HIGHLY INTEGRATED DUAL ELIGIBLE SPECIAL NEEDS PLAN Sample Clauses

HIGHLY INTEGRATED DUAL ELIGIBLE SPECIAL NEEDS PLAN. (“HIDE SNP”) STATUS This paragraph is applicable only to an MAO contracted under this Agreement that shall offer a Medicare Advantage D-SNP Plan Benefit Package (PBP) of integrated Medicare and Medicaid health coverage, consistent with State policy, to eligible Full Benefit Dual Eligible Members in conjunction with the requirements of its AHCCCS Complete Care (ACC), ALTCS DD, or ACC-RBHA health plan in accordance with the eligibility terms, restrictions and requirements for each such health plan as described in of Section 4 of this Agreement. MAO serving Full Benefit Dual Eligible Members through an integrated companion ACC, ALTCS DD, or ACC-RBHA health plan contract with AHCCCS shall be designated annually by CMS as a “HIDE SNP” according to the following CMS requirements:
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HIGHLY INTEGRATED DUAL ELIGIBLE SPECIAL NEEDS PLAN. (HIDE) Status – The MAO shall collaborate with AHCCCS and CMS to achieve HIDE status beginning CY2021 for its participating contracted companion ACC Medicaid MCO, subject to the requirements of the Balanced Budget Act of 2018 and applicable subsequent regulatory guidance issued by CMS.

Related to HIGHLY INTEGRATED DUAL ELIGIBLE SPECIAL NEEDS PLAN

  • Eligible Population 5.1 Program eligibility is determined by applicable law set forth in Program rules and the requirements established in the Program Policy Manual.

  • Loop Provisioning Involving Integrated Digital Loop Carriers 2.6.1 Where InterGlobe has requested an Unbundled Loop and BellSouth uses IDLC systems to provide the local service to the End User and BellSouth has a suitable alternate facility available, BellSouth will make such alternative facilities available to InterGlobe. If a suitable alternative facility is not available, then to the extent it is technically feasible, BellSouth will implement one of the following alternative arrangements for InterGlobe (e.g. hairpinning):

  • Local Circuit Switching Capability, including Tandem Switching Capability 4.2.1 Local circuit switching capability is defined as: (A) line-side facilities, which include, but are not limited to, the connection between a loop termination at a main distribution frame and a switch line card; (B) trunk-side facilities, which include, but are not limited to, the connection between trunk termination at a trunk-side cross-connect panel and a switch trunk card; (C) switching provided by remote switching modules; and (D) all features, functions, and capabilities of the switch, which include, but are not limited to: (1) the basic switching function of connecting lines to lines, line to trunks, trunks to lines, and trunks to trunks, as well as the same basic capabilities made available to BellSouth’s customers, such as a telephone number, white page listings, and dial tone; and (2) all other features that the switch is capable of providing, including but not limited to customer calling, customer local area signaling service features, and Centrex, as well as any technically feasible customized routing functions provided by the switch. Any features that are not currently available but are technically feasible through the switch can be requested through the BFR/NBR process.

  • Single Source Selection Services for tasks in circumstances which meet the requirements of paragraph 3.10 of the Consultant Guidelines for Single Source Selection, may, with the Association's prior agreement, be procured in accordance with the provisions of paragraphs 3.9 through 3.13 of the Consultant Guidelines.

  • Service Eligibility A bonus authorized by subsection (a) may be paid to a person or offi- cer only if the person or officer agrees under subsection (d)—

  • DISTRIBUTION OF CONTRACTOR PRICE LIST AND CONTRACT APPENDICES Contractor shall provide Authorized Users with electronic copies of the Contract, including price lists and Appendices, upon request. OGS CENTRALIZED CONTRACT MODIFICATIONS Contract Updates will be handled as provided in Appendix C – Contract Modification Procedures.

  • Integrated Digital Loop Carriers The feeder portion of some loops may be provide by means of Integrated Digital Loop Carrier (IDLC). IDLC provides a fiber optic cable transmission path that travels directly into BellSouth’s central office local switch. Where BellSouth uses IDLC ,if technically feasible and capacity does exist, BST will provide Al-Call with a Designed DS0 UVL by using alternative provisioning techniques including but not limited to such as “hairpinning” and DAC grooming. Alternative provisioning techniques will be provided at no additional cost to Al-Call . Hairpinning involves providing a DS0 signal from an IDLC-served loop to Al-Call ’s collocation equipment by using a dedicated pathway that traverses BellSouth’s central office switch. BellSouth will provide such DS0 signal to Al-Call by establishing a copper cross connect between the BellSouth switch and Al-Call ’s collocation equipment.

  • Supplemental JBoss Software Conditions Software Access and Software Maintenance for Supplemental JBoss Software is intended and available for Development Purposes only and for up to 25 users for each 16 Core Band Subscription of Red Hat JBoss Middleware Software that you purchased. If you deploy or use the Supplemental JBoss Software for Production Purposes or for more than 25 users, you agree to purchase the appropriate Software Subscriptions for each Unit that you deploy or use. Red Hat’s Open Source Assurance Program applies only to the Red Hat JBoss Middleware Software Subscription that you purchased (such as Red Hat JBoss Enterprise Application Platform in the example above) and does not apply to Supplemental JBoss Software. JBoss xPaaS Subscriptions (defined below) are not considered Supplemental JBoss Software. Each installation and use of JBoss xPaaS Subscriptions Software for either Development Purposes or Production Purposes is a Unit and requires a paid Software Subscription.

  • Plan Arrangements Eligibility – Claim Types All claim types are eligible to be processed through Inter-Plan Arrangements, as described above, except for all dental benefits, and those prescription drug benefits or vision benefits that may be administered by a third party contracted by us to provide the specific service or services. BlueCard® Program Under the BlueCard® Program, when you receive covered healthcare services within the geographic area served by a Host Blue, BCBSRI will remain responsible for doing what we agreed to in the contract. However, the Host Blue is responsible for contracting with and generally handling all interactions with its participating providers. When you receive covered healthcare services outside our service area and the claim is processed through the BlueCard Program, the amount you pay for covered healthcare services is calculated based on the lower of: • the billed covered charges for your covered services; or • the negotiated price that the Host Blue makes available to BCBSRI. Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to your healthcare provider. Sometimes, it is an estimated price that takes into account special arrangements with your healthcare provider or provider group that may include types of settlements, incentive payments and/or other credits or charges. Occasionally, it may be an average price, based on a discount that results in expected average savings for similar types of healthcare providers after taking into account the same types of transactions as with an estimated price. Estimated pricing and average pricing also take into account adjustments to correct for over- or underestimation of past pricing of claims, as noted above. However, such adjustments will not affect the price we have used for your claim because they will not be applied after a claim has already been paid. Negotiated (non–BlueCard Program) Arrangements With respect to one or more Host Blues, in certain instances, instead of using the BlueCard Program, we may process your claims for covered healthcare services through Negotiated Arrangements for National Accounts. The amount you pay for covered healthcare services under this arrangement will be calculated based on the negotiated price (refer to the description of negotiated price in the BlueCard® Program section above) made available to us by the Host Blue.

  • Service Eligibility Criteria 4.3.4.1 High capacity EELs must comply with the following service eligibility requirements:

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