MEDICAID PROVISIONS Sample Clauses

MEDICAID PROVISIONS. Sec. 3811. Extension of the money follows the person rebalancing demonstration program Sec. 3812. Extension of spousal impoverishment protections
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MEDICAID PROVISIONS. 9.1. Exhibit III-B provides a list of Centennial Care Covered Services, activities and reporting responsibilities to be performed by the Provider. Providers will be responsible to perform Centennial Care Covered Services within the scope of practice for which they are credentialed HSD and CMS require that specific terms and conditions be included in this Agreement to comply with the Medicaid managed care laws, regulations, HSD and CMS instructions. Provider expressly acknowledges that it shall be bound by and comply with these provisions when providing Covered Services to Centennial Care Members. 9.2. Provider will be cognizant of the Covered Services provided under the terms of this Agreement. Provider will also assist and educate Members about self-referrals, linkages and how to access Care Coordinators in support of the Presbyterian Centennial Care Program; 9.3. The Primary Care Provider (PCP), if applicable: 9.3.1. With the exception of Dual Eligibles, Health Plan will ensure that each Member is assigned a PCP. For Dual Eligibles, Health Plan will be responsible for coordinating the primary, acute, Behavioral Health and Long-Term Care services with the Member’s Medicare PCP. For all other Members, the PCP shall be a medical or Behavioral Health provider participating with Health Plan who has the responsibility for supervising, coordinating, and providing primary health care to Members, initiating referrals for specialist care, and maintaining the continuity of the Member's care. Health Plan is prohibited from excluding providers as primary care providers based on the proportion of high-risk patients in their caseloads. 9.3.2. Provider acknowledges that the Health Plan shall submit a PCP Report as required by HSD. Provider understands that the monthly PCP Report submitted to HSD will include, at a minimum, the following information: 9.3.2.1. the names of newly enrolled Members and the name of the PCP to which they are assigned or selected; 9.3.2.2. the PCP to Member ratio per two thousand (2,000) Members; 9.3.2.3. the percent of PCP panel slots open; 9.3.2.4. the number of providers serving as PCPs stratified by type (nurse practitioners, internists, pediatricians, etc.); 9.3.2.5. the number of PCP visits per two thousand (2,000) Members; 9.3.2.6. the percent of new Members who did not select a PCP and were assigned to one; and 9.3.2.7. the number of PCP change requests received and processed. 9.4. If Provider acts as a PCP, Provider shall comply with t...

Related to MEDICAID PROVISIONS

  • Medicaid Program Parties (applicable to any Party providing services and supports paid for under Vermont’s Medicaid program and Vermont’s Global Commitment to Health Waiver):

  • Compliance with Health Care Laws Each of the Company and its Subsidiaries is, and at all times has been, in compliance in all material respects with all applicable Health Care Laws, and has not engaged in activities which are, as applicable, cause for false claims liability, civil penalties, or mandatory or permissive exclusion from Medicare, Medicaid, or any other state or federal health care program. For purposes of this Agreement, “Health Care Laws” means: (i) the Federal Food, Drug, and Cosmetic Act (21 U.S.C. §§ 301 et seq.), the Public Health Service Act (42 U.S.C. §§ 201 et seq.), and the regulations promulgated thereunder; (ii) all applicable federal, state, local and all applicable foreign health care related fraud and abuse laws, including, without limitation, the U.S. Anti-Kickback Statute (42 U.S.C. Section 1320a-7b(b)), the U.S. Physician Payment Sunshine Act (42 U.S.C. § 1320a-7h), the U.S. Civil False Claims Act (31 U.S.C. Section 3729 et seq.), the criminal False Claims Law (42 U.S.C. § 1320a-7b(a)), all criminal laws relating to health care fraud and abuse, including but not limited to 18 U.S.C. Sections 286 and 287, and the health care fraud criminal provisions under the U.S. Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) (42 U.S.C. Section 1320d et seq.), the exclusion laws (42 U.S.C. § 1320a-7), the civil monetary penalties law (42 U.S.C. § 1320a-7a), HIPAA, as amended by the Health Information Technology for Economic and Clinical Health Act (42 U.S.C. Section 17921 et seq.), and the regulations promulgated pursuant to such statutes; (iii) Medicare (Title XVIII of the Social Security Act); (iv) Medicaid (Title XIX of the Social Security Act); (v) the Controlled Substances Act (21 U.S.C. §§ 801 et seq.) and the regulations promulgated thereunder; and (vi) any and all other applicable health care laws and regulations. Neither the Company nor, to the knowledge of the Company, any subsidiary has received notice of any claim, action, suit, proceeding, hearing, enforcement, investigation, arbitration or other action from any court or arbitrator or governmental or regulatory authority or third party alleging that any product operation or activity is in material violation of any Health Care Laws, and, to the Company’s knowledge, no such claim, action, suit, proceeding, hearing, enforcement, investigation, arbitration or other action is threatened. Neither the Company nor, to the knowledge of the Company, any subsidiary is a party to or has any ongoing reporting obligations pursuant to any corporate integrity agreements, deferred prosecution agreements, monitoring agreements, consent decrees, settlement orders, plans of correction or similar agreements with or imposed by any governmental or regulatory authority. Additionally, neither the Company, its Subsidiaries nor any of its respective employees, officers or directors has been excluded, suspended or debarred from participation in any U.S. federal health care program or human clinical research or, to the knowledge of the Company, is subject to a governmental inquiry, investigation, proceeding, or other similar action that could reasonably be expected to result in debarment, suspension, or exclusion.

  • Compliance with Federal and State Work Authorization and Immigration Laws The Contractor and all subcontractors, suppliers and consultants must comply with all federal and state work authorization and immigration laws, and must certify compliance using the form set forth in Section 7 (“Georgia Security and Immigration Compliance Act Affidavits”). The required certificates must be filed with the Owner and copied maintained by the Contractor as of the beginning date of this contract and each subcontract, supplier contract, or consultant contract, and upon final payment to the subcontractor or consultant. State officials, including officials of the Georgia Department of Audits and Accounts, officials of the Owner, retain the right to inspect and audit the Project Site and employment records of the Contractor, subcontractors and consultants without notice during normal working hours until Final Completion, and as otherwise specified by law and by Rules and Regulations of the Georgia Department of Audits and Accounts.

  • Injured Workers Provisions At the time an injury occurs, the injured worker's employer shall provide transportation for the worker (if the worker needs it) to a hospital or a physician located within a reasonable distance or to the worker's home. The employer shall pay for the transportation.

  • 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.

  • SAFETY PROVISIONS It is the essence of this Order that all Services to be performed by Seller shall be done in a safe and good workmanlike manner, free of any accidents. Accordingly, Seller shall promulgate, maintain, and enforce appropriate safety and health rules and procedures (including training) with respect to its personnel and the Work to be performed hereunder, which rules and procedures at a minimum shall be the equivalent of or exceed applicable Buyer safety and health rules. All Services performed hereunder shall fully comply with all lawful governmental safety and health requirements, including the rules and standards established by the Occupational Safety and Health Act of 1970 ("OSHA"), as amended, and any other applicable federal, state and/or local safety or health laws, rules or regulations. Any equipment provided by Buyer to Seller for the benefit of Seller's employees or those of its subcontractors shall be at the sole risk and liability of Seller to make sure that such equipment is fit for the use intended and is in proper working order. XXXXXX AGREES TO INDEMNIFY (INCLUDING ATTORNEYS' FEES) DEFEND, AND TO SAVE HARMLESS BUYER FROM ANY AND ALL CLAIMS OF SELLER, SELLER’S SUBCONTRACTORS, AND THEIR EMPLOYEES ARISING OUT OF THE USE OF ANY EQUIPMENT FURNISHED BY BUYER OR ADVICE GIVEN BY BUYER RELATING TO SUCH EQUIPMENT, TO THE FULLEST EXTENT ALLOWED BY LAW, IT BEING UNDERSTOOD THAT BUYER SHALL NOT BE LIABLE UNDER LAW, CONTRACT, NEGLIGENCE, STRICT LIABILITY, OR OTHERWISE. Seller shall maintain a drug and alcohol-free workforce at all times while on Xxxxx's premises/location. Upon Xxxxx's request, Seller shall provide Buyer with a copy of all accident reports prepared by or submitted to Seller, including all OSHA illness and injury reports.

  • REFERENCED CONTRACT PROVISIONS 2 Term: March 10, 20109 through June 30, 20110 3 “Period One” means the period from March 10, 2009 through June 30, 2009 4 “Period Two” means the period from July 1, 2009 through June 30, 2010 5 Maximum Obligation: $88,080 6 Period One Maximum Obligation: $ 44,040 7 Period Two Maximum Obligation: 8 TOTAL CONTRACT MAXIMUM OBLIGATION: $132,120 9 Basis for Reimbursement: Fee for Service 10 11 Payment Method: Fee for Service 12 Notices to COUNTY and CONTRACTOR: 14 COUNTY: County of Orange Health Care Agency 15 Contract Development and Management 16 000 Xxxx 0xx Xxxxxx, Xxxxx 000 00 Xxxxx Xxx, XX 00000-0000 18 CONTRACTOR: National Alliance on Mental Illness 19 dba NAMI Orange County 20 0000 X. 00xx Xxxxxx 00 Xxxxx Xxx, XX 00000 22 Coverage Minimum Limits 24 Workers' Compensation Statutory 25 Employer's Liability $1,000,000 26 Sexual Misconduct Insurance $1,000,000 Comprehensive General Liability Insurancewith $1,000,000 combined single limit 27 Comprehensive broad form Property damage and per occurrence including coverage 28 contractual liability $2,000,000 aggregate 29 Automobile Liability Insurance ), $1,000,000 combined single limit Workers' Compensation Statutory 30 coveringfor owned, non-owned, and hired ) vehicles) per occurrence 31 Employer's Liability Insurance $1,000,000 per occurrence Professional Liability Insurance $1,000,000 per claims made or 34 Sexual Misconduct $1,000,000 per occurrence 35 per occurrence 36

  • 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)].

  • COMPLIANCE WITH GOVERNMENTAL RULES AND REGULATIONS; RECORDS The Trust assumes full responsibility for its compliance with all securities, tax, commodities and other laws, rules and regulations applicable to it.

  • 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

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