Ownership and Affiliation Sample Clauses

Ownership and Affiliation. Check the applicable box to describe the ownership and affiliation between the legal entity offering Health Plan and the legal entity offering the companion MAP: The legal entity offering Health Plan is the same legal entity offering the MAP plan under which SDOH provides capitated payments for provision of the services. Full name of legal entity offering MAP: ______ _ Health Plan shall complete all information below for each D-SNP under this Agreement. Health Plan shall attach copy of Appendix K of the model contract in its entirety when submitting to CMS. See the link below. xxxxx://xxx.xxxxxx.xx.xxx/health_care/medicaid/redesign/mrt90/hlth_plans_prov_prof.htm CMS Contract Code (H#): Albany Franklin Xxxxxx Xxxxxxxx Allegany Xxxxxx Onondaga Seneca Bronx Genesee Ontario Steuben Xxxxxx Xxxxxx Orange Suffolk Cattaraugus Xxxxxxxx Orleans Xxxxxxxx Cayuga Herkimer Oswego Tioga Chautauqua Jefferson Otsego Xxxxxxxx Chemung Kings Xxxxxx Ulster Chenango Xxxxx Queens Xxxxxx Xxxxxxx Xxxxxxxxxx Rensselaer Washington Columbia Madison Xxxxxxxx Xxxxx Xxxxxxxx Xxxxxx Rockland Westchester Delaware Xxxxxxxxxx St. Xxxxxxxx Wyoming Dutchess Nassau Saratoga Xxxxx Erie New York Schenectady Essex Niagara Schoharie Categories of Dual Eligible Beneficiaries Enrolled (Sec. 5.11.2): Health Plan verifies that only Dual Eligible Beneficiaries from the following categories, as defined in Attachment A, are enrolled in this D-SNP: In Medicaid Advantage: FBDE In Fee-For-Service (FFS): QMB SLMB QI QDWI QMB-Plus SLMB-Plus FBDE

Ownership and Affiliation. Check the applicable box to describe the ownership and affiliation between the legal entity offering Health Plan and the legal entity offering the companion IB-Dual:

Ownership and Affiliation. Neither of Parent and Merger Sub is, nor at any time during the last three years has either of them been, an “interested stockholder” (as defined in Section 203 of the DGCL) of the Company. None of Parent, Merger Sub, and to Parent’s knowledge, the other Affiliates of Parent, beneficially owns any shares of Company Common Stock. Neither Parent nor Merger Sub has entered into any contract with any officer or director of the Company in connection with the Transactions.

Ownership and Affiliation. Check the applicable box to describe the ownership and affiliation between the legal entity offering Health Plan and the legal entity offering the companion partial capitation MLTC plan: The legal entity offering Health Plan is the same legal entity offering the partial capitation MLTC plan under which SDOH provides capitated payments for provision of long term services and supports in Appendix A. The legal entity offering Health Plan is a separate legal entity under the same parent organization offering the partial capitation MLTC plan under which SDOH provides capitated payments for the provision of long term services and supports. Health Plan shall attach copy of Appendix K of the model contract in its entirety when submitting to CMS. See the link below. Health Plan that operates an IB-Dual with both Aligned and FFS dual eligible enrollees into the D-SNP. Health Plan shall meet designation for HIDE SNP as defined in this agreement and outlined in the Appendix K link to the model contract. The IB-Dual coverage includes behavioral health and/or long term services and supports. Health Plan is seeking HIDE SNP designation as defined in this agreement. Yes __ _ No_ Plan Name: _______ _ Health Plan has received CMS approval for default enrollment for its MMC/HARP (IB-Dual) contract: Yes ___ No____