IN NETWORK REQUIREMENT Clause Samples

IN NETWORK REQUIREMENT. The benefits provided by ▇▇▇▇ ▇▇ are made possible through a PACE Program Agreement between ▇▇▇▇ ▇▇, the Missouri Department of Social Services’ MO HealthNet Division and the US Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS). The agreement is subject to renewal and, if the PACE Program Agreement is not renewed, the program will be terminated. Should the program be terminated while you are enrolled, ▇▇▇▇ ▇▇ will assist you in returning to other Medicare and/or Medicaid programs for which you are eligible. By signing the ▇▇▇▇ ▇▇ Enrollment Agreement and becoming a participant in the PACE program, you are agreeing to accept benefits ONLY from ▇▇▇▇ ▇▇ in place of your current or previous Medicare and/or Medicaid benefits. Signing the ▇▇▇▇ ▇▇ Enrollment Agreement will trigger enrollment in the program on the date specified and will automatically disenroll you from all other health plans in which you may have been previously enrolled. ▇▇▇▇ ▇▇ will provide the same Medicare and Medicaid services and benefits as your previous provider, and possibly additional services, through a team approach and a specific network of contracted providers. Once you begin to receive services from ▇▇▇▇ ▇▇, you will no longer be able to receive services from other providers without prior authorization from your ▇▇▇▇ ▇▇ team. If you receive services from someone other than ▇▇▇▇ ▇▇ or a ▇▇▇▇ ▇▇ contracted provider, you may be financially responsible for those services. Additionally, if you receive services not authorized by ▇▇▇▇ ▇▇, you may be financially responsible for those services. Emergency services are not included in the In Network Requirement. Please see the Emergency and Urgent Care sections of this handbook for specific information. Please note that you cannot enroll in PACE at a Social Security Office.