Program Exceptions. The PH-MCO is required to establish a Program Exception process, reviewed and approved by the Department, whereby a Provider may request coverage for items or services, which are included in the Member’s benefit package but are not currently listed on the MA Program Fee Schedule. The PH-MCO must also apply the program exception process to requests to exceed limits for items or services that are on the Fee Schedule if the limits are not based in statute or regulation. These requests are recognized by the Department as a Program Exception and are described in 55 Pa. Code §1150.63.
Program Exceptions. The CHC-MCO must establish a program exception process, reviewed and approved by the Department, whereby a Provider or Participant may request coverage for items or services, which are included in the Participant’s benefit package but are not currently listed on the MA Program Fee Schedule. The CHC-MCO must use the program exception process to accept requests to exceed limits for items or services that are on the Fee Schedule if the limits are not based in statute or regulation. These requests are recognized by the Department as a Program Exception as described in 55 Pa. Code § 1150.63.
Program Exceptions. Notwithstanding anything to the contrary in this Agreement, KHE’s status as the limited exclusive provider of Basic Services for all new online Programs developed and launched by Purdue Units during the Term does not apply to Program Exceptions. The following special provisions apply to such Program Exceptions:
Program Exceptions. The Contractor is also required to establish a process, reviewed and approved by the Department, whereby a Provider may request coverage for items or services, which while included under the MA Consumer's benefit package, are not currently listed on the MA Program Fee Schedule. These requests are recognized by the Department as a Program Exception and described in 55 Pa. Code 1150.63.
