Case-by-Case Added Services. Except as provided below, the HMO may offer additional benefits that are outside the scope of services to individual Members on a case-by-case basis, based on Medical Necessity, cost-effectiveness, the wishes of the Member/Member’s family, the potential for improved health status of the Member, and for STAR+PLUS Members based on functional necessity.
Appears in 14 contracts
Samples: Contract Amendment (Centene Corp), Contract Amendment (Centene Corp), Contract Amendment (Centene Corp)
Case-by-Case Added Services. Except as provided below, the HMO may offer additional benefits that are outside the scope of services to individual Members on a case-by-case basis, based on Medical Necessity, cost-effectiveness, the wishes of the Member/Member’s family, the potential for improved health status of the Member, and for STAR+PLUS Members based on functional necessity.
Section 8.1. 2.2, Case-by-Case Added Services, does not apply to the CHIP Perinatal Program.
Appears in 1 contract
Samples: Contract Amendment (Centene Corp)
Case-by-Case Added Services. Except as provided below, the The HMO may offer additional benefits that are outside the scope of services to individual Members on a case-by-case basis, based on Medical Necessity, cost-effectiveness, the wishes of the Member/Member’s family, and the potential for improved health status of the Member. Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, and for STAR+PLUS Members based on functional necessity.Section 8 Version 1.0
Appears in 1 contract
Samples: Managed Care Contract (Centene Corp)
