Indian Health Care Providers Sample Clauses

Indian Health Care Providers. For Contractor’s provider contracts entered into on or after January 1, 2015, Contractor shall reference the Centers for Medicare & Medicaid Services “Model QHP Addendum for Indian Health Care Providers” (“Addendum”) available by search at: xxxxx://xxx.xxx.xxx/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces . Contractor is encouraged to adopt the Addendum whenever it contracts with those Indian health care providers specified in the Addendum. Adoption of the Addendum is not required; it is offered as a resource to assist Contractor in including specified Indian providers in its provider networks.
Sample 1Sample 2Sample 3See All (19)
AutoNDA by SimpleDocs
Indian Health Care Providers. For Contractor’s provider contracts entered into on or after January 1, 2015, Contractor shall reference the Centers for Medicare & Medicaid Services “Model QHP Addendum for Indian Health Care Providers” (“Addendum”) available for download here: xxxxx://xxx.xxxxxxxxxxxxxxxx.xxx.xxx/s/Model_QHP_Addendum_Indian_Healt h_Care_Providers.pdf?v=1 Contractor is encouraged to adopt the Addendum whenever it contracts with those Indian health care providers specified in the Addendum. Adoption of the Addendum is not required; it is offered as a resource to assist Contractor in including specified Indian providers in its provider networks.
Sample 1Sample 2Sample 3See All (8)
Indian Health Care Providers. ‌ Insurer shall maintain sufficient numbers of Indian Health Care Providers (IHCPs) in Insurer’s Provider network to ensure timely access to services from such Providers to those Enrollees eligible to receive such services. Insurer shall provide a quarterly attestation and supporting documentation to FHKC demonstrating compliance with this requirement. Insurer shall allow any Enrollee who is eligible to receive services from a network IHCP to choose the IHCP as his or her PCP so long as the IHCP has the capacity to provide the services. Insurer must also allow any Enrollee who is eligible to receive services from an IHCP to obtain services covered under the Contract from an out-of-network IHCP. Insurer shall allow out-of- network IHCPs to refer Enrollees to a network Provider. Should there be too few IHCPs in the State to ensure timely access to Covered Services, Enrollees who are eligible to receive such services shall be permitted to access out-of-state IHCPs. Insurer shall pay for Covered Services provided to eligible Enrollees by IHCPs, whether participating in the network or not, at either the rate negotiated between Insurer and the IHCP or at a rate not less than the level and amount of payment Insurer would make for services to a non-IHCP network Provider. Insurer shall make all payments to network IHCPs in a timely manner, as required by 42 CFR 447.45 and 447.46. When an IHCP is also an FQHC, but is not a network Provider, Insurer shall pay the IHCP an amount equal to the amount Insurer would pay a participating FQHC that is not an IHCP. When an IHCP is not an FQHC, regardless of network participation status, the IHCP has the right to receive its applicable encounter rate published annually in the Federal Register by the Indian Health Service, or in the absence of such published encounter rate, the amount it would receive if the services were provided by the State’s Medicaid fee for service payment methodology. Insurer shall pay IHCPs the full amount an IHCP is eligible to be paid. No supplemental payments from FHKC will be provided for these payments under any circumstances. Insurer is responsible for the entire amount.
Sample 1Sample 2
Indian Health Care Providers. (i) DVHA must demonstrate that there are sufficient Indian Health Care Providers (IHCPs) participating in the provider network to ensure timely access to services available under the contract from such providers for Indian beneficiaries who are eligible to receive services. (ii) DVHA must ensure that IHCPs, whether participating or not, be paid for covered services provided to Indian beneficiaries who are eligible to receive services at a negotiated rate between DVHA and the IHCP or, in the absence of a negotiated rate, at a rate not less than the level and amount of payment DVHA would make for the services to a participating provider that is not an IHCP. (iii) DVHA must ensure that Indian beneficiaries are permitted to obtain covered services from out-of-network IHCPs from whom the beneficiary is otherwise eligible to receive such services. Conversely, DVHA must permit an out-of-network IHCP to refer an Indian beneficiary to a network provider.
Sample 1
Indian Health Care Providers. 2.7.3.5.1.The STAR+PLUS MMP shall offer Indian Enrollees the option to choose an Indian health care Provider as a PCP if the STAR+PLUS MMP has an Indian PCP in its Network that has capacity to provide such services; in addition, the STAR+PLUS MMP shall permit any Indian who is enrolled in a non-Indian MMP and eligible to receive services from a participating I/T/U Provider to choose to receive Covered Services from that I/T/U Provider.
Sample 1
Indian Health Care Providers. To the extent Participating Provider is an Indian Health Care Provider, Participating Provider shall execute and comply with the Medicaid Managed Care Addendum for Indian Health Care Providers. (Section VII, H).
Sample 1

Related to Indian Health Care Providers

  • Covered Health Care Services We agree to provide coverage for medically necessary covered health care services listed in this agreement. If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. See Section 1.4 for how we identify new services and our guidelines for reviewing and making coverage determinations. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. The term medically necessary is defined in Section 8.0 - Glossary. It does not include all medically appropriate services. The amount of coverage we provide for each health care service differs according to whether or not the service is received:  as an inpatient;  as an outpatient ;  in your home;  in a doctor’s office; or  from a pharmacy. Also coverage differs depending on whether:  the health care provider is a network provider or non-network provider;  deductibles (if any), copayments, or maximum benefit apply;  you have reached your plan year maximum out-of-pocket expense;  there are any exclusions from coverage that apply; or  our allowance for a covered health care service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider. Please see the Summary of Medical Benefits to determine the benefit limits and amount that you pay for the covered health care services listed below. Please see the Summary of Pharmacy Benefits to determine the benefit limits and amount that you pay for prescription drug and diabetic equipment and supplies purchased at a pharmacy.

  • Home Health Care This plan covers the following home care services when provided by a certified home healthcare agency: • nursing services; • services of a home health aide; • visits from a social worker; • medical supplies; and • physical, occupational and speech therapy.

  • Extended Health Care Plan (a) The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable Extended Health Care Plan.

  • Clinical Management for Behavioral Health Services (CMBHS) System The CMBHS is the official record of documentation by System Agency. Grantee shall:

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!