Common use of Healthcare Services Clause in Contracts

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 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(b3.03(A), 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. . (A) 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) i. behavioral health services provided by psychiatrists, psychologists, and licensed clinical social workers; (B) ii. codes R0070 and R0075, related to the transport of portable x-ray equipment; and (C) iii. 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 Agreement. This provision does not limit or 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(b3.03(A), 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. . (A) 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) i. behavioral health services provided by psychiatrists, psychologists, and licensed clinical social workers; (B) ii. codes R0070 and R0075, related to the transport of portable x-ray equipment; and (C) iii. 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.