Common use of Other Requirements Pertaining to Covered Services Clause in Contracts

Other Requirements Pertaining to Covered Services. MCOs must assume responsibility for all covered medical conditions, inclusive of pre-existing conditions of each enrollee as of the effective date of enrollment in the plan. MCOs may not prohibit or otherwise restrict a covered health professional from advising his/her patient about the health status of the individual or medical care or treatment for the individual’s condition or disease, regardless of whether benefits for that care or treatment are provided under the Contract, if the professional is acting within the lawful scope of practice.6 MCOs and their participating providers may not bill or collect any payment from Medicaid enrollees for care that was determined not to be Medically Necessary. Anyone who knowingly and willfully charges for any service provided to a patient under a State Plan approved under Title XIX or under a MCO Contract under 1903(m) of the Social Security Act, money or other consideration at a rate in excess of the rates established by BMS or Contract will be guilty of a felony and upon conviction will be fined no more than $25,000 or imprisoned for no more than five years, or both.

Other Requirements Pertaining to Covered Services. MCOs must assume responsibility for all covered medical conditions, inclusive of pre-existing conditions of each enrollee as of the effective date of enrollment in the plan. MCOs may not prohibit or otherwise restrict a covered health professional from advising his/her patient about the health status of the individual or medical care or treatment for the individual’s condition or disease, regardless of whether benefits for that care or treatment are provided under the Contract, if the professional is acting within the lawful scope of practice.6 practice.5 MCOs and their participating providers may not bill or collect any payment from Medicaid enrollees for care that was determined not to be Medically Necessary. Anyone who knowingly and willfully charges for any service provided to a patient under a State Plan approved under Title XIX or under a MCO Contract under 1903(m) of the Social Security Act, money or other consideration at a rate in excess of the rates established by BMS DHHR or Contract will be guilty of a felony and upon conviction will be fined no more than $25,000 or imprisoned for no more than five years, or both.

Other Requirements Pertaining to Covered Services. MCOs must assume responsibility for all covered medical conditions, inclusive of pre-existing conditions of each enrollee as of the effective date of enrollment in the plan. MCOs may not prohibit or otherwise restrict a covered health professional from advising his/her patient about the health status of the individual or medical care or treatment for the individual’s condition or disease, regardless of whether benefits for that care or treatment are provided under the Contract, if the professional is acting within the lawful scope of practice.6 MCOs and their participating providers may not bill or collect any payment from Medicaid or WVCHIP enrollees for care that was determined not to be Medically Necessary. Anyone who knowingly and willfully charges for any service provided to a patient under a State Plan approved under Title XIX XIX, Title XXI or under a MCO Contract under 1903(m) of the Social Security Act, money or other consideration at a rate in excess of the rates established by BMS or Contract will be guilty of a felony and upon conviction will be fined no more than $25,000 or imprisoned for no more than five years, or both.

Other Requirements Pertaining to Covered Services. MCOs must assume responsibility for all covered medical conditions, inclusive of pre-existing conditions of each enrollee as of the effective date of enrollment in the plan. MCOs may not prohibit or otherwise restrict a covered health professional from advising his/her patient about the health status of the individual or medical care or treatment for the individual’s condition or disease, regardless of whether benefits for that care or treatment are provided under the Contractcontract, if the professional is acting within the lawful scope of practice.6 practice.5 MCOs and their participating providers may not bill xxxx or collect any payment from Medicaid enrollees for care that was determined not to be Medically Necessarymedically necessary. Anyone who knowingly and willfully charges for any service provided to a patient under a State Plan approved under Title XIX or under a MCO Contract contract under 1903(m) of the Social Security Act, money or other consideration at a rate in excess of the rates established by BMS or Contract contract will be guilty of a felony and upon conviction will be fined no more than $25,000 or imprisoned for no more than five years, or both.

Other Requirements Pertaining to Covered Services. MCOs must assume responsibility for all covered medical conditions, inclusive of pre-existing conditions of each enrollee as of the effective date of enrollment in the plan. MCOs may not prohibit or otherwise restrict a covered health professional from advising his/her patient about the health status of the individual or medical care or treatment for the individual’s condition or disease, regardless of whether benefits for that care or treatment are provided under the Contractcontract, if the professional is acting within the lawful scope of practice.6 MCOs and their participating providers may not bill or collect any payment from Medicaid enrollees for care that was determined not to be Medically Necessarymedically necessary. Anyone who knowingly and willfully charges for any service provided to a patient under a State Plan approved under Title XIX or under a MCO Contract contract under 1903(m) of the Social Security Act, money or other consideration at a rate in excess of the rates established by BMS or Contract contract will be guilty of a felony and upon conviction will be fined no more than $25,000 or imprisoned for no more than five years, or both.

Other Requirements Pertaining to Covered Services. MCOs must assume responsibility for all covered medical conditions, inclusive of pre-existing conditions of each enrollee as of the effective date of enrollment in the plan. MCOs may not prohibit or otherwise restrict a covered health professional from advising his/her patient about the health status of the individual or medical care or treatment for the individual’s condition or disease, regardless of whether benefits for that care or treatment are provided under the Contractcontract, if the professional is acting within the lawful scope of practice.6 practice.5 MCOs and their participating providers may not bill or collect any payment from Medicaid enrollees for care that was determined not to be Medically Necessarymedically necessary. Anyone who knowingly and willfully charges for any service provided to a patient under a State Plan approved under Title XIX or under a MCO Contract contract under 1903(m) of the Social Security Act, money or other consideration at a rate in excess of the rates established by BMS or Contract contract will be guilty of a felony and upon conviction will be fined no more than $25,000 or imprisoned for no more than five years, or both.

Other Requirements Pertaining to Covered Services. MCOs must assume responsibility for all covered medical conditions, inclusive of pre-existing conditions of each enrollee as of the effective date of enrollment in the plan. MCOs may not prohibit or otherwise restrict a covered health professional from advising his/her patient about the health status of the individual or medical care or treatment for the individual’s condition or disease, regardless of whether benefits for that care or treatment are provided under the Contractcontract, if the professional is acting within the lawful scope of practice.6 practice.5 MCOs and their participating providers may not bill or collect any payment from Medicaid enrollees for care that was determined not to be Medically Necessary. Anyone who knowingly and willfully charges for any service provided to a patient under a State Plan approved under Title XIX or under a MCO Contract contract under 1903(m) of the Social Security Act, money or other consideration at a rate in excess of the rates established by BMS or Contract contract will be guilty of a felony and upon conviction will be fined no more than $25,000 or imprisoned for no more than five years, or both.

Other Requirements Pertaining to Covered Services. MCOs must assume responsibility for all covered medical conditions, inclusive of pre-existing conditions of each enrollee as of the effective date of enrollment in the plan. MCOs may not prohibit or otherwise restrict a covered health professional from advising his/her patient about the health status of the individual or medical care or treatment for the individual’s condition or disease, regardless of whether benefits for that care or treatment are provided under the Contractcontract, if the professional is acting within the lawful scope of practice.6 MCOs and their participating providers may not bill xxxx or collect any payment from Medicaid enrollees for care that was determined not to be Medically Necessarymedically necessary. Anyone who knowingly and willfully charges for any service provided to a patient under a State Plan approved under Title XIX or under a MCO Contract contract under 1903(m) of the Social Security Act, money or other consideration at a rate in excess of the rates established by BMS or Contract contract will be guilty of a felony and upon conviction will be fined no more than $25,000 or imprisoned for no more than five years, or both.

Other Requirements Pertaining to Covered Services. MCOs must assume responsibility for all covered medical conditions, inclusive of pre-existing conditions of each enrollee as of the effective date of enrollment in the plan. MCOs may not prohibit or otherwise restrict a covered health professional from advising his/her patient about the health status of the individual or medical care or treatment for the individual’s condition or disease, regardless of whether benefits for that care or treatment are provided under the Contract, if the professional is acting within the lawful scope of practice.6 practice.5 MCOs and their participating providers may not bill or collect any payment from Medicaid enrollees for care that was determined not to be Medically Necessary. Anyone who knowingly and willfully charges for any service provided to a patient under a State Plan approved under Title XIX or under a MCO Contract under 1903(m) of the Social Security Act, money or other consideration at a rate in excess of the rates established by BMS or Contract will be guilty of a felony and upon conviction will be fined no more than $25,000 or imprisoned for no more than five years, or both.