Managed Care Withhold Sample Clauses

Managed Care Withhold. For Capitation Payments made for months of service on or after January 1st of the Contract Year, the STATE shall withhold nine point five percent (9.5%) from the basic care portion of the SNBC rates. SNBC Medicaid Nursing Facility payments are excluded from the withhold provision. Of this total, 52/63% (5.0/9.5 x 100) of the withheld funds shall be returned no sooner than July 1st and no later than July 31st of the following year only if, in the judgment of the STATE, performance targets in the contract are achieved. The remaining 47.37% (4.5/9.5 x 100) of withheld funds shall be returned without any consideration of performance no sooner than July 1st and no later than July 31st of the following year as required by Minnesota Statutes, § 256B.69, subd. 5a.
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Managed Care Withhold. 4.5.1 Return of Withhold Based on Performance. The STATE shall withhold as follows: (A) For PMAP the STATE shall withhold eight percent (8%) from the base rates, including BHH. The funds to be passed through the enhanced hospital payments described in section 4.1.13,are excluded from the withhold provision. Of this total, 62.5% (5.0 /8.0 x 100) of the withheld funds (shown in section 4.5.4(B)(1)) shall be returned no sooner than July first and no later than July 31st of the year subsequent to the Contract Year only if, in the judgment of the STATE, performance targets in section 4.5.2 are achieved.
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Managed Care Withhold 
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Related to Managed Care Withhold

  • Medicare Parts A and B of the health care program for the aged and disabled provided by Title XVIII of the United States Social Security Act, as amended from time to time. [MEMBER]. An eligible person who is covered under this Contract (includes Covered Employee[ and covered Dependents, if any)].

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • Medicaid If and when the Resident’s assets/funds have fallen below the Medicaid eligibility levels, and the Resident otherwise satisfies the Medicaid eligibility requirements and is not entitled to any other third party coverage, the Resident may be eligible for Medicaid (often referred to as the “payor of last resort”). THE RESIDENT, RESIDENT REPRESENTATIVE AND SPONSOR AGREE TO NOTIFY THE FACILITY AT LEAST THREE (3) MONTHS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S FUNDS (APPROXIMATELY $50,000) AND/OR INSURANCE COVERAGE TO CONFIRM THAT A MEDICAID APPLICATION HAS OR WILL BE SUBMITTED TIMELY AND ENSURE THAT ALL ELIGIBILITY REQUIREMENTS HAVE BEEN MET. THE RESIDENT, RESIDENT REPRESENTATIVE AND/OR SPONSOR AGREE TO PREPARE AND FILE AN APPLICATION FOR MEDICAID BENEFITS PRIOR TO THE

  • Medical Benefits - Prescription Drugs Administered by a Provider (other than a pharmacist)

  • Open Enrollment KFHPWA will allow enrollment of Subscribers and Dependents who did not enroll when newly eligible as described above during a limited period of time specified by the Group and KFHPWA.