Cost of Care Sample Clauses

Cost of Care is the valuation of Covered Services and other health care services provided or arranged by Medical Group, as described in Section 5.7.
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Cost of CareCertain provisions of this Agreement require that Medical Group provide or arrange health care services which are not covered by Capitation Payments at Cost of Care and certain provisions of this Agreement require that Covered Services be valued at Cost of Care. For purposes of this Agreement, “Cost of Care” shall be calculated using the lesser of billed charges or in accordance with the PacifiCare Fee Schedule. The PacifiCare Fee Schedule shall be based upon the following: (i) for professional services that are included under the Medicare RBRVS Fee Schedule, reimbursement shall be one hundred percent (100%) of Medicare’s geographically adjusted fee schedule according to the Medicare payment locality the provider resides in; (ii) for all other health care services (other than inpatient and outpatient Hospital Services) that are not included in RBRVS but included in a Medicare Fee Schedule, reimbursement shall be one hundred percent (100%) of the Medicare rate for the current period as released by HCFA by December of the preceding year; (iii) for inpatient and outpatient Hospital Services, the Cost of Care shall be the actual amounts paid by PacifiCare; (iv) for any other Covered Services that do not fall within any of the above specified categories, (other than inpatient and outpatient Hospital Services), reimbursement shall be the lesser of fifty percent (50%) of billed charges or amount determined under PacifiCare’s Fee Schedule.
Cost of Care is the value of Medical Services as defined in this Agreement and as calculated pursuant to the formula set forth in Attachment A4, incorporated in full herein by reference.
Cost of CareCertain provisions of this Agreement require that Medical Group provide or arrange health care services which are not covered by Capitation Payments at Cost of Care and certain provisions of this Agreement require that Covered Services be valued at Cost of Care. For purposes of this Agreement, “Cost of Care” shall mean the amount determined to be payable for such health care services or Covered Services by PacifiCare as follows: (i) for professional services which are paid under the Medicare Fee Schedule, the Cost of Care shall be the lesser of billed charges or amount payable under the Medicare Fee Schedule; (ii) for all other health care services (other than inpatient and outpatient Hospital Services) which are paid by Medicare, the Cost of Care shall be the lesser of billed charges or amount payable by Medicare; (iii) for any other Covered Services or health care services covered under a Managed Care Plan which do not fall within any of the above specified categories, other than inpatient and outpatient Hospital Services, the Cost of Care shall be the lesser of billed charges or amount determined under PacifiCare’s allowable fee schedule.
Cost of Care. Definition Cost of care for Medicaid clients with diabetes Target Population(s) • Medicaid clients with a diagnosis of diabetes Measure Xxxxxxx or Source N/A Technical Specifications Clients with diabetes have a diagnosis according to the HEDIS® Value Set: Diabetes Cost of care based on all encounters data for each client with diabetes during the measurement period Exclusion Criteria STAR+PLUS eligible members 65 years and older Medicare/Medicaid (dual eligible). Data Source(s)/ Data Collection Method(s) • Medicaid encounter data • Medicaid enrollment file Comparison Group(s)/ Subgroup(s) • RHP and/or RHP tier • Race/ethnicity Analytic Method(s) • Difference-in-difference comparison of cost of care for Medicaid clients with diabetes seen by a DSRIP performing provider versus those seen by non-DSRIP providers o Proposed pre-period: DY4 o Proposed post-period: DY8 Benchmark • None Hypothesis 1.3: DSRIP incentivized performing providers to improve quality-related outcomes, specified as Category C population-based clinical outcome measures.
Cost of CareCertain provisions of this Agreement require that Medical Group provide health care services which are not covered by Capitation Payments at Cost of Care and certain provisions of this Agreement require that Medical Group Services be valued at
Cost of Care a. The self-pay Resident agrees to pay AH the sum of $ per day, payable monthly in advance for services outlined in this agreement. b. If the Resident has filed a Medicaid application or is in the process of filing a Medicaid application, he/she must pay AH the monthly rate stated in the paragraph above until her/his Medicaid application is approved. AH shall refund any and all excess payment on the account upon receipt of the Medicaid approval. c. If the Resident is covered by Medicaid, he/she must remit his/her monthly income from different sources, known as Net Annual Monthly Income (NAMI), to AH as specified by the Department of Social Services. It is the responsibility of the Resident or Responsible Party to remit payment within five days into the current month. d. When a Resident applies for Medicaid coverage (while his or her Medicaid application is pending), he/she must start remitting his/her estimated NAMI to AH on a monthly basis from the desired effective date of coverage.
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Cost of CareAnother person who has voluntarily agreed to pay with his/her own funds (list below). _________________________________________________________________________________
Cost of CareCertain provisions of this Agreement require that Medical Group provide health care services which are not covered by Capitation Payments at Cost of Care and certain provisions of this Agreement require that Medical Group Services be valued at Cost of Care. For purposes of this Agreement, "Cost of Care" shall mean the amount determined under Health Plan's fee schedule, attached as EXHIBIT 1 to the Base Agreement for such services. Health Plan may revise its fee-schedule from time to time by providing thirty (30) days prior written notice to Medical Group; provided, however, that the fee schedule utilized under this Agreement shall be no less favorable to Medical Group than the fee schedule utilized by Health Plan for other Participating Providers in the state.

Related to Cost of Care

  • Cost of Living Adjustments (Years 1 and 2: 2020-2021 and 2021-2022)

  • MAINTENANCE & REPAIR Tenant agrees that if there is any delay in maintenance or repairs for reasons beyond Landlord's control, this shall have no effect on Tenant's obligations under this lease.

  • Maintenance, Etc The Company will maintain, preserve and keep, and will cause each Consolidated Subsidiary to maintain, preserve and keep, its properties which are used in the conduct of its business (whether owned in fee or a leasehold interest) in good repair and working order, ordinary wear and tear excepted, and from time to time will make all necessary repairs, replacements and renewals as the Company may determine to be appropriate to the conduct of its business.

  • Maintenance of Profitability Seller shall not permit, for any Test Period, Net Income for such Test Period, before income taxes for such Test Period and distributions made during such Test Period, to be less than $1.00.

  • Maintenance & Repairs 5.1 Lessee shall at all times be responsible for maintaining at its own expense the leased premises in a clean, orderly and safety condition, except as hereinafter provided. Lessee shall be responsible, at its own expense, to clean and maintain all trade fixtures, machinery and equipment furnished by Lessee within the leased premises. Lessee shall be responsible to deposit normal office waste and rubbish at a location at the Central School as designated by Lessor. 5.2 Lessee shall be responsible to perform all repairs the need for which is caused by Xxxxxx's use of the premises except that Lessor shall be responsible to perform major repairs of a structural nature. Lessor shall be responsible to arrange for removal of waste and rubbish from the location designated as the deposit location for lessees. All costs incurred by Lessor pursuant to the obligations of this Paragraph shall be included within "operating costs". 5.3 Lessor shall provide custodian services for the common areas of Central School. Costs incurred by Lessor in providing such custodian services shall be included within "operating costs".

  • Cost of Collection If default is made in the payment of this Note, Borrower shall pay the Holder hereof reasonable costs of collection, including reasonable attorneys' fees.

  • Cost of Services Except to the extent specified otherwise in the Agreement, all costs of performing the Services are included in the Contract Price and TOMRA shall not be entitled to any further payment in respect thereof.

  • COST OF LIVING ALLOWANCE 29:01 All employees within the Bargaining Unit shall be paid a cost of living allowance based on the cost of living formula as set forth below: The cost of living allowance will be determined in accordance with changes in the Consumer Price Index, published by Statistics Canada (1961 = 100) and hereinafter referred to as the Consumer Price Index. The base Consumer Price Index shall be the Consumer Price Index for February 2016. The first (1st) cost of living adjustment shall be based on the Consumer Price Index of May, 2016, and each three (3) months thereafter compared to the base Consumer Price Index for February 2016. Cost of living adjustments shall be made on pay periods commencing 11:59 p.m. on the following dates: July 5, 2016; October 11, 2016; January 17, 2017; and April 10, 2017. The cost of living rate adjustment shall be One ($0.01) Cent per hour for each point five (.5) change in the Consumer Price Index. The cost of living allowance will be adjusted up or down if and as required for each quarterly period in accordance with the above mentioned formula, provided, however, that in no event will a decline in the Consumer Price Index below the figure as recorded for February, 2016, minus 2.5 points provide a basis for further reduction in the straight time rates set forth in Schedule "A" of the within Agreement. The amount of cost of living Allowance in effect at any time shall be included in computing vacation pay, holiday pay, call-in pay, sick pay, paid leave of absence and Workplace Safety Insurance Board payments. The amount of cost of living allowance shall be included in computing overtime pay except that there shall be no pyramiding as stated in clause 19:06 of the within Agreement. As of June 30, 2016, the cost of living rate adjustment less Five ($0.05) Cents* will be added to the base rates set forth in Schedule "A" in order to create new base rates - said new base rates to be effective as of July 1, 2016. Upon creation of new base rates as provided in the preceding paragraph, a new base Consumer Price Index shall be established and shall be calculated as being the Consumer Price Index for February 2016 minus 2.5 points. This article shall be frozen during the life of the Collective Agreement and no monies will be generated or paid during the term of the Collective Agreement. *The Five ($0.05) Cents referred to was folded into the Base Hourly Wage Rates noted in Schedule “A” effective July 1, 1986. The University of Windsor and C.U.P.E., Local 1001 recognize that some Employees in the Bargaining Unit are using the Sick Leave Plan for illness and various medical appointments above the normal average within the University staff. The Union believes it is the duty of the Employer to manage the Sick Leave Plan and the Union's duty to represent their members eligible to receive sick pay to the best of their ability. To assist the Employer with their concern over the use of the Plan and to protect the interest of the members against any possible erosion of the existing Plan, the Union agrees to counsel all employees by letter and by presentations at general meetings on the need for regular attendance. Further, the Union will encourage members, whenever possible, to schedule appointments after their shift has concluded or as near to the end of their shift as possible.

  • Equipment Maintenance The Contractor agrees that when Contract funds are used to pay for all or part of the purchase costs of any equipment that costs $5,000 or more per item, and the purchase of such equipment is identified in an exhibit to this Contract, such equipment is, upon the purchase or receipt, the property of the County and/or federal/state government. The Contractor shall be responsible for all proper care and maintenance of the equipment, including securing and insuring such equipment.

  • Cost of the Work The sum of all allowable costs necessarily incurred and paid by Contractor in the proper performance of the Work.

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