Services Outside the Program Sample Clauses

Services Outside the Program. The following services are excluded by DVHA from Program payments, and will be excluded from the payments by ACO and will be reimbursed by DVHA directly to Participants: 2.4.1 Services Not Covered in the Program. The following services are paid for by DVHA but are not included in the Program: 2.4.1.1 Pharmacy; 2.4.1.2 Nursing Facility Care; 2.4.1.3 Psychiatric Treatment in State Psychiatric Hospital; 2.4.1.4 Level 1 (involuntary placement) Inpatient Psychiatric Stays (in any hospital when paid for by DVHA);

Services Outside the Program. The services included in the Program will be based on the allowed claims incurred for each Exchange-offered product in a manner consistent with ACO strategy and approved by the Board of Managers Exclusions include claims allowable under separate benefit riders.

Services Outside the Program. The following services are excluded by DVHA from Program payments, and will be excluded from the payments by ACO and will be reimbursed by DVHA directly to Participants:

Services Outside the Program. The services included in the Program will be based on the allowed claims incurred by MVP for each Exchange offered Vermont product and the negotiated fee schedules with MVP in a manner consistent with ACO strategy and approved by the Board of Managers. Exclusions include retail pharmacy claims.

Services Outside the Program. The services included in the UVMHN Program Agreement will be based on the allowed claims incurred within the Total Cost of Care in a manner consistent with ACO strategy and approved by the Board of Managers. Exclusions may include Retail Pharmacy and other claims allowable under separate benefit riders.