Common use of Prohibition on Billing Recipients for Covered Services Clause in Contracts

Prohibition on Billing Recipients for Covered Services. The MCO, its providers and subcontractors shall not xxxx a member for services in the benefit package provided during the member’s enrollment period in the MCO, except as provided for in the 1915(c) waiver post-eligibility treatment of income and the purchase of enhanced services as allowed under this article, Section J., Department Policy for Member Use of Personal Resources. This provision pertains even if the: a. MCO becomes insolvent; b. Department does not pay the MCO for covered services provided to the member; c. Department or the MCO does not pay the provider that furnishes the services under a subcontractual referral or other arrangement; and, d. Payment for services furnished under a subcontract, referral, or other arrangement, to the extent that those payments are in excess of the amount that the member would owe if the MCO provided the service directly.

Prohibition on Billing Recipients for Covered Services. The MCO, its providers and subcontractors shall not xxxx a member for services in the benefit package provided during the member’s enrollment period in the MCO, except as provided for in the 1915(c) waiver post-eligibility treatment of income and the purchase of enhanced services as allowed under this article, Section J.K., Department Policy for Member Use of Personal Resources. This provision pertains even if the: a. MCO becomes insolvent; b. Department does not pay the MCO for covered services provided to the member; c. Department or the MCO does not pay the provider that furnishes the services under a subcontractual referral or other arrangement; and, d. Payment for services furnished under a subcontract, referral, or other arrangement, to the extent that those payments are in excess of the amount that the member would owe if the MCO provided the service directly.

Prohibition on Billing Recipients for Covered Services. The MCO, its providers and subcontractors shall not xxxx bill a member for services in the benefit package provided during the member’s enrollment period in the MCO, except as provided for in the 1915(c) waiver post-eligibility treatment of income and the purchase of enhanced services as allowed under this article, Section J., Department Policy for Member Use of Personal Resources. This provision pertains even if the: a. MCO becomes insolvent; b. Department does not pay the MCO for covered services provided to the member; c. Department or the MCO does not pay the provider that furnishes the services under a subcontractual referral or other arrangement; and, d. Payment for services furnished under a subcontract, referral, or other arrangement, to the extent that those payments are in excess of the amount that the member would owe if the MCO provided the service directly.