Restriction Program definition

Restriction Program means the program required by 42 CFR 431.54(e) and 42 CFR 456.3 that provides safeguards against inappropriate and excessive use of Medicaid services. Risk Contract means a contract under which the contractor assumes risk for the cost of the services covered under the contract; and incurs loss if the cost of furnishing the services exceeds the payments under the contract. Risk Corridor means a risk sharing mechanism in which the Department and the Contractor may share in profits and losses under the Contract outside of a predetermined threshold amount.
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Restriction Program means the program mandated by 42 CFR 431.54(e) for Medicaid Eligible Individuals who over-utilize Medicaid services. Retention Covered Service means orthodontic retention including the removal of orthodontic appliances and the creation and fitting of a retainer. Risk Contract means a contract under which the Contractor assumes risk for the cost of the services covered under the contract; and incurs loss if the cost of furnishing the services exceeds the payments under the contract. XXX means the System for Award Management database.
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Restriction Program means the Federally mandated program (42 CFR 431.54(e)) for Medicaid clients who over-utilize Medicaid services. If the DEPARTMENT in conjunction with the CONTRACTOR finds that an Enrollee has utilized Medicaid services at a frequency or amount that is not Medically Necessary, as determined in accordance with utilization guidelines adopted by the DEPARTMENT, the DEPARTMENT may place the Enrollee under the Restriction Program for a reasonable period of time to obtain Medicaid services from designated providers only.
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Examples of Restriction Program in a sentence

  • The Department has the sole authority to restrict Recipients and has oversight responsibility of the PH-MCO’s Recipient Restriction Program.

  • The PH-MCO will maintain a Recipient Restriction Program to interface with the Department’s Recipient Restriction Program, will provide for appropriate professional resources to manage the Program and to cooperate with the Department in all procedures necessary to restrict Recipients.

  • The first shall be an Employee and Executive Incentive Compensation Restriction Program as described below in Section A.

  • In order to compare proposals on an apples-to-apples basis and give VCEA greatest flexibility in assembling its team, each service category will be scored on a 100-point system regardless of whether proposals come from a single or multiple providers.

  • Verify the member’s eligibility, and determine whether the member is enrolled in an MCO, Emergency Only Program, or the Restriction Program; assigned to a Primary Care Provider; covered by a third party; or responsible for a co-payment or co-insurance.

  • The CHC-MCO will maintain a Participant Restriction Program to interface with the Department’s Recipient Lock-in Program, and will provide for appropriate professional resources to manage the CHC-MCO program and to cooperate with the Department in all procedures necessary to restrict Participants.

  • Contractor may restrict an Enrollee for a reasonable period of time to a designated PCP, WHCP or Provider of pharmacy services when: (i) the Department indicates the Enrollee was included in the Department’s Recipient Restriction Program pursuant to 89 Ill.

  • Recipient Restriction Program (RRP)‌ Medicaid members who have been assigned to a designated pharmacy are required to receive all pharmacy services from the selected pharmacy provider.

  • For example, temporary or secondary pharmacies may be assigned as approved by the member’s Restriction Program Case Manager for specific reasons such as the member has a change of address or the restricted pharmacy does not carry a specific medication.

  • The PH-MCO will maintain a Recipient Restriction Program to interface with the Department’s Recipient Restriction Program, will provide for appropriate professional resources to manage the Program and to cooperate with the Department in all procedures necessary to restrict Members.


More Definitions of Restriction Program

Restriction Program means the program required by 42 CFR § 431.54(e) and 42 CFR § 456.3 that provides safeguards against unnecessary or inappropriate use of Medicaid services and against excess payments.
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Related to Restriction Program

  • Compliance Program means the program established by CNYCC to prevent, detect, and address compliance issues that arise with respect to PPS operations, projects or activities.

  • Service program or “service” means any medical care ambulance service or nontransport service that has received authorization by the department.

  • Shadow tray means a device attached to the radiation head to support auxiliary beam blocking material.

  • Award Transfer Program means any program instituted by the Committee which would permit Participants the opportunity to transfer any outstanding Awards to a financial institution or other person or entity approved by the Committee.

  • Notice Program means the methods provided for in this Agreement for giving the Notice and consists of Email Notice, Postcard Notice, and Long Form Notice, which shall be substantially in the forms as the exhibits attached to this Agreement.

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

  • Eligible program means a program of education or training which:

  • 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.

  • Loan Program means the State Treasurer’s Interest-Free Loan Program for Colorado School Districts authorized pursuant to the Loan Program Statutes.

  • 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.

  • Uniform Grant Management Standards or “UGMS” means uniform grant and contract administration procedures, developed under the authority of Chapter 783 of the Texas

  • Cooperative education program means a written voluntary agreement between and among districts to provide certain educational programs for pupils in certain groups of districts. The written agreement shall be approved by all affected districts at least annually and shall specify the educational programs to be provided and the estimated number of pupils from each district who will participate in the educational programs.

  • Education program or activity means locations, events, or circumstances for which the school district exercises substantial control over both the respondent and the context in which the sexual harassment occurs and includes school district education programs or activities that occur on or off of school district property.

  • Nursing program means a series of courses leading to an LPN certificate or an ADN degree provided through a Wyoming community college; or a BSN degree or a Master’s degree provided through the University of Wyoming; or, in the case of a candidate for a doctoral degree, provided through an institution offering the required nursing education courses under contract with the WICHE, or in a distance nursing education program provided through a university that is regionally accredited.

  • Compliance Plan means the compliance obligations, program, and procedures described in this Consent Decree at paragraph 13.

  • Texas Grant Management Standards or “TxGMS” means uniform grant and contract administration procedures, developed under the authority of Chapter 783 of the Texas Government Code, to promote the efficient use of public funds in local government and in programs requiring cooperation among local, state, and federal agencies. Under this Grant Agreement, TxGMS applies to Grantee except as otherwise provided by applicable law or directed by System Agency. Additionally, except as otherwise provided by applicable law, in the event of a conflict between TxGMS and applicable federal or state law, federal law prevails over state law and state law prevails over TxGMS.

  • Application Program means a computer program which is intended to be executed for the purpose of performing useful work for the user of the information being processed. Application programs are developed or otherwise acquired by the user of the Hardware/Software system, but they may be supplied by the Contractor.

  • Prescription monitoring program means the electronic system within the Department of Health Professions that monitors the dispensing of certain controlled substances.

  • Alternative education program means a school or separate class group designed to best serve students’ educational needs and interests and assist students in achieving the academic standards of the district and the state.

  • Paycheck Protection Program means loan program created by Section 1102 of the CARES Act.

  • PACE program means a program implemented by a municipality to stimulate energy efficiency and renewable energy projects in conformity with Act 270.

  • Program Parameter means, in respect of a program, the provincial standards (such as operational, financial or service standards and policies, operating manuals and program eligibility), directives, guidelines and expectations and requirements for that program;

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

  • Quality Assurance Program means the overall quality program and associated activities including the Department’s Quality Assurance, Design-Builder Quality Control, the Contract’s quality requirements for design and construction to assure compliance with Department Specifications and procedures.

  • Wild animal means any mammal, bird, fish, or other creature of a wild nature endowed with sensation and the power of voluntary motion.

  • E-Verify Program above means the employment verification program administered by the United States Department of Homeland Security, the Social Security Administration, or any successor program.