Modification of Section 6. 4, Continuity of Care and Out-of-Network Providers
Modification of Section 6. 5, EMERGENCY SERVICES Section 6.5.1 is replaced with the following language:
6.5.1 HMO must pay for the professional, facility, and ancillary services that are medically necessary to perform the medical screening examination and stabilization of HMO Member presenting as an emergency medical condition or an emergency behavioral health condition to the hospital emergency department, 24 hours a day, 7 days a week, rendered by either HMO's in-network or out-of-network providers.
6.5.1.1 For all out-of-network providers, HMO will pay a reasonable and customary amount for emergency services. HMO will pay a reasonable and customary amount for services for all out-of-network emergency services provider claims with dates of service between September 1, 2002 and November 30, 2002. HMO must forward any complaints submitted by out-of-network emergency services providers during this time to HHSC. HHSC will review all complaints and determine whether payments were reasonable and customary. HHSC will direct the HMO to pay a reasonable and customary amount, as determined by HHSC, if it concludes that the payments were not reasonable and customary for the provider.
6.5.1.2 For all out-of-network emergency services provider claims with dates of service on or after December 1, 2002, HMO must pay providers a reasonable and customary amount consistent with a methodology approved by HHSC. HMO must submit its methodology, along with any supporting documentation, to HHSC by September 30, 2002. HHSC will review and respond to the information by November 15, 2002. HMO must forward any complaints by out-of-network emergency services providers submitted after December 1, 2002 to HHSC, which will review all complaints. If HHSC determines that payment is not consistent with the HMO's approved methodology, the HMO must pay the emergency services provider a rate, using the approved reasonable and customary methodology, as determined by HHSC. Failure to comply with this provision constitutes a default under Article XVI, Default and Remedies.
Modification of Section 6. 20. Section 6.20 of the Credit Agreement is hereby deleted in its entirety and is hereby replaced with the following:
Modification of Section 6. Section 6 of the Agreement is hereby amended and restated in its entirety as follows:
Modification of Section 6. 01. ----------------------------
Section 6.01 (b) of the Credit Agreement is hereby amended to read in its entirety as set forth below:
Modification of Section 6. Subsection 6.05(d) of the Credit ---------------------------- Agreement is hereby amended by deleting the phrase "provided such Subsidiaries have executed and delivered a Subsidiary Guaranty in favor of the Agent" therefrom.
Modification of Section 6. Section 6.07 of the Credit Agreement is ---------------------------- hereby amended by adding the word "and" immediately before the parenthetical "
Modification of Section 6. Section 6.08 of the Credit Agreement is ---------------------------- hereby amended by replacing the word "or" appearing in the sixth line thereof with a "," and by adding the clause "or (iv) transfers and conveyances of assets from the Subsidiaries of Borrower to the Borrower as provided for in Section 5.11 and permitted under Section 6.04." ------------ ------------
Modification of Section 6. 15, 1915(c) WAIVER SERVICE (COMMUNITY BASED ALTERNATIVES)
Modification of Section 6. 3(a). The recitals and Section 6.3(a) of ------------------------------ the Agreement shall be deemed to be modified to reflect that Buyer is a wholly- owned subsidiary of CCIC, and not a wholly-owned subsidiary of Crown Communication Inc.
