SNBC Covered Services Sample Clauses

SNBC Covered Services. The MCO shall provide, or arrange to have provided, to all SNBC Enrollees comprehensive preventive, diagnostic, therapeutic and rehabilitative services as defined in: 1) Minnesota Statutes, § 256B.0625 and corresponding Minnesota Rules, Parts 9505.0170 to 9505.0475; 2), and 2) Home Care Services as defined in Minnesota Statutes, §§ 256B.0651through 256B.0656 except for personal care assistant services, private duty nursing services and personal care Qualified Professional supervision services as authorized by Minnesota Statutes, § 256B.69, subd. 28. Except for sections 6.27 (prescription drugs) and 6.36 (transplants) or as otherwise specified in the Contract. These services shall be provided to the extent that the above law and rules were in effect on the Effective Day of this Contract. Sections 6.27 and 6.36 shall be provided to the extent that the above law and rules are in effect. The MCO shall also provide, or arrange to have provided to Enrollees, Medicare benefits as provided pursuant to 42 U.S.C. § 1395, and Specialized Medicare Advantage (MA) plans for Special Needs Enrollees, known as Special Needs Plans (SNPs), established by the Medicare Modernization Act (MMA) of 2003, pursuant to the MCOs MA/SNP contract with CMS. All covered benefits, except for services mandated by state or federal law, are subject to determination by the MCO of Medical Necessity, as defined in section 2.87. For purposes of this section, mandated services do not include the benefits described in Minnesota Statutes, Chapter 256B. The MCO shall provide services that shall include but are not limited to the following:
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SNBC Covered Services. ‌ The MCO shall provide, or arrange to have provided, to all SNBC Enrollees comprehensive preventive, diagnostic, therapeutic and rehabilitative and long term care services as defined in Minnesota Statutes, Chapters 245G, 256 and 256B and corresponding Minnesota Rules, Parts 9505.0170 to 9505.0475; and Home Care Services as defined in Minnesota Statutes, §§ 256B.0651 through 256B.0656, excluding personal care assistant services, home care nursing services and personal care Qualified Professional supervision services as authorized by Minnesota Statutes, §256B.69, subd. 28. Except for sections 6.1.41 (Prescription Drugs and Over-the-Counter Drugs) and 6.1.53 (Transplants) or as otherwise specified in the Contract, these services shall be provided to the extent that the above law and rules were in effect on the Effective Date of this Contract. Services in sections 6.1.41 and 6.1.53 shall be provided to the extent that the above law and rules are in effect.‌‌‌‌‌‌‌‌‌‌‌‌ The MCO shall also provide, or arrange to have provided to SNBC SNP Enrollees, Medicare benefits as provided pursuant to 42 USC §1395, and Specialized Medicare Advantage (MA) plans for Special Needs Enrollees, known as Special Needs Plans (SNPs), established by the Medicare Modernization Act of 2003, pursuant to the MCOs MA/SNP contract with CMS.
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Related to SNBC Covered Services

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

  • Non-Covered Services MCOs are not permitted to provide Medicaid excluded services that include, but are not limited to, the following: 1. All non-medically necessary services; 2. Sterilization of a mentally incompetent or institutionalized individual; 3. Except in an emergency, inpatient hospital tests that are not ordered by the attending physician or other licensed practitioner, acting within the scope of practices, who is responsible for the diagnosis or treatment of a particular patient’s condition; 4. All organ transplants, except for those specified in Appendix A; 5. Treatments for infertility4 and for the reversal of sterilization;

  • Provision of Covered Services Contractor shall require each Participating Provider to ensure that each subcontracting arrangement entered into by each Participating Provider complies with the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by Covered California and Contractor, and which may include the following: i. Coordination with Covered California and other programs and stakeholders (Section 3.1); ii. Relationship of the parties as independent contractors (Section 1.3(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.3(b)); iii. Participating Provider Directory requirements (Section 4.4.4);

  • Shared Services CUPE agrees to adopt a shared services model that will allow other Trusts to join the shared services model. The shared services office of the Trust is responsible for the services to support the administration of benefits for the members, and to assist in the delivery of benefits on a sustainable, efficient and cost effective basis recognizing the value of benefits to the members.

  • Required Services Consultant agrees to perform the services, and deliver to City the “Deliverables” (if any) described in the attached Exhibit A, incorporated into the Agreement by this reference, within the time frames set forth therein, time being of the essence for this Agreement. The services and/or Deliverables described in Exhibit A shall be referred to herein as the “Required Services.”

  • Grandfathered Services Services identified in GTE Tariffs as grandfathered in any manner are available for resale only to end user customers that already have such grandfathered service. An existing end user customer may not move a grandfathered service to a new service location. Grandfathered services are subject to a resale discount.

  • Mastectomy Services Inpatient

  • Services and Compensation Consultant shall perform the services described in Exhibit A (the “Services”) for the Company (or its designee), and the Company agrees to pay Consultant the compensation described in Exhibit A for Consultant’s performance of the Services.

  • Medical Services Plan Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. The City shall pay one hundred percent (100%) of the premiums required by the plan.

  • Managed Services HP will provide the services as described in a Statement of Work (“SOW”) attached to this Agreement or incorporating it by reference. Each party will appoint a single point of contact as set forth in the SOW who will serve as their primary representative, have overall responsibility for managing performance, and meet with the other party’s representative to review progress. Change requests are governed by the change management procedures as set forth in the SOW.