DOWNSTREAM PROVIDERDownstream Provider • October 22nd, 2021
This Appendix applies with respect to the provision of health care services that Provider provides directly to Covered Persons through Health Plan’s (as defined herein) products or benefit plans under the State of Hawaii QUEST Integration program (“QI”) (“State Program”) as governed by the State’s designated regulatory agencies. Provider has agreed to provide Covered Services to Covered persons who receive their coverage pursuant to a contract between the State and Health Plan (the “State Contract” as defined herein). The State Contract and applicable State and federal law require that the provisions contained in this Appendix be part of the Agreement. In the event of a conflict between this Appendix and other appendices or any provision of the Agreement, the provisions of this Appendix shall control except with regard to benefit contracts outside the scope of this Appendix or unless otherwise required by law. In the event Subcontractor is required to amend or supplement this Appendix
DOWNSTREAM PROVIDERDownstream Provider • August 31st, 2016
This Appendix applies with respect to the provision of health care services that Provider provides directly to Covered Persons through Health Plan’s (as defined herein) products or benefit plans under the KanCare, Kansas’ Medicaid and/or Children’s Health Insurance (“CHIP”) program (the “State Program”) as governed by the State’s designated regulatory agencies. In the event of a conflict between this Appendix and other appendices or any provision of the Agreement, the provisions of this Appendix shall control except with regard to benefit plans outside the scope of this Appendix or unless otherwise required by law. In the event Subcontractor is required to amend or supplement this Appendix as required or requested by Health Plan and the State to comply with federal or State regulations, Subcontractor will unilaterally initiate such additions, deletions or modifications.
DOWNSTREAM PROVIDERDownstream Provider • May 11th, 2022
This Appendix applies with respect to the provision of health care services that Provider provides directly to Covered Persons through Health Plan’s (as defined herein) products or benefit plans including the State of New Mexico Centennial Care program (the “Centennial Care Program,” as further defined below) as governed by the State’s designated regulatory agencies. Provider has agreed to provide Covered Services to Covered Persons who receive their coverage pursuant to a contract between the State and Health Plan (the “Centennial Care Contract” as defined herein). The Centennial Care Contract and applicable State and federal law require that the provisions contained in this Appendix be part of the Agreement. In the event of a conflict between this Appendix and other appendices or any provision of the Agreement, the provisions of this Appendix shall control except with regard to benefit contracts outside the scope of this Appendix or unless otherwise required by law. In the event Subc
THIS MARYLAND MEDICAID REGULATORY REQUIREMENTS APPENDIX (thisDownstream Provider • June 22nd, 2017
This Appendix applies with respect to the provision of health care services that Provider provides directly to Covered Persons through Health Plan’s (as defined herein) products or benefit plans under the State of Maryland Medicaid managed care program (the “State Medicaid Program”) as governed by the State’s designated regulatory agencies. Provider has agreed to provide Covered Services to Covered Persons who receive their coverage pursuant to a contract between the State and Health Plan (the “State Contract,” as defined herein). The State Contract and applicable State and federal law require that the provisions contained in this Appendix be a part of the Agreement. In the event of a conflict between this Appendix as it pertains to Medicaid Covered Persons and other appendices or any provision of the Agreement, this Appendix shall control except with regard to benefit plans outside the scope of this Appendix or unless otherwise required by law. In the event Subcontractor is required t
THIS OHIO MEDICAID AND CHIP REGULATORY REQUIREMENTS APPENDIX (thisDownstream Provider • December 5th, 2022
This Appendix applies to benefit plans sponsored, issued or administered by United under the State’s Medicaid program, CHIP program and, as applicable, benefit plans for other state-based healthcare programs (the “State Program”) as governed by the State’s designated agencies. In the event of a conflict between this Appendix and other appendices or any provision of the Agreement, the provisions of this Appendix shall control except with regard to benefit plans outside the scope of this Appendix or unless otherwise required by law.
THIS INDIANA STATE PROGRAM REGULATORY REQUIREMENTS APPENDIX (thisDownstream Provider • November 30th, 2023
The requirements of this Appendix apply to benefit plans sponsored, issued or administered by UnitedHealthcare Insurance Company or one of its Affiliates (referred to in this Appendix as “United”) under the State’s Medicaid program, CHIP program and, as applicable, benefit plans for other state-based healthcare programs for low-income individuals (the “State Program”) as governed by the State’s designated regulatory agencies. In the event of a conflict between this Appendix and other appendices or any provision of the Agreement, the provisions of this Appendix shall control except with regard to benefit plans outside the scope of this Appendix or unless otherwise required by law. In the event United is required to amend or supplement this Appendix as required by law or requested by the State to comply with federal or State regulations, United will unilaterally initiate such additions, deletions or modifications.
DOWNSTREAM PROVIDERDownstream Provider • March 1st, 2024
(this “Appendix”) supplements and is made part of the provider agreement (the “Agreement”) between UnitedHealthcare of Washington, Inc. (referred to in this Appendix as “Carrier”) and the party named in the Agreement (“Provider”).
DOWNSTREAM PROVIDERDownstream Provider • June 13th, 2024
The requirements of this Appendix apply to benefit plans sponsored, issued or administered by UnitedHealthcare of Pennsylvania, Inc. (referred to herein as “United”), an Affiliate of UnitedHealthcare Insurance Company, for Customer who are eligible to receive health care benefits under the State of Pennsylvania Medical Assistance managed care program (the “Medical Assistance Program”) and the Children’s Health Insurance Program (“CHIP”) Program (each a “State Program” and collectively, the “State Programs”) as governed by the State’s designated regulatory agencies. In the event of a conflict between this Appendix and other appendices or any provision of the Agreement, the provisions of this Appendix shall control except with regard to benefit plans outside the scope of this Appendix or unless otherwise required by law. In the event United is required to amend or supplement this Appendix as required or requested by the State, Provider agrees that United shall be permitted unilaterally t
THIS IOWA STATE PROGRAMS REGULATORY REQUIREMENTS APPENDIX (thisDownstream Provider • August 31st, 2016
This Appendix applies with respect to the provision of health care services that Provider provides directly to Covered Persons through Health Plan’s (as defined herein) products or benefit plans under the Iowa Medicaid, Iowa Health and Wellness Plan, Healthy and Well Kids in Iowa (hawk-i) and related programs (the “State Program”) as governed by the State’s designated regulatory agencies. Provider has agreed to provide Covered Services to Covered Persons who receive their coverage pursuant to a contract between the State and Health Plan (the “State Contract” as defined herein). The State Contract and applicable State and federal law require that the provisions contained in this Appendix be part of the Agreement. In the event of a conflict between this Appendix and other appendices or any provision of the Agreement, the provisions of this Appendix shall control except with regard to benefit plans outside the scope of this Appendix or unless otherwise required by law. In the event Subcon
DOWNSTREAM PROVIDERDownstream Provider • July 9th, 2024
The requirements of this Appendix apply to “State Program” (as defined below) benefit plans sponsored, issued or administered by Carrier, including the State’s Apple Health and related programs, and Washington Benefit Plans for the Uninsured, as governed by the State’s designated regulatory agencies. In the event of a conflict between this Appendix and other appendices or any provision of the Agreement, the provisions of this Appendix shall control except with regard to benefit plans outside the scope of this Appendix or unless otherwise required by law. In the event Carrier is required to amend or supplement this Appendix as required or requested by the State to comply with federal or State regulatory requirements, Provider agrees that Carrier shall be permitted to unilaterally initiate such additions, deletions or modifications.
DOWNSTREAM PROVIDERDownstream Provider • August 9th, 2024
This Appendix applies with respect to the provision of health care services that Provider provides directly to Covered Persons through Health Plan’s (as defined herein) products or benefit plans under the State of Hawaii QUEST Integration program (“QI”) (“State Program”) as governed by the State’s designated regulatory agencies. Provider has agreed to provide Covered Services to Covered persons who receive their coverage pursuant to a contract between the State and Health Plan (the “State Contract” as defined herein). The State Contract and applicable State and federal law require that the provisions contained in this Appendix be part of the Agreement. In the event of a conflict between this Appendix and other appendices or any provision of the Agreement, the provisions of this Appendix shall control except with regard to benefit contracts outside the scope of this Appendix or unless otherwise required by law. In the event Subcontractor is required to amend or supplement this Appendix
THIS OHIO MEDICAID AND CHIP REGULATORY REQUIREMENTS APPENDIX (thisDownstream Provider • December 5th, 2022
This Appendix applies to benefit plans sponsored, issued or administered by United under the State’s Medicaid program, CHIP program and, as applicable, benefit plans for other state-based healthcare programs (the “State Program”) as governed by the State’s designated agencies. In the event of a conflict between this Appendix and other appendices or any provision of the Agreement, the provisions of this Appendix shall control except with regard to benefit plans outside the scope of this Appendix or unless otherwise required by law.
THIS MARYLAND MEDICAID REGULATORY REQUIREMENTS APPENDIX (thisDownstream Provider • February 15th, 2023
The requirements of this Appendix apply to Medicaid benefit plans sponsored, issued or administered by UnitedHealthcare of the Mid-Atlantic, Inc. (referred to in this Appendix as “United”) under the State of Maryland Medicaid Managed Care Program (the “State Program”) as governed by the State’s designated regulatory agencies. In the event of a conflict between this Appendix and other appendices or any provision of the Agreement, the provisions of this Appendix shall control except with regard to benefit plans outside the scope of this Appendix or unless otherwise required by law. In the event United is required to amend or supplement this Appendix as required or requested by the State to comply with federal or State regulations, United will unilaterally initiate such additions, deletions or modifications.
