Healthcare Services. (a) The MA Dual SNP must provide the MA Product to all Dual Eligible Members and Other Dual SNP Members who are qualified to receive such services under the terms of the MA Agreement.
(1) The MA Dual SNP must pay all eligible Network Providers and out-of-network providers the Cost Sharing Obligations incurred on behalf of Dual Eligible Members. Nothing in this Agreement precludes the MA Dual SNP from entering into agreements with Network Providers or out-of-network providers that vary the amount or method of payment for the Cost Sharing Obligations or from utilizing the MA Dual SNP’s coordination of benefits procedures.
(2) The MA Dual SNP is not responsible for paying Network Providers or out-of-network providers for the Deductibles, Coinsurance, and Co-payments incurred by Other Dual SNP Members.
(b) Unless the healthcare service or benefit is also covered under the MA Product, and is thus considered to be a Medicare benefit, the MA Dual SNP is not responsible for providing Medicaid-only wrap services or benefits to Dual Eligible Members or Other Dual SNP Members and is not expected to assume any obligations to provide Medicaid services or benefits other than those outlined in this Agreement. This provision does not limit or otherwise restrict the MA Dual SNP’s obligation to provide Coordination of Care pursuant to Section 3.05.
Healthcare Services. (a) The MA Dual SNP must provide the MA Product to all Dual Eligible Members and Other Dual SNP Members who are qualified to receive such services under the terms of the MA Agreement.
(1) The MA Dual SNP must pay all eligible Network Providers and out-of-network providers the Cost Sharing Obligations incurred on behalf of Dual Eligible Members. Except as provided in Section 3.03(b), the amount or method of payment for Cost Sharing Obligations included in the agreements with Network Providers or out-of-network providers may differ between agreements. In accordance with the Medicaid State Plan, Supplement 1 to Attachment 4.19-B, the amount of the payment of Cost Sharing Obligations for the following services must be the same as or greater than the Medicare rate for the services:
(A) behavioral health services provided by psychiatrists, psychologists, and licensed clinical social workers;
(B) codes R0070 and R0075, related to the transport of portable x-ray equipment; and
(C) ambulance services, including ground and air ambulance service.
(2) The MA Dual SNP is not responsible for paying Network Providers or out-of-network providers for the Deductibles, Coinsurance, and Co-payments incurred by Other Dual SNP Members.
(b) Unless the healthcare service or benefit is also covered under the MA Product, and is thus considered to be a Medicare benefit, the MA Dual SNP is not responsible for providing Medicaid-only wrap services or benefits to Dual Eligible Members or Other Dual SNP Members and is not expected to assume any obligations to provide Medicaid services or benefits other than those outlined in this Agreement Coordination of Care pursuant to Section 3.05.
Healthcare Services. (a) The MA Health Plan must provide the MA Product to all Dual Eligible Members who are qualified to receive such services under the terms of the MA Agreement. The MA Health Plan must pay all eligible Network Providers and out-of-network providers the Cost Sharing Obligations incurred on behalf of Dual Eligible Members. Except as provided in Section 3.03(b), the amount or method of payment for Cost Sharing Obligations included in the agreements with Network Providers or out-of-network providers may differ between agreements.
(b) In accordance with the Medicaid State Plan, Supplement 1 to Attachment 4.19-B, the amount of the MA Health Plan payment of Cost Sharing Obligations for the following services must be the same as or greater than the Medicare rate for the services:
1. behavioral health services provided by psychiatrists, psychologists, and licensed clinical social workers;
2. the services identified by codes R0070 and R0075, relating to the transport of portable x-ray equipment; and
3. ambulance services, including ground and air ambulance services.
Healthcare Services. The MA Health Plan must provide the MA Product to all Dual Eligible Members who are qualified to receive such services under the terms of the MA Agreement. The MA Health Plan must pay all eligible Network Providers and out-of-network providers the Cost Sharing Obligations incurred on behalf of Dual Eligible Members. Nothing in this Agreement precludes the MA Health Plan from entering into agreements with Network Providers or out-of-network providers that vary the amount or method of payment for the Cost Sharing Obligations or from utilizing the MA Health Plan's coordination of benefits procedures.
Healthcare Services. 23.1.1 The Concessionaire agrees and undertakes that the District Hospital shall provide the Healthcare Services, in accordance with the provisions of this Agreement, Applicable Laws, Applicable Permits, Good Healthcare Practice and Good Clinical Practice and Good Industry Practice.
23.1.2 The Concessionaire shall ensure that the infrastructure and facilities incorporated in the District Hospital under the Development Works are adequate to operate and maintain the District Hospital of Patient Intake Capacity.
Healthcare Services. All Inpatient and non-routine Outpatient non-Emergency Mental Health, Severe Mental Illness, and Substance Related and Addictive Disorder Services, including: o Intensive outpatient program treatment. o Outpatient electro-convulsive treatment. o Psychological testing. All Specialist visits or consultations. Prosthetic Devices, Orthotic Devices and Durable Medical Equipment. Allergy testing or treatment (e.g., skin, RAST); angioplasty; physiotherapy or Manual Manipulation and; habilitative and rehabilitation therapy (physical, speech, occupational).
Healthcare Services. If you are admitted as an Inpatient to the Hospital, you or your Practitioner needs to notify us as soon as possible so we can review your Hospital stay.
Healthcare Services. The term "Healthcare Services" shall mean the medical and related healthcare services provided by Physician to patients.
Healthcare Services. 9.1 The Provider shall ensure adequate access to the services provided under this Agreement in accordance with the prevailing medical community standards.
9.2 The services covered by this Agreement must be in accordance with the South Carolina State Plan for Medical Assistance under Title XIX of the Social Security Act, and the Provider shall provide these services to Medicaid Managed Care Members through the last day that this Agreement is in effect. All final Medicaid benefit determinations are within the sole and exclusive authority of the Department or its designee.
9.3 The Provider may not refuse to provide Medically Necessary Services or covered preventive services to Medicaid Managed Care Members for non-medical reasons.
9.4 The Provider shall render Emergency Services without the requirement of prior authorization of any kind.
9.5 The Provider shall not be prohibited or otherwise restricted from advising a Medicaid Managed Care Member about the health status of the Medicaid Managed Care Member or medical care or treatment for the Medicaid Managed Care Member’s condition or disease, regardless of whether benefits for such care or treatment are provided under the Department’s Medicaid Managed Care Agreement, if Provider is acting within the lawful scope of practice.
9.6 The Subcontractor shall not include covenant-not-to-compete requirements or exclusive Provider clauses in its Provider agreements. Specifically, the Subcontractor is precluded from requiring that the Provider not provide services for any other South Carolina Medicaid Managed Care Contractor. In addition, the Subcontractor shall not enter into subcontracts that contain compensation terms that discourage Provider or any other providers from serving any specific eligibility category. No provision in this Subcontract shall create a covenant-not-to-compete agreement or exclusive Provider clause.
9.7 The Provider must take adequate steps to ensure that Medicaid Managed Care Members with limited English skills receive, free of charge, the language assistance necessary to afford them meaningful and equal access to the benefits and services provided under this Agreement in accordance with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et. seq.) (2001, as amended) and it’s implementing regulation at 45 C.F.R. Part 80 (2001, as amended).
9.8 The Provider shall provide effective Continuity of Care activities, if applicable, that seek to ensure that the appropriate personnel, including ...
Healthcare Services. (a) Both Parties recognise the need to upgrade and modernise the health sector through investment in health infrastructure, promotion of healthcare services, access to technologies, developing human resources, encouraging medical tourism, sharing of knowledge on Research and Development in the field of medicine and health.
(b) The Parties agree to cooperate in the health sector:
(i) by partnering in the setting up of specialised hospitals including such fields as endocrinology and cancer treatment;
(ii) by setting up of Indian hospitals/clinics in Mauritius to treat patients from the African region and for the purpose of further developing the medical tourism sector including cardiology, orthopaedics, plastic and cosmetic surgery, fertility and hair grafting;
(iii) by bringing Indian brands in wellness centers and health resorts to Mauritius which are visited by tourists;
(iv) by setting up an AYUSH Hospital in the field of Traditional/ Ayurvedic Medicine;
(v) in the promotion of herbal and ayurvedic medicine through the supply of quality products as well in developing policies with regard to an Indigenous Knowledge System that would encompass medicinal herbs, procedures, processes that need to be preserved and/or economically exploited;
(vi) in the outsourcing of high precision diagnostic tests to Indian laboratories in instances where the tests cannot be carried out in Mauritius.
(vii) by sharing expertise in the field of haematology facilities, which includes the transfer of know-how, capacity building, training of staff, sending of patients for treatment, visiting teams;
(viii) by having assistance for specialised training and capacity building in areas such as neurosurgery, paediatric surgery, renal transplant, interventional radiology, cardiology, ENT and molecular pathology/genetics;AYUSH systems and Infectious diseases;
(ix) by facilitating the collaboration of R&D activities of Indian pharmaceutical companies in Mauritiusincluding R&D activities in AYUSH systems;
(x) by facilitating ties between Mauritian medical andAYUSHservices with Indian hospitals for extending healthcare to Mauritius and African countries through telemedicine and medical tourism.
