Medicaid Rates Sample Clauses

Medicaid Rates. Negotiated Rates Except as provided in sub b., if the IHCP can negotiate such agreements with third party providers, the IHCP may pay third party providers less than Medicaid fee-for-service rates. The Medicaid Rate for Nursing Home Services In determining the payment rate for the purchase of nursing home services, the IHCP must employ the Medicaid fee-for-service nursing home rate methodology applied solely to the Indian Health Care Provider (IHCP)’s residents in that nursing facility. IHCPs may use either the acuity of the IHCP’s nursing home residents as of a specific date or each individual member’s daily acuity. The Medicaid fee-for-service nursing home rate methodology includes any retroactive adjustments to the Medicaid fee-for-service rates for the nursing home. IHCPs must apply nursing home retroactive rate adjustments within 90 days of DHS posting an updated rate for the nursing home, utilizing provider submitted member acuity information. DHS will periodically provide MCOs with member- specific acuity rosters, which MCOs have the option to use to further reconcile provider-submitted acuity levels. There is no timeframe for this optional reconciliation. Medicaid Fee-For-Service Rates The IHCP shall not pay itself or its third party providers more than the Medicaid fee-for-service rates for Medicaid covered services in the benefit package except when it determines, on an individualized basis, that it is unable or impractical to otherwise obtain the service. Paying above the Medicaid fee-for-service rate includes paying more than Medicaid fee-for- service would pay when coordinating benefits with others. A listing of the specific fee-for-service Medicaid services exempt from the requirements in this section can be found in the Care Management Organization (CMO) Pricing Administration Guide on the ForwardHealth website. IHCP Notification of Payment Above the Medicaid Fee-For Service Rate In the event that an IHCP contracts at a rate above the Medicaid fee-for- service rate, the IHCP must submit a notification to the MCO and Department.
Sample 1
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Medicaid Rates a. Negotiated Rates If the MCO can negotiate such agreements with providers, the MCO may pay providers less than Medicaid fee-for-service rates. b. The Medicaid Rate for Nursing Home Services In determining the “Medicaid fee-for-service rate” in Article VIII.N.8.a. and c. for the purchase of nursing home services, the MCO must employ the Medicaid fee-for-service nursing home rate methodology applied solely to the MCO’s residents in that nursing facility.
Sample 1
Medicaid Rates. MCO Notification of Payment Above the Medicaid Fee-For Service Rate In the event that an MCO contracts at a rate above the Medicaid fee-for-service rate, the MCO will document and track each situation. The MCO must submit a single comprehensive report to the Department at XXXXXXXXX@xxx.xxxxxxxxx.xxx in February and August of each year (see xxxxx://xxx.xxx.xxxxxxxxx.xxx/familycare/mcos/report-reqs.pdf for the specific due dates) as a component of the Quarterly Report required under Article XIV.C.3. The information will be reported to the Department on a form provided by the Department. The MCO will identify expenditures on the services paid for above the Medicaid Fee-For-Service Rate within the LTCare IES.
Sample 1
Medicaid Rates 
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Related to Medicaid Rates

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  • 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 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):

  • Subcontracting for Medicaid Services Notwithstanding any permitted subcontracting of services to be performed under this Agreement, Party shall remain responsible for ensuring that this Agreement is fully performed according to its terms, that subcontractor remains in compliance with the terms hereof, and that subcontractor complies with all state and federal laws and regulations relating to the Medicaid program in Vermont. Subcontracts, and any service provider agreements entered into by Party in connection with the performance of this Agreement, must clearly specify in writing the responsibilities of the subcontractor or other service provider and Party must retain the authority to revoke its subcontract or service provider agreement or to impose other sanctions if the performance of the subcontractor or service provider is inadequate or if its performance deviates from any requirement of this Agreement. Party shall make available on request all contracts, subcontracts and service provider agreements between the Party, subcontractors and other service providers to the Agency of Human Services and any of its departments as well as to the Center for Medicare and Medicaid Services.

  • Compassionate Care Leave 1. For the purposes of this article “family member” means:

  • Medicaid Notification of Termination Requirements Party shall follow the Department of Vermont Health Access Managed-Care-Organization enrollee-notification requirements, to include the requirement that Party provide timely notice of any termination of its practice.

  • Contractor Standards Contractor shall comply with Contractor Standards provisions codified in the SDMC. Contractor understands and agrees that violation of Contractor Standards may be considered a material breach of the Contract and may result in Contract termination, debarment, and other sanctions.

  • Standard Hazard and Flood Insurance Policies For each Mortgage Loan (other than a Cooperative Loan), the Master Servicer shall maintain, or cause to be maintained by each Servicer, standard fire and casualty insurance and, where applicable, flood insurance, all in accordance with the provisions of this Agreement and the related Servicing Agreement, as applicable. It is understood and agreed that such insurance shall be with insurers meeting the eligibility requirements set forth in the applicable Servicing Agreement and that no earthquake or other additional insurance is to be required of any Mortgagor or to be maintained on property acquired in respect of a defaulted loan, other than pursuant to such applicable laws and regulations as shall at any time be in force and as shall require such additional insurance. Pursuant to Section 4.01, any amounts collected by the Master Servicer, or by any Servicer, under any insurance policies maintained pursuant to this Section 9.16 or any Servicing Agreement (other than amounts to be applied to the restoration or repair of the property subject to the related Mortgage or released to the Mortgagor in accordance with the applicable Servicing Agreement) shall be deposited into the Collection Account, subject to withdrawal pursuant to Section 4.02. Any cost incurred by the Master Servicer or any Servicer in maintaining any such insurance if the Mortgagor defaults in its obligation to do so shall be added to the amount owing under the Mortgage Loan where the terms of the Mortgage Loan so permit; provided, however, that the addition of any such cost shall not be taken into account for purposes of calculating the distributions to be made to Certificateholders and shall be recoverable by the Master Servicer or such Servicer pursuant to Section 4.02.

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

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