Medicaid Program Sample Clauses

Medicaid Program. If CCPN or any subsidiary established for such purpose applies for and is accepted for participation in the Medicaid Program and enters into an agreement with the State of North Carolina or other entity acting on behalf of the State of North Carolina, Practice shall:
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Medicaid Program. Promote provision of immunizations for Medicaid clients at their medical homes, including Healthy Options, whenever possible.* • Promote collaboration with MAA for Medicaid eligibles to increase immunization levels through specific program initiatives.* • Provide technical support for local health jurisdictions and health care providers that treat Medicaid eligibles on vaccine and immunization practice issues.* • Determine what proportion of the state distributed vaccine was purchased for Title XIX clients.* • Promote assessment activities for Medicaid eligible children.* • Participate in meetings with DSHS-MAA to review and assess progress toward year 2000 goals.**
Sample 1
Medicaid Program. The South Carolina medical assistance plan under Title XIX of the Social Security Act. For purposes of this Appendix, Medicaid Program may refer to the government agency responsible for administering the Medicaid Program (SCDHHS) and may also be read to include other government oversight agencies including, as applicable, the South Carolina Department of Insurance and the Centers for Medicare and Medicaid Services (“CMS”).
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Medicaid Program a. Establish eligibility policy, regulations, and procedures.
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Medicaid Program. The state Medicaid program which pays for services furnished to the Medicaid Member not enrolled in a Medicaid managed care plan, in accordance with the Medicaid State Plan’s fee- for-service methodology.
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Related to Medicaid Program

  • Medicare If the Resident meets the eligibility requirements for skilled nursing facility benefits under the Medicare Part A Hospital Insurance Program, the Facility will bill Medicare directly for Part A services provided to the Resident. Medicare will reimburse the Facility a fixed per diem or daily fee based on the Resident’s classification within the Medicare RUG IV guidelines or successor guidelines thereto. If the Resident continues to be eligible, Medicare may provide coverage of up to 100 days of care. The first 20 days of covered services are fully paid by Medicare and the next 80 days (days 21 through 100) of the covered services are paid in part by Medicare and subject to a daily coinsurance amount for which the Resident is responsible. A Resident with Medicare Part B and/or Part D coverage, who subsequently exhausts his/her Part A coverage or no longer needs a skilled level of care under Part A, may still be eligible to receive coverage for certain Part B services (previously included in the Part A payment to the Facility) and/or Part D services when Part A coverage ends. Medicare will terminate coverage for Medicare beneficiaries receiving physical, occupational and/or speech therapy (“therapy services”) if the Resident does not receive therapy for three (3) consecutive days, whether planned or unplanned, for any reason, including illness or refusals, doctor appointments or religious holidays. If such therapy was the basis for Medicare Part A coverage, the Resident would be responsible for the cost of his/her stay, unless another payor source is available. If Medicare denies coverage and denies further payment and/or recoups any payment made to the Facility, the Resident, Resident Representative, and/or Sponsor hereby agree to pay to the Facility any outstanding amounts for unpaid services not covered by other third party payers, subject to applicable federal and state laws and regulations. Such amounts shall be calculated in accordance with the Facility’s applicable prevailing private rates and charges for all basic and additional services provided to the Resident. Except for specifically excluded services, most nursing home services are covered under the consolidated billing requirements for Medicare Part A beneficiaries or under an all-inclusive rate for other third party insurers and managed care organizations (MCOs). Under these requirements, the Facility is responsible for furnishing directly, or arranging for, the services for its residents covered by Medicare Part A and MCOs. When not directly providing services, the Facility is required to enter into arrangements with outside providers and must exercise professional responsibility and control over the arranged-for services. All services that the Resident requires must be provided by the Facility or an outside provider approved by the Facility. Before obtaining any services outside of the Facility, the Resident must consult the Facility. While the Resident has the right to choose a health care provider, the Resident understands that by selecting the Facility, the Resident has effectively exercised his/her right of free choice with respect to the entire package of services for which the Facility is responsible under the consolidated billing and third party billing requirements. The Resident agrees that he/she will not arrange for the provision of ancillary services unless the Resident has obtained prior approval from the Facility. MEDICARE PART A, MANAGED CARE, AND THIRD-PARTY INSURANCE

  • COMPLIANCE BY CONTRACTOR WITH LAWS AND REGULATIONS/ EQUAL EMPLOYMENT OPPORTUNITY 6.1 In connection with the performance of the Services, the Contractor shall comply with all applicable statutes, laws, regulations, and orders of federal, state, county or municipal authorities which impose any obligation or duty upon the Contractor, including, but not limited to, civil rights and equal employment opportunity laws. In addition, if this Agreement is funded in any part by monies of the United States, the Contractor shall comply with all federal executive orders, rules, regulations and statutes, and with any rules, regulations and guidelines as the State or the United States issue to implement these regulations. The Contractor shall also comply with all applicable intellectual property laws.

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