Specific to MA Program. The PH-MCO will participate in the MA Program, will arrange for the provision of those medical and related services essential to the medical care of its Members, and will comply with all federal and Pennsylvania laws generally and specifically governing participation in the MA Program. The PH-MCO agrees that all services provided hereunder must be provided in the manner prescribed by 42 U.S.C. §300e(b), and warrants that the organization and operation of the PH-MCO is in compliance with 42 U.S.C. §300e(c). The PH-MCO will comply with all applicable rules, regulations, and Bulletins promulgated under such laws including, but not limited to, 42 U.S.C. §300e; 42 U.S.C. §§1396 et seq.; 62 P.S. §§101 et. seq.; 42 C.F.R. Parts 431 through 481 and 45 C.F.R Parts 74, 80, and 84, and the Department regulations as specified in Exhibit A, Managed Care Regulatory Compliance Guidelines. In compliance with ARRA 5006(a), the PH-MCO is prohibited from imposing enrollment fees, premiums, cost sharing, or similar charges on Indians served by an Indian health care provider; Indian Health Service (IHS); an Indian Tribe, Tribal Organization, or Urban Indian Organization (I/T/U) or through referral under contract health services (CHS). Any cost sharing imposed by the PH-MCO on enrollees is in accordance with Medicaid fee for service requirements at 42 C.F.R. §§447.50-447.82 and the Social Security Act §§1916(a)(2)(D) and (b)(2)(D).
Specific to MA Program. The PH-MCO agrees to participate in the MA Program and to arrange for the provision of those medical and related services essential to the medical care of those individuals being served, and to comply with all federal and Pennsylvania laws generally and specifically governing participation in the MA Program. The PH-MCO agrees that all services provided hereunder must be provided in the manner prescribed by 42 U.S.C. 300e(b), and warrants that the organization and operation of the PH-MCO is in compliance with 42 U.S.C. 300e(c). The PH-MCO agrees to comply with all applicable rules, regulations, and Bulletins promulgated under such laws including, but not limited to, 42 U.S.C. 300e; 42 U.S.C. 1396 et seq.; 62 P.S. 101 et. seq.; 42 CFR Parts 431 through 481 and 45 CFR Parts 74, 80, and 84, and the Department of Public Welfare regulations as specified in Exhibit A of this Agreement, Managed Care Regulatory Compliance Guidelines.
Specific to MA Program. The PH-MCO will participate in the MA Program, will arrange for the provision of those medical and related services essential to the medical care of its Members, and will comply with all federal and Pennsylvania laws generally and specifically governing participation in the MA Program. The PH-MCO agrees that all services provided hereunder must be provided in the manner prescribed by 42 U.S.C. §300e(b), and warrants that the organization and operation of the PH-MCO is in compliance with 42 U.S.C. §300e(c). The PH-MCO will comply with all applicable rules, regulations, and Bulletins promulgated under such laws including, but not limited to, 42 U.S.C. §300e; 42 U.S.C. §§1396 et seq.; 62 P.S. §§101 et. seq.; 42 C.F.R. Parts 431 through 481 and 45 C.F.R Parts 74, 80, and 84, and the Department regulations as specified in Exhibit A, Managed Care Regulatory Compliance Guidelines.
Specific to MA Program. The Contractor agrees to participate in the MA Program and to arrange for the provision of those medical and related services essential to the medical care of those individuals being served, and to comply with all federal and Pennsylvania laws generally and specifically governing participation in the MA Program. The Contractor agrees that all services provided hereunder shall be provided in the manner prescribed by 42 U.S.C.A. 300e(b), and warrants that the organization and operation of the Contractor is in compliance with 42 U.S.C.A. 300e(c). The Contractor agrees to comply with all applicable rules, regulations, and Bulletins promulgated under such laws including, but not limited to, 42 U.S.C.A. 300e, 1396 et seq.; 62 P.S. 101 et. seq.; 42 C.F.R. Parts 431 through 481 and 45 C.F.R. Parts 74, 80, and 84, and the Department of Public Welfare regulations as specified in Exhibit A of this Agreement, General Guidelines for Managed Care Regulatory Review, and, the HealthChoices Proposers' Library, Exhibit C of this Agreement for a list of applicable regulations.
Specific to MA Program. A. The Primary Contractor shall participate in the MA Program and arrange for the provision of behavioral health services included in Appendix 2 PSR, and comply with all federal and Pennsylvania laws generally and specifically governing participation in
B. The Primary Contractor shall comply with all applicable bulletins that are provided in writing to Primary Contractor, rules, and regulations established under law including, but not limited to applicable provisions of: 42 U.S.C. § 1396 et. seq.; 62 P.S. § 101 et. seq.; and applicable U.S. Department of Health & Human Services regulations, including but not limited to 42 CFR Parts 431 through 481 and 45 CFR Parts 80 and 84. The Primary Contractor shall require each BH-MCO and each Subcontractor to comply fully with this Section, and shall require that its Subcontractors require their Subcontractors and Providers to comply with same.
