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 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. Some services are not included in the Contractor’s capitation rates for the Hoosier Healthwise HIP 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- 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- carved-out services are the responsibility of the Contractor for reimbursement. Listed below are the carved-out services in the Hoosier Healthwise HIP program and the conditions under which related services are the Contractor’s responsibility. The Hoosier Healthwise 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 HIP 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- 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- carved-out services are the responsibility of the Contractor for reimbursement. Listed below are the carved-out services in the Hoosier Healthwise HIP program and the conditions under which related services are the Contractor’s responsibility. The Hoosier Healthwise HIP MCE Policies and Procedures Manual describes these carved-out services in greater detail. 3.11.1 Medicaid Rehabilitation Option (MRO) Services 3.11.2 1915(i) State Plan Home and Community-Based Services