CORE BENEFITS AND SERVICES Sample Clauses

CORE BENEFITS AND SERVICES. The CONTRACTOR shall cover the physical health and Behavioral Health Services outlined within this Section of this contract.
Sample 1Sample 2Sample 3See All (13)
AutoNDA by SimpleDocs
CORE BENEFITS AND SERVICES. The CONTRACTOR shall cover the physical health and Behavioral Health Services outlined within this Section of this contract. Ambulance ✓ Ancillary Medical Services ✓ Audiological Services ✓ Autism Spectrum Disorder (ASD) Services ✓ Behavioral Health and Outpatient Services ✓ Chiropractic Care ✓ Community Long Term Care Waiver Services ✓ Communicable Disease Services ✓ Dental Services ✓ Developmental Evaluation Centers ✓ Durable Medical Equipment ✓ Early Intervention Services ✓ EPSDT ✓ Emergency and Post Stabilization Services ✓ Family Planning ✓ Home Health Services ✓ Hysterectomies ✓ Independent Laboratory and X-Ray Services ✓ Inpatient Hospital Services ✓ Institutional Long-Term Care Facilities/Nursing Facilities 90 Days appx Maternity Services ✓ Outpatient Services ✓ Pharmacy ✓ Physician Services ✓ Rehabilitative Therapies for Children ✓ Sterilization ✓ Substance Abuse ✓ Targeted Case Management Referral Assistance Transplant and Transplant Related Services ✓ Vaccine Services ✓ Vision Care Exams ✓ 4.1 General Core Benefits and Services Requirements Core Benefits shall be available to each Medicaid Managed Care Member within the CONTRACTOR's Service Area. The CONTRACTOR shall provide Core Benefits and services to Medicaid Managed Care Members, pursuant to the provisions of this contract. The CONTRACTOR shall: 4.1.1 Implement Procedures to coordinate the delivery of physical health, Behavioral Health, and long-term care services that it furnishes with services the member receives from any other entity. 4.1.2 Furnish Core Benefits and services in accordance with Medical Necessity and in an amount, duration, and scope that is no less than the amount, duration, and scope for the same services furnished to beneficiaries and for beneficiaries under the age of 21 up to the limits as specified in the Medicaid FFS Program as defined in the State Plan, administrative rule and Department Process and Procedure Manual and all applicable federal and state statues, rule, and regulations. (42 CFR § 438.210(a)(2)) 4.1.3 Follow any modified version of a Core Benefit and/or service under the Medicaid FFS Program—the amount, duration and/or scope of services— unless otherwise exempted by the Department. 4.1.4 Honor and pay for Core Benefits and services for new Medicaid Managed Care Members or when a new Benefit/service is added as a Core Benefit/service. 4.1.5 Ensure that services are covered in accordance with 42 CFR § 438.210, as follows: 4.1.5.1 Shall ensure that servic...
Sample 1Sample 2
CORE BENEFITS AND SERVICES. The CONTRACTOR shall cover the physical health and Behavioral Health Services outlined within this Section of this contract. Ambulance ✓ Ancillary Medical Services ✓ Audiological Services ✓ Autism Spectrum Disorder (ASD) Services ✓ Behavioral Health and Outpatient Services ✓ Chiropractic Care ✓ Community Long Term Care Waiver Services ✓ Communicable Disease Services ✓ Dental Services ✓ Developmental Evaluation Centers ✓ 2/1/2024 Carve In Durable Medical Equipment ✓ Early Intervention Services ✓ EPSDT ✓ Emergency and Post Stabilization Services ✓ Family Planning ✓ Home Health Services ✓ Hysterectomies ✓ Independent Laboratory and X-Ray Services ✓ Inpatient Hospital Services ✓ Institutional Long-Term Care Facilities/Nursing Facilities 90 Days appx Maternity Services ✓ Outpatient Services ✓ Pharmacy ✓ Physician Services ✓ Rehabilitative Therapies for Children ✓ Sterilization ✓ Substance Abuse ✓ Targeted Case Management Referral Assistance Transplant and Transplant Related Services ✓ Fully Carved In 2/1/2024 Vaccine Services ✓ Vision Care Exams ✓
Sample 1
CORE BENEFITS AND SERVICES. The CONTRACTOR shall cover the physical health and Behavioral Health Services outlined within this Section of this contract. Ambulance ✓ Ancillary Medical Services ✓ Audiological Services ✓ Autism Spectrum Disorder (ASD) Services ✓ Behavioral Health and Outpatient Services ✓ Chiropractic Care ✓ Community Long Term Care Waiver Services ✓ Communicable Disease Services ✓ Dental Services ✓ Developmental Evaluation Centers ✓ Durable Medical Equipment ✓ Early Intervention Services ✓ EPSDT ✓ Emergency and Post Stabilization Services ✓ Family Planning ✓ Home Health Services ✓ Hysterectomies ✓ Independent Laboratory and X-Ray Services ✓ Inpatient Hospital Services ✓ Institutional Long-Term Care Facilities/Nursing Facilities 90 Days appx Maternity Services ✓ Outpatient Services ✓ Pharmacy ✓ Physician Services ✓ Rehabilitative Therapies for Children ✓ Sterilization ✓ Substance Abuse ✓ Targeted Case Management Referral Assistance Transplant and Transplant Related Services ✓ Vaccine Services ✓ Vision Care Exams ✓
Sample 1
CORE BENEFITS AND SERVICES. Core benefits and services, as defined in Appendix B, shall be available through the CCN to each Medicaid member within the Coordinated Care Network - Prepaid. The CCN shall provide a mechanism to reduce inappropriate and duplicative use of health care services. Services shall be furnished in an amount, duration, and scope that is no less than the amount, duration, and scope for the same services furnished to eligibles under Medicaid fee-for-service as specified in 42 CFR §438.210(a)(1) and (2) and must meet the requirements set forth in this Provider Agreement and CCN-P Policy and Procedure Guide. The CCN: 4.1.1 Shall ensure that services are sufficient in amount, duration, and scope to reasonably be expected to achieve the purpose for which the services are furnished. 4.1.2 May not arbitrarily deny or reduce the amount, duration, or scope of a required service because of diagnosis, type of illness, or condition of the member; 4.1.3 May place appropriate limits on a service (a) on the basis of certain criteria, such as medical necessity; or (b) for the purpose of utilization 4.1.4 May exceed the limits as specified in the minimum FFS service requirements outlined in CCN-P Policy and Procedure Guide. No medical service limitation can be more restrictive than those that currently exist under the Title XIX Louisiana Medicaid State Plan. 4.1.5 In the provision of core benefits and services outlined and defined in this Provider Agreement and the CCN-
Sample 1
CORE BENEFITS AND SERVICES. The CONTRACTOR shall cover the physical health and Behavioral Health Services outlined within this Section of this contract. Ambulance ✓ Ancillary Medical Services ✓ Audiological Services ✓ Behavioral Health and Outpatient Services ✓ Chiropractic Care ✓ Community Long Term Care Waiver Services ✓ Comunicable Disease Services ✓ Dental Services ✓ Developmental Evaluation Centers ✓ Durable Medical Equipment ✓ EPSDT ✓ Emergency and Post Stabilization Services ✓ Family Planning ✓ Home Health Services ✓ Hysterectomies ✓ Independent Laboratory and X-Ray Services ✓ Inpatient Hospital Services ✓ Institutional Long-Term Care Facilities/Nursing Facilities 90 Days appx Maternity Services ✓ Outpatient Services ✓ Pharmacy ✓ Physician Services ✓ Rehabilitative Therapies for Children ✓ Sterilization ✓ Substance Abuse ✓ Targeted Case Management Referral Assistance Transplant and Transplant Related Services Limited – See P&P Vaccine Services ✓ Vision Care Exams ✓
Sample 1

Related to CORE BENEFITS AND SERVICES

  • Services and Compensation Consultant shall perform the services described in Exhibit A (the “Services”) for the Company (or its designee), and the Company agrees to pay Consultant the compensation described in Exhibit A for Consultant’s performance of the Services.

  • Compensation and Fringe Benefits (a) The Company shall, during the Term of Employment, pay to the Executive as compensation for the performance of his duties and obligations a salary of $240,000 per annum. This compensation is subject to annual review and adjustment, as appropriate in the judgment of the Company. The compensation payable pursuant to this Section 5(a) shall be payable in equal semi-monthly installments on the last day of each such pay period. (b) The Executive shall be enrolled and participate in any retirement, group insurance and other fringe benefit plans and arrangements which are applicable to the similarly situated personnel of the Company and in effect from time to time, if the Executive is eligible therefor, in each case in accordance with and subject to the provisions thereof.

  • Programs and Services Every aspect of the service you provide is considered part of your program, and therefore it must be accessible to individuals with disabilities. This includes parking lots, service counters and spaces, transportation (shuttles, etc.), agendas, flyers, emails, online services, phone calls, meetings, celebrations, classes, recreational activities and more. The guidance in this document is primarily intended to help you provide accessible programs by providing you with the tools to: ▪ survey facilities and identify common architectural barriers for people with disabilities; ▪ identify common ADA compliance problems in your communications and activities; and ▪ remove barriers and fix common ADA compliance problems in these areas. Your programs can be broken into three main categories, (Communications, Facilities, and Activities) which will be covered in more detail below.

  • Enhanced Services The State encourages the Contractor to cover programs that enhance the general health and well-being of its Hoosier Healthwise members, including programs that address preventive health, risk factors or personal responsibility. These enhanced programs and services are above and beyond those covered in the Hoosier Healthwise program. In addition, all enhanced services shall comply with the member incentives guidelines set forth in Section 6.2.2 and other relevant state and federal rules regarding inducements. All enhanced services offered by the Contractor must be pre-approved by OMPP prior to initiating such services. Enhanced services may include, but are not limited to, such items as:

  • Compensation Benefits and Reimbursement (a) The compensation specified under this Agreement shall constitute the salary and benefits paid for the duties described in Section 2. The Bank shall pay Executive as compensation a salary of not less than [$ ] per year (“Base Salary”). Such Base Salary shall be payable biweekly, or with such other frequency as officers and employees are generally paid. During the period of this Agreement, Executive’s Base Salary shall be reviewed at least annually. Such review shall be conducted by a committee designated by the Board, and the Bank may increase, but not decrease (except a decrease that is generally applicable to all employees) Executive’s Base Salary (with any increase in Base Salary to become “Base Salary” for purposes of this Agreement). Base Salary shall not include any director’s fees that the Executive is entitled to receive as a director of the Bank or any affiliate of the Bank. Such director’s fees shall be separately paid to the Executive. (b) Executive will be entitled to participate in and receive benefits under any employee benefit plans including, but not limited to, retirement plans, supplemental retirement plans, pension plans, profit-sharing plans, health-and-accident insurance plans, medical coverage or any other employee benefit plan or arrangement made available by the Bank currently or in the future to its senior executives and key management employees. Executive will be entitled to participate in any incentive compensation and bonus plans offered by the Bank in which Executive is eligible to participate. Nothing paid to Executive under any such plan or arrangement will be deemed to be in lieu of other compensation to which Executive is entitled under this Agreement. (c) In addition to the Base Salary provided for by paragraph (a) of this Section 3, the Bank shall pay or reimburse Executive for all reasonable travel and other reasonable expenses incurred by Executive performing his obligations under this Agreement and may provide such additional compensation in such form and such amounts as the Board may from time to time determine. The Bank shall reimburse Executive for his ordinary and necessary business expenses including, without limitation, fees for memberships in such clubs and organizations as Executive and the Board shall mutually agree are necessary and appropriate for business purposes, and travel and entertainment expenses, incurred in connection with the performance of his duties under this Agreement.

  • Compensation and Benefits Subject to the terms and conditions of this Agreement, during the Employment Period, while Executive is employed by the Employer, the Employer shall compensate Executive for Executive’s services as follows for periods following the Effective Date: (a) Executive shall be compensated at an annual rate of $290,000 (the “Annual Base Salary”), which shall be payable in accordance with the Employer’s normal payroll practices as are in effect from time to time. Beginning on January 1, 2012 and on each anniversary of such date, Executive’s rate of Annual Base Salary shall be reviewed by the Compensation Committee (the “Compensation Committee”) of the Board of Directors of the Company (the “Board”), and following such review, the Annual Base Salary may be adjusted upward but in no event will it be decreased. (b) Executive shall be entitled to receive performance based annual incentive bonuses (each, the “Incentive Bonus”) from the Employer for each fiscal year ending during the Employment Period. Any such Incentive Bonus shall be paid to Executive within thirty (30) days of the completion of the annual audit by the Company’s auditor, but in no event later than two and one-half months after the close of each such fiscal year. Executive’s target Incentive Bonus shall be not less than forty percent (40%) of the Annual Base Salary, which Incentive Bonus shall be determined by specific performance criteria established from time to time by the Compensation Committee. (c) Executive shall be eligible to participate, subject to the terms and conditions thereof, in all other incentive plans and programs, including such cash and deferred bonus programs and equity incentive plans as may be in effect from time to time with respect to senior executives employed by the Employer on as favorable a basis as provided to other similarly situated senior executives. Executive and Executive’s dependents, as the case may be, shall be eligible to participate in all pension and similar benefit plans (qualified, non-qualified and supplemental), profit sharing, 401(k), as well as all medical and dental, disability, group and executive life, accidental death and travel accident insurance, and other similar welfare benefit plans and programs of the Employer, subject to the terms and conditions thereof, as in effect from time to time with respect to senior executives employed by the Employer on as favorable a basis as provided to other similarly situated senior executives. (d) Executive shall be entitled to accrue vacation at a rate of no less than four (4) weeks paid vacation for each calendar year, subject to the Employer’s vacation programs and policies as may be in effect during the Employment Period. (e) Executive shall be reimbursed by the Employer, on terms and conditions that are substantially similar to those that apply to other similarly situated executives of the Employer, for reasonable out-of-pocket expenses for entertainment, travel, meals, lodging and similar items which are consistent with the Employer’s expense reimbursement policy and actually incurred by Executive in the promotion of the Employer’s business.

  • Developer Compensation for Emergency Services If, during an Emergency State, the Developer provides services at the request or direction of the NYISO or Connecting Transmission Owner, the Developer will be compensated for such services in accordance with the NYISO Services Tariff.

  • Compensation for Services Provided As compensation for providing portfolio supervisory services in its capacity as Portfolio Supervisor, evaluation services in its capacity as Evaluator, and for providing bookkeeping and other administrative services to the Trust of a character described in Section 26(a)(2)(C) of the Investment Company Act of 1940, and to the extent that such services are in addition to, and do not duplicate, the services to be provided hereunder by the Trustee, First Trust Advisors L.P. shall receive, in arrears, against a statement or statements therefor submitted to the Trustee monthly or annually an aggregate annual fee in the per Unit amount set forth in Part II of the Trust Agreement for the Trust, calculated based on the largest number of Units outstanding during the calendar year, except during the initial offering period as determined in Section 4.01 of this Indenture, in which case the fee is calculated based on the largest number of Units outstanding during the period for which the compensation is paid (such annual fee to be pro rated for any calendar year in which First Trust Advisors L.P. provides services described herein during less than the whole of such year). Such fee may exceed the actual cost of providing such services for the Trust, but at no time will the total amount received for such services rendered to unit investment trusts of which the Depositor is the sponsor in any calendar year exceed the aggregate cost to First Trust Advisors L.P. of supplying such services in such year. Such compensation may, from time to time, be adjusted provided that the total adjustment upward does not, at the time of such adjustment, exceed the percentage of the total increase after the date hereof in consumer prices for services as measured by the United States Department of Labor Consumer Price Index entitled "All Services Less Rent of Shelter" or similar index, if such index should no longer be published. The consent or concurrence of any Unit holder hereunder shall not be required for any such adjustment or increase. Such compensation shall be paid by the Trustee, upon receipt of an invoice therefor from First Trust Advisors L.P., which shall constitute the representation by First Trust Advisors L.P. that the bookkeeping and administrative services for which compensation is claimed are properly compensable hereunder and that the aggregate cost incurred by First Trust Advisors L.P. of providing portfolio supervisory, evaluation and bookkeeping and administrative services hereunder was not less than the compensation claimed, upon which representation the Trustee may conclusively rely. Such compensation shall be charged against the Income and/or Capital Accounts in accordance with Section 3.05. If the cash balance in the Income and Capital Accounts shall be insufficient to provide for amounts payable pursuant to this Section 4.03, the Trustee shall have the power to sell (i) Securities from the current list of Securities designated to be sold pursuant to Section 5.02 hereof, or (ii) if no such Securities have been so designated, such Securities as the Trustee may see fit to sell in its own discretion, and to apply the proceeds of any such sale in payment of the amounts payable pursuant to this Section 4.03. Any moneys payable to First Trust Advisors L.P. pursuant to this Section 4.03 shall be secured by a lien on the Trust prior to the interest of Unit holders, but no such lien shall be prior to any lien in favor of the Trustee under the provisions of Section 6.04 herein.

  • Compensation for Consulting Services For each quarter (i.e., three-month period) that Executive provides consulting services to MediciNova pursuant to the option of MediciNova contained in Section 9 above, MediciNova shall pay Executive a sum equal to fifteen percent (15%) of Executive’s annual Base Compensation which shall be applicable at the time of Executive’s termination of employment with MediciNova (prorated for any period of less than a quarter). The parties expressly agree that when Executive is performing consulting services for MediciNova, Executive is acting as an independent contractor. Therefore, Executive shall be solely liable for Social Security and income taxes that result from Executive’s compensation as a consultant. In addition, Executive shall not be entitled to any other benefits including, without limitation, such group medical, life and disability insurance and other benefits as may be provided to employees and/or executives of MediciNova.

  • Health Benefits For the eighteen (18) month period following the Termination Date, provided that Executive is eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretion.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!