Participating Plan Service Capacity. CMS and the Commonwealth shall contract with Participating Plans that demonstrate the capacity to provide, directly or by subcontracting with other qualified entities, the full continuum of Medicare and Medicaid covered services to Enrollees, in accordance with this MOU, CMS guidance, and the three-way contract. Medicare covered benefits shall be provided in accordance with 42 CFR 422 and 42 CFR 423 et seq. Medicaid covered benefits shall be provided in accordance with the requirements in the approved Medicaid State Plan, including any applicable State Plan Amendments, the 1115(a) MassHealth Demonstration, and in accordance with the requirements specified in the Commonwealth RFR and this MOU. In accordance with the three-way contract and this MOU, CMS and the Commonwealth may choose to allow for greater flexibility in offering supplemental benefits that exceed those currently covered by either Medicare or Medicaid, as discussed in Appendix 7. CMS, the Commonwealth, and Participating Plans will ensure that beneficiaries have access to an adequate network of medical, drug, behavioral health, and supportive service providers that are appropriate and capable of addressing the needs of this diverse population, as discussed in more detail in Appendix 7.
Participating Plan Service Capacity. CMS and California shall contract with Prime Contractor Plans that demonstrate the capacity to provide, directly or by subcontracting with other qualified entities, the full continuum of Medicare and Medicaid covered services to enrollees, in accordance with this MOU, CMS guidance, and the three-way contract. Medicare covered benefits shall be provided in accordance with 42 CFR 422 and 42 CFR 423 et seq. Medicaid covered benefits under the Demonstration shall be provided in accordance 42 CFR 438 and with the requirements in the approved Medicaid State Plan, including any applicable State Plan Amendments and waiver authority discussed in Appendix 5, and in accordance with the requirements specified in the State Request for Solutions and this MOU. In accordance with the three-way contract and this MOU, CMS and California may choose to allow for greater flexibility in offering additional benefits that exceed those currently covered by either Medicare or Medicaid, as discussed in Appendix 7. CMS, California, and Participating Plans will ensure that beneficiaries have access to an adequate network of medical, drug, behavioral health, and supportive service providers that are appropriate and capable of addressing the needs of this diverse population, as discussed in more detail in Appendix 7.
Participating Plan Service Capacity. CMS and DMAS shall contract with Participating Plans that demonstrate the capacity to provide, directly or by subcontracting with other qualified entities, the full continuum of Medicare and Medicaid covered services to Enrollees, in accordance with this MOU, CMS guidance, and the three-way contract. Medicare covered benefits shall be provided in accordance with 42 CFR 422 and 42 CFR 423 et seq. Medicaid covered benefits under the Demonstration shall be provided in accordance with 42 CFR 438 and with the requirements in the approved Medicaid State Plan, including any applicable State Plan amendments and §1915(c) EDCD Waiver, and in accordance with the requirements specified in DMAS’ RFP and this MOU. In accordance with the three-way contract and this MOU, CMS and DMAS may choose to allow for greater flexibility in offering additional benefits that exceed those currently covered by either Medicare or Medicaid, as discussed in Appendix 7. CMS, DMAS, and Participating Plans will ensure that beneficiaries have access to an adequate network of medical, drug, behavioral health, and Long-Term Services and Supports (LTSS) providers that are appropriate and capable of addressing the needs of this diverse population, as discussed in more detail in Appendix 7.
Participating Plan Service Capacity. CMS and the State shall contract with Participating Plans that demonstrate the capacity to provide, directly or by subcontracting with other qualified entities, the full continuum of Medicare and Medicaid covered services to Enrollees, in accordance with this MOU, CMS guidance, and the three-way contract. Medicare covered benefits shall be provided in accordance with 42 CFR 422 and 42 CFR 423 et seq. Medicaid covered benefits shall be provided in accordance with the requirements in the approved Medicaid State Plan, including any applicable State Plan Amendments, the -waivers in Appendix 4 and Appendix 5, and in accordance with the requirements specified in the State certification documents and this MOU. In accordance with the three-way contract and this MOU, CMS and the State may choose to allow for greater flexibility in offering supplemental benefits that exceed those currently covered by either Medicare or Medicaid, as discussed in Appendix 7. CMS, the State, and Participating Plans will ensure that beneficiaries have access to an adequate network of medical, drug, behavioral health, and supportive service providers that are appropriate and capable of addressing the needs of this diverse population, as discussed in more detail in Appendix 7.
