Medicaid Coverage Clause Samples
Medicaid Coverage a. Under no circumstances will Local Government bill Medicaid for those Facility Medicaid recipients under age 65 from any Medicaid payors.
b. Covered services provided to Facility Medicaid recipients will be billed to Facility in accordance with established CMS billing guidelines.
c. Facility will reimburse Local Government the current published Medicaid Fee Schedule rate applicable to the El Paso, Texas geographic area.
Medicaid Coverage a. Under no circumstances will Local Government bill Medicaid for those Facility Medicaid recipients under age 65 from any Medicaid payors.
b. Local Government will bill Facility in accordance with the current established CMS billing guidelines. Facility will reimburse Local Government one hundred and ten percent (110%) of the current published Medicare Fee Schedule.
Medicaid Coverage a. Medicaid coverage must be extended for children receiving a IV-E subsidy for as long as there is an adoption assistance agreement in effect. In some cases, Medicaid may not provide sufficient coverage to meet all of the child's needs. In this event, a special service payment may be used concurrently with Medicaid to pay for services not covered by Medicaid. October 2009 VOLUME VII, SECTION III, CHAPTER C Section 8 Page 135 b. Medicaid coverage for children receiving a State subsidy may be extended after adoption when:
1) the child has a special medical or rehabilitative need and the child's own income and resources do not exceed the ADC or Medicaid income limit for a single person; or
2) the income and resources of the adoptive family unit meet Medicaid eligibility requirements. In determining the family's eligibility for Medicaid, subsidy payments are not counted as income.
3) Medicaid waiver service, if child is in a facility for 30 days or more.