Common use of Carved-out Services Clause in Contracts

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.

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. Respondents The Contractor shall describe maintain strategies proposed to ensure coordination for carved-out services.