Common use of Program Exceptions Clause in Contracts

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. The CHC-MCO must establish a program exception process, reviewed and approved by the Department, whereby a Provider or Participant may request coverage coverage, under extraordinary circumstances, for items or services, which services that are included in of a type covered by the Participant’s benefit package MA program 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. 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 also apply 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. ‌ The CHC-MCO must is required to 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 ParticipantMember’s benefit package but are not currently listed on the MA Program Fee Schedule. The CHCPH-MCO must use also apply 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 and are described in 55 Pa. PA Code § 1150.63.§1150.63.‌