MEDICAID COVERED SERVICES NOT PROVIDED BY CONTRACTOR Sample Clauses

MEDICAID COVERED SERVICES NOT PROVIDED BY CONTRACTOR. A. Mental Health/Substance Use Disorder. Mental Health and Substance Use Disorder services (except for the conditions listed in Articles 4.1.2A and 4.1.2B) will be managed by the State or its agent for non-DDD and non-MLTSS enrollees, including all NJ FamilyCare enrollees. 1. With the exception of those behavioral health services listed as excluded from managed care coverage in B.4.4 Behavioral Health Services Dictionary, the Contractor will retain responsibility for furnishing all mental health/substance use disorder services to Medicaid enrollees who are enrolled in MLTSS or clients of the Division of Developmental Disabilities in accordance with Article 4.1.2. 2. The Contractor will retain responsibility for furnishing medically necessary detoxification in a medical acute care inpatient setting. B. Behavioral Health Services available to Members in the ABP and NJ FamilyCare A, remaining in fee-for-service for non-MLTSS and non-DDD populations. 1. Psychiatric Emergency Rehabilitation Services (PERS)/Affiliated Emergency Services 2. Substance Use Disorder Partial Day Treatment 3. Substance Use Disorder Outpatient
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MEDICAID COVERED SERVICES NOT PROVIDED BY CONTRACTOR. A. Mental Health/Substance Abuse. The following mental health/substance abuse services (except for the conditions listed in 4.1.2.B) will be managed by the State or its agent for non-DDD enrollees, including all NJ FamilyCare enrollees. (The contractor will retain responsibility for furnishing menial health/substance abuse services, excluding the cost of the drugs listed below, to Medicaid enrollees who are clients of the Division of Developmental Disabilities). • Substance Abuse Services—diagnosis, treatment, and detoxification • Costs for Methadone maintenance and its administration • Mental Health Services
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MEDICAID COVERED SERVICES NOT PROVIDED BY CONTRACTOR. A. Mental Health/Substance Abuse. Mental health and substance abuse services (except for the conditions listed in Article 4.1.2.B) will be managed by the State or its agent for non-DDD and non-MLTSS enrollees, including all NJ FamilyCare enrollees. 1. The Contractor will retain responsibility for furnishing mental health/substance abuse services, excluding partial care and partial hospitalization services and the cost of the drugs listed below, to Medicaid enrollees who are clients of the Division of Developmental Disabilities in accordance with Article 4.1.2. 2. The Contractor will retain responsibility for furnishing mental health/opioid treatment services, including partial care and partial hospitalization services and the cost of the drugs for opioid treatment and its administration to MLTSS Members in accordance with Article 9.9. 3. The Contractor will retain responsibility for furnishing medically necessary detoxification in a medical acute care inpatient setting.
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MEDICAID COVERED SERVICES NOT PROVIDED BY CONTRACTOR. A. Mental Health/Substance Abuse. Mental health and substance abuse services (except for the conditions listed in Article 4.1.2.B) will be managed by the State or its agent for non-DDD and non-MLTSS enrollees, including all NJ FamilyCare enrollees. 1. The Contractor will retain responsibility for furnishing mental health/substance abuse services, excluding partial care and partial hospitalization services and the cost of the drugs listed below, to Medicaid enrollees who are clients of the Division of Developmental Disabilities in accordance with Article 4.1.2. 2. The Contractor will retain responsibility for furnishing mental health/opioid treatment services, including partial care and partial hospitalization services and the cost of the drugs for opioid treatment and its administration to MLTSS Members in accordance with Article 9.9. 3. The Contractor will retain responsibility for furnishing medically necessary detoxification in a medical acute care inpatient setting. B. Behavioral Health Services available to Members in the ABP and NJ FamilyCare A, remaining in fee-for-service for non-MLTSS and non-DDD populations. 1. Psychiatric Emergency Rehabilitation Services (PERS)/Affiliated Emergency Services 2. Substance Abuse Partial Day Treatment 3. Substance Abuse Outpatient 4. Substance Abuse Intensive Outpatient 5. Substance Abuse Short Term Residential 6. Non-acute Detoxification 7. Targeted Case Management (ICMS) 8. Program of Assertive Community Treatment (PACT)
Sample 1
MEDICAID COVERED SERVICES NOT PROVIDED BY CONTRACTOR. A. Mental Health/Substance Abuse. The following mental health/substance abuse services (except for the conditions listed in Article 4.1.2.B) will be managed by the State or its agent for non- DDD and non-MLTSS enrollees, including all NJ FamilyCare enrollees. The Contractor will retain responsibility for furnishing mental health/substance abuse services, excluding partial care and partial hospitalization services and the cost of the drugs listed below, to Medicaid enrollees who are clients of the Division of Developmental Disabilities in accordance with Article 4.1.
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Related to MEDICAID COVERED SERVICES NOT PROVIDED BY CONTRACTOR

  • Non-Covered Services MCOs are not permitted to provide Medicaid excluded services that include, but are not limited to, the following: 1. All non-medically necessary services; 2. Sterilization of a mentally incompetent or institutionalized individual; 3. Except in an emergency, inpatient hospital tests that are not ordered by the attending physician or other licensed practitioner, acting within the scope of practices, who is responsible for the diagnosis or treatment of a particular patient’s condition; 4. All organ transplants, except for those specified in Appendix A; 5. Treatments for infertility4 and for the reversal of sterilization;

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

  • Claim by Contractor After receipt of the Notice of Termination from the state, the Contractor shall submit any claim for additional costs not covered herein or elsewhere in the Contract within 60 days of the effective termination date, and not thereafter. Should the Contractor fail to submit a claim within the 60-day period, the State may, at its sole discretion, based on information available to it, determine what, if any, compensation is due the Contractor and pay the Contractor the determined amount.

  • Subcontractor Any vendor, subcontractor or other Person that is not responsible for the overall servicing (as “servicing” is commonly understood by participants in the mortgage-backed securities market) of Mortgage Loans but performs one or more discrete functions identified in Item 1122(d) of Regulation AB with respect to Mortgage Loans under the direction or authority of the Servicer or a Subservicer.

  • Independent Contractor; Workers’ Compensation Insurance The Contractor is performing as an independent entity under this Contract. No part of this Contract shall be construed to represent the creation of an employment, agency, partnership or joint venture agreement between the parties. Neither party will assume liability for any injury (including death) to any persons, or damage to any property, arising out of the acts or omissions of the agents, employees or subcontractors of the other party. The Contractor shall provide all necessary unemployment and workers’ compensation insurance for the Contractor’s employees, and shall provide the State with a Certificate of Insurance evidencing such coverage prior to starting work under this Contract.

  • Performance by Contractor The Contractor, at the Contractor's own expense, shall, except as herein otherwise specifically provided, furnish and provide all and every kind of labour and superintendence, services, tools, implements, machinery, plant materials, articles and whatsoever is necessary for the due execution of the work. The Contractor shall fully construct and erect the work in the most thorough, professional and substantial manner, in every respect to the satisfaction and approval of the Engineer. The Contractor shall complete the work within the time specified herein and deliver it to the Minister in the manner and upon the terms and conditions of the Contract.

  • Transportation of Accident Victims Transportation to the nearest physician or hospital for employees requiring medical care as a result of an on-the-job accident shall be at the expense of the Employer.

  • Contractor Certification for Contractor Employees Introduction Texas Education Code Chapter 22 requires entities that contract with school districts to provide services to obtain criminal history record information regarding covered employees. Contractors must certify to the district that they have complied. Covered employees with disqualifying criminal histories are prohibited from serving at a school district. Definitions: Covered employees: Employees of a contractor or subcontractor who have or will have continuing duties related to the service to be performed at the District and have or will have direct contact with students. The District will be the final arbiter of what constitutes direct contact with students. Disqualifying criminal history: Any conviction or other criminal history information designated by the District, or one of the following offenses, if at the time of the offense, the victim was under 18 or enrolled in a public school: (a) a felony offense under Title 5, Texas Penal Code; (b) an offense for which a defendant is required to register as a sex offender under Chapter 62, Texas Code of Criminal Procedure; or (c) an equivalent offense under federal law or the laws of another state. I certify that: NONE (Section A) of the employees of Contractor and any subcontractors are covered employees, as defined above. If this box is checked, I further certify that Contractor has taken precautions or imposed conditions to ensure that the employees of Contractor and any subcontractor will not become covered employees. Contractor will maintain these precautions or conditions throughout the time the contracted services are provided. OR SOME (Section B) or all of the employees of Contractor and any subcontractor are covered employees. If this box is checked, I further certify that: (1) Contractor has obtained all required criminal history record information regarding its covered employees. None of the covered employees has a disqualifying criminal history.

  • Coordination with Workers' Compensation When an employee has incurred an on-the- job injury or an on-the-job disability and has filed a claim for workers' compensation, medical costs connected with the injury or disability shall be paid by the employee's health plan, pursuant to M.S. 176.191, Subdivision 3.

  • Services to be performed by Contractor In consideration of the payments set forth herein and in Exhibit “B,” Contractor shall perform services for County in accordance with the terms, conditions and specifications set forth herein and in Exhibit “A.”