Common use of Healthcare Services Clause in Contracts

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. (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. (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 Plan’s 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.