Protection Against Insolvency. The Contractor shall maintain a positive net worth, and such capital, additional surplus, line of credit and securities that equal to or exceed the minimum requirements established by the Mississippi Department of Insurance pursuant to Miss. Code Xxx. Section 00-00-000 et. seq. (1972, as amended) as a condition for certification as a Health Maintenance Organization. The Contractor shall maintain appropriate Contractors and provisions for the fulfillment of its covenants and obligations pursuant to this contract in the event the Contractor or any material subcontractor or supplier should become insolvent. The Contractor shall submit to the Division for review and approval, a description and evidence of any arrangements made for protection against the risk of insolvency. The Contractor shall provide written notice to the Division at least sixty (60) days prior to the effective date of any change or modification in any such arrangements. Medicaid enrollees will not be held liable, for the following: • CCO’s debts, in the event of insolvency; • Covered services provided to the enrollee, for which the State does not pay the CCO; • Covered services provided to the enrollee, for which the State, or the CCO does not pay the individual or health care provider that furnishes the services under a contractual, referral, or other arrangement; and/or • Liability for payments for covered services furnished under a contract, referral, or other arrangement, to the extent that those payments are in excess of the amount that the enrollee would owe if the CCO provided the services directly.
Appears in 3 contracts
Samples: medicaid.ms.gov, medicaid.ms.gov, medicaid.ms.gov
Protection Against Insolvency. The Contractor shall maintain a positive net worth, and such capital, additional surplus, line of credit and securities that equal to or exceed the minimum requirements established by the Mississippi Department of Insurance pursuant to Miss. Code Xxx. Section 00-00-000 et. seq. (1972, as amended) as a condition for certification as a Health Maintenance Organization. The Contractor shall maintain appropriate Contractors and provisions for the fulfillment of its covenants and obligations pursuant to this contract in the event the Contractor or any material subcontractor or supplier should become insolvent. The Contractor shall submit to the Division for review and approval, a description and evidence of any arrangements made for protection against the risk of insolvency. The Contractor shall provide written notice to the Division at least sixty (60) days prior to the effective date of any change or modification in any such arrangements. Medicaid enrollees will not be held liable, for the following: • CCO’s debts, in the event of insolvency; • Covered services provided to the enrollee, for which the State does not pay the CCO; • Covered services provided to the enrollee, for which the State, or the CCO does not pay the individual or health care provider that furnishes the services under a contractual, referral, or other arrangement; and/or • Liability for payments for covered services furnished under a contract, referral, or other arrangement, to the extent that those payments are in excess of the amount that the enrollee would owe if the CCO provided the services directly.
Appears in 2 contracts
Samples: www.medicaid.ms.gov, medicaid.ms.gov
