Waiver Members Sample Clauses

Waiver Members. Section 8.3.1.2 is revised to change the name from "1915(c) Nursing Facility Waiver Services Available to Members Who Qualify for 1915(c) Nursing Facility Waiver Services" to "1915(c) STAR+PLUS Waiver Services Available to Members Who Qualify for 1915(c) STAR+PLUS Waiver Services" and to update the licensure and certification requirements. Section 8.3.6.6 is added to require STAR+PLUS HMOs to contact Members at least twice a year and to document that contact. Section 8.4.2 is revised to add the 98% standard for complaint resolution. Revision 1.19 September 1, 2011 Section 8.1.1.1 is modified to remove redundant language. Section 8.1.4 is modified to require HMOs to contract with any willing ambulance provider that meets the HMO’s credentialing requirements and agrees to the HMO’s contract terms and rates. Section 8.1.4.8 is modified to add language for the ACA requirement regarding Healthcare Acquired Conditions (HAC) pursuant to the Patient Protection and Affordable Care Act of 2010 (Pubic Law 111–148) as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), together known as the Affordable Care Act (ACA). Section 2702 of ACA prohibits federal payments to States for any amount expended under Medicaid for health care-acquired conditions. Section 8.1.4.8.1 is added pursuant to the Patient Protection and Affordable Care Act of 2010 (Pubic Law 111–148) as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), together known as the Affordable Care Act (ACA). Section 2702 of ACA prohibits federal payments to States for any amount expended under Medicaid for health care-acquired conditions. Section 8.1.4.9 is modified to clarify compliance with 42 CFR 438.10(f)(5). Section 8.1.5.6 is modified to add clarification that the HMOs provide oral interpretive services free of charge, as required by 42 CFR 438.10(c)(4). Section 8.1.7.8 is modified to clarify current federal physician incentive plan requirements for Medicaid, and to add these requirements for CHIP. Section 8.1.8, Second Paragraph, is amended to refer to federal regulations regarding medical record content. Section 8.1.9 is modified to clarify the age requirements. Section 8.1.12.1 is modified to clarify that appropriate health care professionals must perform assessments, as required by 42 CFR 438.208(c)(2). Section 8.1.17.2 is modified to add the dates of service for which Bariatric Supplemental Reports are required. Section 8.1.18.5 ...

Waiver Members. Section 8.3.1.2 is revised to change the name from "1915(c) Nursing Facility Waiver Services Available to Members Who Qualify for 1915(c) Nursing Facility Waiver Services" to "1915(c) STAR+PLUS Waiver Services Available to Members Who Qualify for 1915(c) STAR+PLUS Waiver Services" and to update the licensure and certification requirements. Section 8.3.6.6 is added to require STAR+PLUS HMOs to contact Members at least twice a year and to document that contact. Section 8.4.2 is revised to add the 98% standard for complaint resolution. 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision.

Waiver Members. The parties acknowledge and agree that they are waiving their constitutional rights to have Disputes determined by a court or jury trial and instead are voluntarily agreeing to the use of binding arbitration as described in this Agreement. Nothing contained herein is intended to create (nor shall it be construed to create) any right of any Member to independently initiate the arbitration procedure established herein.

Waiver Members. In addition to physical health benefits (see Section A.2.6.1.3) and behavioral health benefits (see Section A.2.6.1.4), effective July 1, 2021, the CONTRACTOR shall provide long-term services and supports as described in this Section A.2.