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.
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.
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.
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.
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.
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.”
