Managed Care Contracts. The Management Company shall solicit, negotiate and administer all managed care contracts on behalf of the Medical Group based on parameters and criteria established by the Operations Committee. Such services shall be performed by the Management Company as agent of the Medical Group, and all managed care contracts shall be subject to the Medical Group's prior approval of any such contract. The Management Company shall prepare cost forecasts and other analyses as reasonably requested by the Medical Group in order to allow the Medical Group to make an informed decision with respect to each proposed contract.
Managed Care Contracts. No FFP is available for activities covered under contracts and/or modifications to existing contracts that are subject to 42 CFR 438 requirements prior to CMS approval of model contract language. The state shall submit any supporting documentation deemed necessary by CMS. The state must provide CMS with a minimum of 45 days to review and approve changes. CMS reserves the right, as a corrective action, to withhold FFP (either partial or full) for the Demonstration, until the contract compliance requirement is met.
Managed Care Contracts. All contracts and modifications of existing contracts between the Commonwealth and MCOs or between the Commonwealth and Partnership Plans must be prior approved by CMS. The Commonwealth will provide CMS with a minimum of 90 calendar days to review and approve changes. MassHealth may make periodic payments of the types described below to managed care entities (MCE), including MCOs, Partnership Plans and PIHPs, and direct that these payments be made to hospitals in the MCEs’ networks: For example, starting in MCO Rate Year 2017 (October 1, 2016-September 30, 2017), MassHealth will direct its contracted MCOs to make payments to hospitals in their networks as an incentive for hospitals to report on and subsequently improve access to appropriate medical and diagnostic equipment for members with disabilities. MassHealth will calculate the payments for which each hospital is eligible based on current year Medicaid Gross Patient Service Revenue and will direct the MCOs to make payments accordingly, contingent on the hospitals meeting requirements set forth by MassHealth. While this program will not be renewed automatically, it will be a multi- year initiative in which the first two years will require reporting by hospitals on access to medical and diagnostic equipment, and future years will include related performance requirements for hospitals. In future years this program may also be administered by Accountable Care Partnership Plans, in accordance with Attachment O and Q. Public Contracts. Contracts with public agencies, that are not competitively bid in a process involving multiple bidders, shall not exceed the documented costs incurred in furnishing covered services to eligible individuals (or a reasonable estimate with an adjustment factor no greater than the annual change in the consumer price index), unless the contractual payment rate is set at the same rate for both public and private providers. This requirement does not apply to contracts under the SNCP as outlined in STC 54.
Managed Care Contracts. All contracts and modifications of existing contracts between the Commonwealth and MCOs must be prior approved by CMS. The Commonwealth will provide CMS with a minimum of 30 days to review and approve changes.
Managed Care Contracts. 6.6.1 The arrangements to assign AstraZeneca's existing managed care contracts to Prometheus (or to AstraZeneca (or its designee) from Prometheus pursuant to Article 20 (Consequences of Termination)) are set out in Schedule J (Transitional Obligations Regarding Managed Market Contracts).
6.6.2 AstraZeneca shall as soon as reasonably practicable following the Effective Date and in any event within ninety (90) days after the Effective Date, withdraw or remove the Product from any AstraZeneca patient assistance programs including the AstraZeneca Together Rx® program and the AstraZeneca Caring Partners program. AstraZeneca shall have the right to continue to distribute the Product in the Territory in connection with such patient assistance programs solely for purposes of fulfilling its obligations that relate directly to orders received under such programs prior to such withdrawal or removal date. In addition, AstraZeneca shall remove the Product from all applicable Medicare contracts within ninety (90) days of the Effective Date. AstraZeneca shall remain liable for all administrative, reporting and related responsibilities up through the date of removal. As of the Effective Date, AstraZeneca shall cease enrolling new patients in the AstraZeneca Patient Assistance program. All patients enrolled in such program on or before the Effective Date, who meet eligibility criteria and adhere to the annual re-enrollment process shall be permitted to remain in such program throughout the Term. Prometheus shall permit AstraZeneca to set aside sufficient Product quantity throughout the Term to enable AstraZeneca to supply Product to program enrollees. AstraZeneca shall not pay Prometheus for such Product and AstraZeneca shall (i) bear all costs associated, or arising in connection, with the AstraZeneca Patient Assistance program, and (ii) remain liable for all administrative, reporting, financial and other responsibilities related to the AstraZeneca Patient Assistance program during and after the Term and Prometheus shall not have any obligations (including any financial obligations) in connection with any such AstraZeneca Patient Assistance program.
6.6.3 Pipeline Inventory adjustment shall be handled by the Parties as set forth in Schedule S (Pipeline Inventory Adjustment Formulas).
Managed Care Contracts. No FFP is available for activities covered under contracts and/or modifications to existing contracts that are subject to 42 CFR 438 requirements prior to CMS approval of such contracts and/or contract amendments. The state shall submit any supporting documentation deemed necessary by CMS. The state must provide CMS with a minimum of 45 days to review and approve changes. If changes to contracts are needed based on CMS approval of initial or amended STCs, the state must submit amended contracts within 60 days of approval of the demonstration documents. CMS reserves the right, as a corrective action, to withhold FFP (either partial or full) for the demonstration, until the contract compliance requirement is met.
Managed Care Contracts. Without the prior written consent of the Required Banks, which shall not be unreasonably withheld, Parent will not at any time permit the gross revenue of Parent and its Subsidiaries, determined in conformity with GAAP as of any month and calculated for the immediately preceding twelve (12) month period, generated during such twelve (12) month period from (a) contracts providing exclusively for managed care plus (b) the managed care portions of contracts providing for Employee Assistance Programs and managed care to exceed in the aggregate twenty-five percent (25%) of total gross revenue of Parent and its Subsidiaries generated during such twelve (12) month period, determined in conformity with GAAP.
Managed Care Contracts. MidSouth shall negotiate and administer all ---------------------- managed care Contracts on behalf of the Practice and shall consult with the Practice on all professional or clinical matters relating thereto. The Practice, at its discretion, shall have the right to enter into or reject such contracts negotiated by MidSouth. Such contracts shall be and will remain the property of the Practice.
Managed Care Contracts. (a) Gross revenue during the immediately preceding 12 month period from contracts providing exclusively for managed care $
(b) Gross revenue during the immediately preceding 12 month period from the managed care portions of contracts providing for EAS and managed care $
(c) Total Managed Care Gross Revenue (14(a) plus (14(b)) $
(d) Total Gross Revenue during such 12 month period $ (e) 25% of 14(d) $
Managed Care Contracts. This Section sets forth the parties' agreements concerning managed care contracts. As used in this Section the term "Managed Care Contract" means any payment arrangement other than a fee-for-service payment arrangement based on charges or discounts from charges. For purposes of this Section 3, references to MMC shall be limited to MMC, and shall not include or otherwise bind MMC IPA, Inc. or MMC North IPA No. 1., Inc. However, MMC will use all reasonable efforts to persuade MMC IPA, Inc. and MMC North IPA No. 1, Inc. to adhere to the commitments made by MMC (where appropriate) in this Section 3.
