Covered Medicaid Services Sample Clauses

Covered Medicaid Services a. The Health Plan shall ensure the provision of the Medicaid services as denoted by an “X” in Table 5 below and as specified in applicable exhibits to Attachment I, Scope of Services, and as defined in Attachment II, Core Contract Provisions, Section I, Definitions and Acronyms; Section V, Covered Services; and Section VI, Behavioral Health Care. b. For non-Reform populations, Medicaid State Plan dental services and transportation services (notated in Table 5 with an asterisk and in bold-type font) are considered optional services, and the Health Plan may request that the Agency allow the Health Plan to provide these services under this Contract. The denotation of an “X” in Table 5 below indicates the Agency has approved the Health Plan to cover these services. See Item 3, Other Service Requirements, of this subsection and Attachment II, Core Contract Provisions, Exhibit 5, Covered Services, for more information regarding optional services. (1) For optional dental services for the non-Reform population, the Health Plan is further limited as follows: (a) Dental services include the arrangement and provision of Medicaid State Plan dental services to the adult and child populations. The Health Plan shall comply with the limitations and exclusions in the Medicaid Dental Services Coverage and Limitations & Reimbursement Handbooks. (b) In no instance may the limitations or exclusions imposed by the Health Plan be more stringent than those specified in the Medicaid Dental Services Coverage and Limitations & Reimbursement Handbooks. (2) For optional transportation for the non-Reform population, the Health Plan is further limited as follows: (a) Only certain HMOs are authorized to provide transportation services to non- Reform populations. The only county for which optional transportation services may be authorized is Miami-Dade County. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract (b) Transportation services include the arrangement and provision of an appropriate mode of transportation, including emergency transportation services, for enrollees to receive medically necessary health care services. The Health Plan shall comply with the limitations and exclusions in the Medicaid Transportation Coverage and Limitations Handbook. (c) In no instance may the limitations or exclusions imposed by the Health Plan be more stringent than those specified in the Medicaid Transportation Coverage and Limitations Handbook. (d) If an “X” is listed in the Non-Reform c...
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Covered Medicaid Services. HMOs are not restricted to providing Wisconsin Medicaid covered services. Sometimes HMOs find that other treatment methods may be more appropriate than Medicaid covered services, or result in better outcomes. None of the provisions of this Contract that are applicable to Wisconsin Medicaid covered services apply to other services that an HMO may choose to provide, except that abortions, hysterectomies and sterilizations must comply with 42 CFR 441 Subpart E and 42 CFR 441 Subpart F. Whether the service provided is an alternative or replacement to a Wisconsin Medicaid covered service or is a Wisconsin Medicaid covered service, the HMO or HMO provider is not allowed to xxxx the enrollee for the service.
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Covered Medicaid Services. The Managed Care Plan shall ensure the provision of the Medicaid services specified in Attachment II, Core Contract Provisions, Section V, Covered Services, Section VI, Behavioral Health Services, and as specified in applicable exhibits to Attachment II. At a minimum, they shall include: Adult companion care Adult day health care Assisted living Assistive care services Attendant care Behavioral management Care coordination/Case management Caregiver training Home accessibility adaptation Home-delivered meals Homemaker Hospice Intermittent and skilled nursing Medical equipment and supplies Medication administration Medication management Nursing facility Nutritional assessment/Risk reduction Personal care Personal emergency response system (PERS) Respite care Therapies, occupational, physical, respiratory, and speech Transportation, non-emergency
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Related to Covered Medicaid Services

  • Subcontracting for Medicaid Services Notwithstanding any permitted subcontracting of services to be performed under this Agreement, Party shall remain responsible for ensuring that this Agreement is fully performed according to its terms, that subcontractor remains in compliance with the terms hereof, and that subcontractor complies with all state and federal laws and regulations relating to the Medicaid program in Vermont. Subcontracts, and any service provider agreements entered into by Party in connection with the performance of this Agreement, must clearly specify in writing the responsibilities of the subcontractor or other service provider and Party must retain the authority to revoke its subcontract or service provider agreement or to impose other sanctions if the performance of the subcontractor or service provider is inadequate or if its performance deviates from any requirement of this Agreement. Party shall make available on request all contracts, subcontracts and service provider agreements between the Party, subcontractors and other service providers to the Agency of Human Services and any of its departments as well as to the Center for Medicare and Medicaid Services.

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.

  • Contracted Services PPG and Member Physicians shall render Contracted Services which are not PPG Capitated Services to Members covered under this Addendum B and shall be compensated on a fee-for-service basis at the rates set forth in Addendum E. PPG shall submit claims in accordance with the terms of this Agreement and State and federal law.

  • Medical Services Plan Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. The City shall pay one hundred percent (100%) of the premiums required by the plan.

  • Medicaid If and when the Resident’s assets/funds have fallen below the Medicaid eligibility levels, and the Resident otherwise satisfies the Medicaid eligibility requirements and is not entitled to any other third party coverage, the Resident may be eligible for Medicaid (often referred to as the “payor of last resort”). THE RESIDENT, RESIDENT REPRESENTATIVE AND SPONSOR AGREE TO NOTIFY THE FACILITY AT LEAST THREE (3) MONTHS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S FUNDS (APPROXIMATELY $50,000) AND/OR INSURANCE COVERAGE TO CONFIRM THAT A MEDICAID APPLICATION HAS OR WILL BE SUBMITTED TIMELY AND ENSURE THAT ALL ELIGIBILITY REQUIREMENTS HAVE BEEN MET. THE RESIDENT, RESIDENT REPRESENTATIVE AND/OR SPONSOR AGREE TO PREPARE AND FILE AN APPLICATION FOR MEDICAID BENEFITS PRIOR TO THE

  • Medical Services We do not Cover medical services or dental services that are medical in nature, including any Hospital charges or prescription drug charges.

  • Approved Services; Additional Services Registry Operator shall be entitled to provide the Registry Services described in clauses (a) and (b) of the first paragraph of Section 2.1 in the Specification 6 attached hereto (“Specification 6”) and such other Registry Services set forth on Exhibit A (collectively, the “Approved Services”). If Registry Operator desires to provide any Registry Service that is not an Approved Service or is a material modification to an Approved Service (each, an “Additional Service”), Registry Operator shall submit a request for approval of such Additional Service pursuant to the Registry Services Evaluation Policy at xxxx://xxx.xxxxx.xxx/en/registries/rsep/rsep.html, as such policy may be amended from time to time in accordance with the bylaws of ICANN (as amended from time to time, the “ICANN Bylaws”) applicable to Consensus Policies (the “RSEP”). Registry Operator may offer Additional Services only with the written approval of ICANN, and, upon any such approval, such Additional Services shall be deemed Registry Services under this Agreement. In its reasonable discretion, ICANN may require an amendment to this Agreement reflecting the provision of any Additional Service which is approved pursuant to the RSEP, which amendment shall be in a form reasonably acceptable to the parties.

  • Medicaid Program Parties (applicable to any Party providing services and supports paid for under Vermont’s Medicaid program and Vermont’s Global Commitment to Health Waiver):

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

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

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