · determining financial reporting policies, maintaining adequate controls over financial reporting to provide complete and accurate financial information and disclosures that are certified by officers of the Funds. Providing sub-certifications, as requested by officers of the Funds, for the adequacy of such controls and the completeness and accuracy of information included in Form N-CSR or any other form that may require certification; · periodic testing of Internal Revenue Code qualification requirements; · prepare and furnish fund performance information; · prepare and disseminate vendor survey information; · prepare and file Rule 24f-2 notices and payment; and · such other administrative services as agreed to by the parties, not otherwise performed by Price Associates under the Investment Management Agreement.

  • EFT SERVICES If approved, you may conduct any one (1) or more of the EFT services offered by the Credit Union.

  • Development Services During the term of this Agreement, the Provider agrees to provide to or on behalf of the Port the professional services and related items described in Exhibit A (collectively, the “Development Services”) in accordance with the terms and conditions of this Agreement. The Provider specifically agrees to include at least one Port representative in any economic development negotiations or discussions in which the Provider is involved concerning (i) a port-related business prospect or (ii) a business transaction which will ultimately require Port involvement, financial or otherwise.

  • Construction Management Services a. A-E may be required to review and recommend approval of submittals, shop drawings, Request for Information (RFI) and/or calculations for temporary structures such as trench shoring, false work and other temporary structural forms. b. A-E may be required to review and advise the County Representative on the overall project schedule, including staging and completion dates, duration, milestones, and interfaces. Immediately notify Representative if the proposed work schedule does not conform to the contract documents, including the plans, specifications, and permits or that may require special inspection or testing, or work stoppage. c. Review on a monthly basis the project schedule and/or Critical Path Method (CPM) schedule submitted by the Construction Contractor. Make recommendations concerning the Construction Contractor’s adherence thereto. Recommend possible solutions to scheduling problems so as to complete the project on time, within budget, and in accordance with the contract drawings and specifications. d. Review scope of work and identify potential contract change orders. Prepare independent cost estimates for any changes resulting from design revisions or change in field conditions. Prepare and recommend for approval all contract change orders. e. Evaluate the merit of any potential claims or requests for equitable adjustment submitted by the Construction Contractor. Prepare analysis of potential claims include recommendations regarding settlement of the claims. f. Assist County staff in project related issues with other Agencies, or departments, engineering and material testing support firms, CEQA consultants, utilities agencies, etc. g. Assist in community outreach meetings and media relations h. Review for acceptance/approval of Storm Water Pollution Prevention Plan (SWPPP) in accordance with the general Permit of Discharges of Storm Water Associated with Construction Activity (Construction General Permit, including dewatering/diversion plans per the State’s DeMinimus Permit).

  • Cloud Services You will not intentionally (a) interfere with other customers’ access to, or use of, the Cloud Service, or with its security; (b) facilitate the attack or disruption of the Cloud Service, including a denial of service attack, unauthorized access, penetration testing, crawling, or distribution of malware (including viruses, trojan horses, worms, time bombs, spyware, adware, and cancelbots); (c) cause an unusual spike or increase in Your use of the Cloud Service that negatively impacts the Cloud Service’s operation; or (d) submit any information that is not contemplated in the applicable Documentation.

  • Asset Management Services (i) Real Estate and Related Services: (a) Investigate, select and, on behalf of the Company, engage and conduct business with (including enter contracts with) such Persons as the Advisor deems necessary to the proper performance of its obligations as set forth in this Agreement, including but not limited to consultants, accountants, lenders, technical advisors, attorneys, brokers, underwriters, corporate fiduciaries, escrow agents, depositaries, custodians, agents for collection, insurers, insurance agents, developers, construction companies, Property Managers and any and all Persons acting in any other capacity deemed by the Advisor necessary or desirable for the performance of any of the foregoing services; (b) Negotiate and service the Company’s debt facilities and other financings; (c) Monitor applicable markets and obtain reports (which may be prepared by the Advisor or its Affiliates) where appropriate, concerning the value of investments of the Company; (d) Monitor and evaluate the performance of each asset of the Company and the Company’s overall portfolio of assets, provide daily management services to the Company and perform and supervise the various management and operational functions related to the Company’s investments; (e) Formulate and oversee the implementation of strategies for the administration, promotion, management, operation, maintenance, improvement, financing and refinancing, marketing, leasing and disposition of Properties, Loans and other Permitted Investments on an overall portfolio basis; (f) Consult with the Company’s officers and the Board and assist the Board in the formulation and implementation of the Company’s financial policies, and, as necessary, furnish the Board with advice and recommendations with respect to the making of investments consistent with the investment objectives and policies of the Company and in connection with any borrowings proposed to be undertaken by the Company; (g) Oversee the performance by the Property Managers of their duties, including collection and proper deposits of rental payments and payment of Property expenses and maintenance; (h) Conduct periodic on-site property visits to some or all (as the Advisor deems reasonably necessary) of the Properties to inspect the physical condition of the Properties and to evaluate the performance of the Property Managers; (i) Review, analyze and comment upon the operating budgets, capital budgets and leasing plans prepared and submitted by each Property Manager and aggregate these property budgets into the Company’s overall budget; (j) Coordinate and manage relationships between the Company and any co-venturers or partners; and (k) Consult with the Company’s officers and the Board and provide assistance with the evaluation and approval of potential asset dispositions, sales and refinancings. (ii) Accounting and Other Administrative Services: (a) Provide the day-to-day management of the Company and perform and supervise the various administrative functions reasonably necessary for the management of the Company; (b) From time to time, or at any time reasonably requested by the Board, make reports to the Board on the Advisor’s performance of services to the Company under this Agreement; (c) Make reports to the Conflicts Committee each quarter of the investments that have been made by other programs sponsored by the Advisor or any of its Affiliates, including KBS Realty Advisors LLC, as well as any investments that have been made by the Advisor or any of its Affiliates directly; (d) Provide or arrange for any administrative services and items, legal and other services, office space, office furnishings, personnel and other overhead items necessary and incidental to the Company’s business and operations; (e) Provide financial and operational planning services; (f) Maintain accounting and other record-keeping functions at the Company and investment levels, including information concerning the activities of the Company as shall be required to prepare and to file all periodic financial reports, tax returns and any other information required to be filed with the SEC, the Internal Revenue Service and any other regulatory agency; (g) Maintain and preserve all appropriate books and records of the Company; (h) Provide tax and compliance services and coordinate with appropriate third parties, including the Company’s independent auditors and other consultants, on related tax matters; (i) Provide the Company with all necessary cash management services; (j) Manage and coordinate with the transfer agent the dividend process and payments to Stockholders; (k) Consult with the Company’s officers and the Board and assist the Board in evaluating and obtaining adequate insurance coverage based upon risk management determinations; (l) Provide the Company’s officers and the Board with timely updates related to the overall regulatory environment affecting the Company, as well as managing compliance with such matters, including but not limited to compliance with the Xxxxxxxx-Xxxxx Act of 2002; (m) Consult with the Company’s officers and the Board relating to the corporate governance structure and appropriate policies and procedures related thereto; (n) Perform all reporting, record keeping, internal controls and similar matters in a manner to allow the Company to comply with applicable law, including federal and state securities laws and the Xxxxxxxx-Xxxxx Act of 2002; (o) Notify the Board of all proposed material transactions before they are completed; and (p) Do all things necessary to assure its ability to render the services described in this Agreement.

  • Support Services Rehabilitation, counselling and EAP’s. Support is strictly non- punitive, and can be accessed at anytime (self-identification of the need for help is strongly encouraged).

  • TRANSPORT SERVICES Upon the conclusion of such multilateral negotiations, the Parties shall conduct a review for the purpose of discussing appropriate amendments to this Agreement so as to incorporate the results of such multilateral negotiations.

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