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 Services to be performed by Contractor under this Agreement may involve the performance of trade work covered by the provisions of Section 6.22(e) [Prevailing Wages] of the Administrative Code or Section 21C [Miscellaneous Prevailing Wage Requirements] (collectively, “Covered Services”). The provisions of Section 6.22(e) and 21C of the Administrative Code are incorporated as provisions of this Agreement as if fully set forth herein and will apply to any Covered Services performed by Contractor and its subcontractors.

  • Non-Covered Services MCOs are not permitted to provide Medicaid excluded services that include, but are not limited to, the following:

  • Provision of Covered Services Contractor shall undertake commercially reasonable efforts to ensure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider complies with the applicable terms and conditions set forth in this Agreement, as mutually agreed upon by Covered California and Contractor, and which may include the following:

  • Shared Services 5.1.1 ETFO 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.

  • 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 This plan provides coverage for a minimum of forty-eight (48) hours in a hospital following a mastectomy and a minimum of twenty-four (24) hours in a hospital following an axillary node dissection. Any decision to shorten these minimum coverages shall be made by the attending physician in consultation with and upon agreement with you. If you participate in an early discharge, defined as inpatient care following a mastectomy that is less than forty-eight (48) hours and inpatient care following an axillary node dissection that is less than twenty-four (24) hours, coverage shall include a minimum of one (1) home visit conducted by a physician or registered nurse.

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

  • Medical Services Plan 10.1.1 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.

  • Covered Benefits and Services The Contractor shall provide to its Hoosier Healthwise members, at a minimum, all benefits and services deemed “medically reasonable and necessary” and covered by the IHCP, and included in the Indiana Administrative Code and under the Contract with the State. A covered service is considered medically necessary if it meets the definition as set forth in 405 IAC 5-2-17. The Contractor shall deliver covered services sufficient in amount, duration or scope to reasonably expect that provision of such services would achieve the purpose of the furnished services. Costs for these services are the basis of the Contractor’s capitation rate and are, therefore, the responsibility of the Contractor. Coverage may not be arbitrarily denied or reduced and is subject to certain limitations in accordance with CFR 438.210(a)(4), which specifies when Contractors may place appropriate limits on services:  On the basis of criteria applied under the State plan, such as medical necessity; or  For the purpose of utilization control, provided the services furnished are sufficient in amount, duration or scope to reasonably be expected to achieve the purpose for which the services are furnished.

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