Common use of Carved-out Services Clause in Contracts

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 HIP populations and, therefore, are not the responsibility of the Contractor. These services are referred to as “carved-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.