Coordination of Health Care Services Sample Clauses

Coordination of Health Care Services. MA Health Plan shall provide the Dual Eligible SNP benefits to all Dual Eligible MA Health Plan enrollees who are qualified to receive such services under the terms of the MA Agreement. Under this Agreement, MA Health Plan shall retain responsibility for providing, or arranging for benefits to be provided for individuals entitled to receive medical assistance under Title XIX which are Medicare covered benefits and any supplemental benefits as filed by MA Health Plan and approved by CMS. 2.3.1 On an annual basis, MA Health Plan shall determine its benefits for the calendar year that will be provided to Dual Eligible enrollees under the Dual Eligible SNP. Such benefits will be approved by CMS prior to January 1 of each successive calendar year. 2.3.2 MA Health Plan shall develop comparison charts (“Comparison Charts”) summarizing the products and services offered under the various MA Health Plan’s Dual Eligible SNP plans for each service area in the State. To be included on the comparison chart are (i) list of benefits offered by the MA Health Plan; (ii) a list of Medicaid benefits offered by the State to qualified Dual Eligible beneficiaries; (iii) MA Health Plan’s defined cost sharing for each benefit; (iv) the State’s Medicaid Cost Sharing Obligations for each benefit; and (v) identification of overlap between MA Health Plan’s benefits, services and cost sharing with the State’s Medicaid Cost Sharing Obligations for each benefit and each qualified beneficiary. The State will review and approve the comparison charts with regard to appropriate documentation of Medicaid benefits and cost sharing offered by the State. 2.3.3 MA Health Plan shall distribute such Comparison Charts to appropriate MA Health Plan departments and personnel for the express purpose of providing education and resources to MA Health Plan staff to enable efficient and appropriate coordination of benefits that may be available to Dual Eligible enrollees under their State Medicaid program. 2.3.4 MA Health Plan shall distribute such Comparison Charts to MA Health Plan participating providers for the express purpose of providing education and resources to MA Health Plan participating providers to enable efficient and appropriate collection of applicable cost sharing under MA Health Plan’s Dual Eligible SNP plan benefits and as required by Section 2.4 of this Agreement.
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Coordination of Health Care Services. To the extent and in the manner ------------------------------------ required by the terms of the Master Agreement, Provider will cooperate with each behavioral health organization (BHO) and the primary care providers under contract with or employed by such BHO who provide medical services to Enrollees in an effort to (i) coordinate and integrate health care services provided to each Enrollee by such providers and Provider, (ii) help ensure the appropriateness of all health care services provided to Enrollee and (iii) help ensure that such health care services are provided in a manner that allows the most efficient use of resources and the achievement of quality health outcomes.
Sample 1
Coordination of Health Care Services. MA Health Plan will provide the Dual Eligible Special Needs Plan benefits to all Dual Eligible MA Health Plan enrollees who are qualified to receive such services under the terms of the MA Agreement. Under this Agreement, MA Health Plan shall retain responsibility for providing or arranging for benefits to be provided for individuals entitled to receive medical assistance under Title XIX which are Medicare covered benefits and any supplemental benefits as filed by MA Health Plan and approved by CMS. Health Plan will coordinate access to Medicaid covered services. Such coordination may include identification and referrals to needed services, assistance in care planning, and assistance in obtaining appointments for needed services.”
Sample 1
Coordination of Health Care Services. To the extent and in the manner required by the terms of the Plan Contract, Provider will cooperate with each MCO and the primary care providers under contract with or employed by such MCO who provide medical services, to Enrollees in an effort to (i) coordinate and integrate health care services provided to each Enrollee by such providers and Provider, (ii) help ensure the appropriateness of all health care services provided to the Enrollee and (iii) help ensure that such health care services are. provided in a manner that allows the most efficient use of resources and the achievement of quality health outcomes.
Sample 1
Coordination of Health Care Services. MA Health Plan shall provide the Dual Eligible SNP benefits to all Dual Eligible MA Health Plan enrollees who are qualified to receive such services under the terms of the MA Agreement. Under this Agreement, MA Health Plan shall retain responsibility for providing, or arranging for benefits to be provided for individuals entitled to receive medical assistance under Title XIX which are Medicare covered benefits and any supplemental benefits as filed by MA Health Plan and approved by CMS. 2.3.1 On an annual basis, MA Health Plan shall determine its benefits for the calendar year that will be provided to Dual Eligible enrollees under the Dual Eligible SNP. Such benefits will be approved by CMS prior to January 1 of each successive calendar year. 2.3.2 MA Health Plan shall develop comparison charts (“Comparison Charts”) summarizing the products and services offered under the various MA Health Plan’s Dual Eligible SNP plans for each service area in the State. To be included on the comparison chart are (i) list of benefits offered by the MA Health Plan; (ii) a list of Medicaid benefits offered by the State to qualified Dual Eligible beneficiaries; (iii) MA Health Plan’s defined cost sharing for each benefit;
Sample 1

Related to Coordination of Health Care Services

  • COVERED HEALTHCARE SERVICES This section describes covered healthcare services. This plan covers services only if they meet all of the following requirements: • Listed as a covered healthcare service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered healthcare service under this plan. • Medically necessary, consistent with our medical policies and related guidelines at the time the services are provided. • Not listed in Exclusions Section. • Received while a member is enrolled in the plan. • Consistent with applicable state or federal law. We review medical necessity in accordance with our medical policies and related guidelines. Our medical policies can be found on our website. Our medical policies are written to help administer benefits for the purpose of claims payment. They are made available to you for informational purposes and are subject to change. Medical policies are not meant to be used as a guide for your medical treatment. Your medical treatment remains a decision made by you with your physician. If you have questions about our medical policies, please call Customer Service. When a new service or drug becomes available, when possible, we will review it within six (6) months of one of the events described below to determine whether the new service or drug will be covered: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final Food and Drug Administration (FDA) approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). During the review period, new services and drugs are not covered. For all covered healthcare services, please see the Summary of Medical Benefits and the Summary of Pharmacy Benefits to determine the amount that you pay and any benefit limits.

  • Vision Care Services For purposes of coordination of benefits, vision care services covered under other plans are not considered an allowable expense, as defined in the Coordination of Benefits and Subrogation in Section 7.

  • Office Visits (other than Preventive Care Services) This plan covers office and clinic visits to diagnose or treat a sickness or injury. Office visit copayments differ depending on the type of provider you see. This plan covers physician visits in your home if you have an injury or illness that: • confines you to your home; or • requires special transportation; and • because of this injury or illness, you are physically unable to travel to the provider’s

  • Home Health Care This plan covers the following home care services when provided by a certified home healthcare agency: • nursing services; • services of a home health aide; • visits from a social worker; • medical supplies; and • physical, occupational and speech therapy.

  • Health Care Operations “Health Care Operations” shall have the same meaning as the term “health care operations” in 45 CFR §164.501.

  • REGULATORY ADMINISTRATION SERVICES BNY Mellon shall provide the following regulatory administration services for each Fund and Series:  Assist the Fund in responding to SEC examination requests by providing requested documents in the possession of BNY Mellon that are on the SEC examination request list and by making employees responsible for providing services available to regulatory authorities having jurisdiction over the performance of such services as may be required or reasonably requested by such regulatory authorities;  Assist with and/or coordinate such other filings, notices and regulatory matters and other due diligence requests or requests for proposal on such terms and conditions as BNY Mellon and the applicable Fund on behalf of itself and its Series may mutually agree upon in writing from time to time; and

  • Core Services The Company agrees to provide to the Municipality the Core Services set forth in Schedule “A”. The Company and the Municipality may amend Schedule “A” from time to time upon mutual agreement.

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

  • Extended Health Care Plan ‌ The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable extended health care plan.

  • Educational Services Any service or supply for education, training or retraining services or testing including: special education, remedial education; cognitive remediation; wilderness/outdoor treatment, therapy or adventure programs (whether or not the program is part of a Residential Treatment facility or otherwise licensed institution); job training or job hardening programs; educational services and schooling or any such related or similar program including therapeutic programs within a school setting.

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