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.
Sample 1Sample 2Sample 3See All (11)
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 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
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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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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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.

  • 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 Unless otherwise stated in the Agreement or in the Order, Company grants Customer a limited, non-transferable, non-sublicenseable, non-exclusive, worldwide license to access and use the Number of Units of Cloud Services during the Term solely for internal business purposes in accordance with the applicable license restrictions stated in the Business Unit Terms, Order, and Documentation. Additional Cloud Service Terms are stated at xxxxx://xxxxx.xxxxx.xxx/#cloud-services, which are incorporated by reference.

  • 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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