CalOptima Program definition

CalOptima Program means the Medi-Cal Programs administered by CalOptima under contract with DHCS.
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CalOptima Program means the Medi-Cal, OneCare (Medicare Advantage), Program of All-Inclusive Care for the Elderly (PACE), and OneCare connect (Cal MediConnect) programs administered by CalOptima. Provider participates in the specific CalOptima Program(s) identified on Attachment A.
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Examples of CalOptima Program in a sentence

  • Notice shall be given by first-class mail, postage prepaid to the attention of the State or Federal contracting officer for the pertinent CalOptima Program.

  • County shall verify a Member’s eligibility for the applicable CalOptima Program benefits upon receiving a request for Covered Services.

  • Member grievances, complaints, and/or appeals shall be resolved in accordance with Federal and/or State laws, regulations and Government Guidance and as set forth in CalOptima Policies relating to the applicable CalOptima Program.

  • County shall coordinate benefits with other programs or entitlements recognizing where other OHC is primary coverage in accordance with CalOptima Program requirements.

  • Additional procedures related to claims processing and payment are set forth in the attached CalOptima Program Addenda.

  • County shall cooperate with CalOptima and Government Agencies in any complaint, appeal or other review of LHA Services (e.g., medical necessity) and shall accept as final all decisions regarding disputes over LHA Services by CalOptima or such Government Agencies, as applicable, and as required under the applicable CalOptima Program.

  • Notwithstanding the foregoing, County Associates may collect Share of Cost (SOC), co-payments, and deductibles if, and to the extent, required under a specific CalOptima Program and applicable law.

  • County shall cooperate with CalOptima and Government Agencies in any complaint, appeal or other review of Behavioral Health Services (e.g., medical necessity) and shall accept as final all decisions regarding disputes over Behavioral Health Services by CalOptima or such Government Agencies, as applicable, and as required under the applicable CalOptima Program.

  • County shall cooperate with CalOptima and Government Agencies in any complaint, appeal or other review of LHA Services ( e.g., medical necessity) and shall accept as final all decisions regarding disputes over LHA Services by CalOptima or such Government Agencies, as applicable, and as required under the applicable CalOptima Program.

  • Services include those outpatient behavioral health Covered Services set forth in the relevant CalOptima Program that are: (a) included as covered services under the applicable Government Contract, (b) within the practitioner’s normal scope of practice, and (c) Medically Necessary.

Related to CalOptima Program

  • Marketing program means a program established by order of the director pursuant to this act prescribing rules and regulations governing the marketing for processing, distributing, selling, or handling an agricultural commodity produced in this state or agricultural commodity input during a specified period and

  • Development Program means the implementation of the development plan.

  • Program Plan means the tobacco settlement program plan dated February 14, 2001, including exhibits to the program plan, submitted by the authority to the legislative council and the executive council, to provide the state with a secure and stable source of funding for the purposes designated by section 12E.3A and other provisions of this chapter.

  • Prescription monitoring program “PMP,” or “program” means the program established pursuant to 657—Chapter 37 for the collection and maintenance of PMP information and for the provision of PMP information to authorized individuals.

  • Collaborative drug therapy management means participation by an authorized pharmacist and a physician in the management of drug therapy pursuant to a written community practice protocol or a written hospital practice protocol.

  • Commercialization Plan has the meaning set forth in Section 6.2.

  • Medical marijuana product means a product that contains cannabinoids that have been extracted from plant material or the resin therefrom by physical or chemical means and is intended for administration to a licensed patient, including but not limited to concentrates, oils, tinctures, edibles, pills, topical forms, gels, creams, and other derivative forms, except that this term does not include live plant forms.

  • Collaborative pharmacy practice agreement means a written and signed

  • Development Plans means a coherent set of operations defined and financed exclusively by the OCTs in the framework of their own policies and strategies of development, and those agreed upon between an OCT and the Member State to which it is linked;

  • Pilot program means the pilot program identified and funded through the Funding Agreement and described in that Funding Agreement and its attachments.

  • Educational program means a program for educating and preparing physician assistants which is approved by the board.

  • Commercialization or “Commercialize” means activities directed to marketing, promoting, research and development as required, manufacturing for sale, offering for sale, distributing, importing or selling a product, including sub-licensing or sub-contracting of these activities.

  • Medical cannabis card means the same as that term is defined in Section 26-61a-102.

  • AML Program has the meaning ascribed thereto in Schedule 2.1(F)(8) hereof.

  • Marijuana products means concentrated marijuana products and marijuana products that are comprised of marijuana and other ingredients and are intended for use or consumption, such as, but not limited to, edible products, ointments, and tinctures.

  • Licensed Program means the executable processing programs of licensed information, which is composed of various modules in the Licensed Software package provided by the Licensor.

  • Educator preparation program means a planned sequence of academic courses and experiences leading to a recommendation for licensure by the State Board.

  • Indicators of student progress and growth means the results of assessment(s) of students as defined in N.J.A.C. 6A:8, Standards and Assessment.

  • Research-based means a program or practice that has some research demonstrating effectiveness, but that does not yet meet the standard of evidence-based practices.

  • Training program means an NCA-approved Iowa college, the Iowa law enforcement academy or an Iowa hospital approved by the department to conduct emergency medical care training.

  • Education program means any program that is principally engaged in the provision of education, including, but not limited to, early childhood education, elementary and secondary education, postsecondary education, special education, job training, career and technical education, and adult education, and any program that is administered by an educational agency or institution.

  • Development Plan has the meaning set forth in Section 3.2.

  • CRAF Program means the Civil Reserve Air Fleet Program authorized under 10 U.S.C. Section 9511 et seq. or any similar or substitute program under the laws of the United States.

  • Marketing Plan has the meaning set forth in Section 4.3(a).

  • Marijuana product means marijuana as defined in 50-32-101 and marijuana-infused products

  • Joint Commercialization Committee or “JCC” has the meaning set forth in Section 3.4 (Joint Commercialization Committee).