General Statement of Purpose and Intent. A. The Agency desires to contract with primary care physician groups willing to participate in the ACHN Program to provide primary care services directly and to coordinate other health care needs through the appropriate referral and authorization of Medicaid services. The ACHN Program applies to certain Medicaid recipients who may receive services from a group. This Agreement describes the terms and conditions under which this Agreement is made and the responsibilities of the parties thereto.
B. Except as herein specifically provided otherwise, this Agreement shall inure to the benefit of and be binding upon the parties hereto and their respective successors. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the Agency and the named Group. Nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other third person.
General Statement of Purpose and Intent. The ACHN is defined by the federal government and the Agency as a voluntary Medicaid program that provides care coordination for recipients to achieve improved health outcomes and to minimize duplication of health care services and costs. It is designed to add an additional level of support to DHCP by intensively coordinating the care of maternity recipients. Maternity care coordination in the ACHN is accomplished by, among other services, managing patient-centered care through best practices, connecting recipients with needed resources, teaching self-management skills, providing transitional care, and linking recipients to medical and behavioral services.
General Statement of Purpose and Intent. This Agreement describes the terms and conditions and duties of the Parties when a Provider applies with the Provider Services Section of the Department’s Division of Health Benefits (“DHB”) to conduct presumptive eligibility determinations for the Medicaid program. This Agreement shall be construed as supplementary to the terms and conditions of the Medicaid Provider Administrative Participation Agreement, except to the extent superseded by the specific terms of this Agreement. Except for Centers for Medicare and Medicaid Services regulatory and guidance publications or changes to Department policies communicated by the Department and its Divisions or its fiscal intermediary (currently CSC, or its successor), no alterations or modifications shall be made to the terms of the Agreement unless through a written amendment executed by both parties.
General Statement of Purpose and Intent. The EBCI Tribal Option is a managed care option for federally recognized tribal members and other individuals eligible to receive Indian Health Services. The EBCI Tribal Option, through CIHA, serving as an IMCE, is responsible for administering the EBCI Tribal Option as a fee-for- service PCCM entity.
General Statement of Purpose and Intent
