INSERT NEW SECTION H Clause Samples
INSERT NEW SECTION H. 11.1.1 The Contractor shall ensure The Contractor and each through its contracts, provider (whether or not the subcontracts and in any other provider participates in the appropriate manner that Contractor's provider network) neither Enrollees nor the through which the Contractor District are held liable for furnishes or arranges for the Contractor's debts in the furnishing of items or event of Contractor's services covered under the insolvency. contract to an enrolled individual shall comply with the requirements of 1932(b)(6) of the Social Security Act, 42 U.S.C. 1396u-2(b)(6), that an enrolled individual or the individual's family or caregiver may not be held liable or be subject to collection efforts for: . debts or other obligations of the Contractor or any provider participating in the Contractor's provider network in the event of insolvency; . the cost of items and services covered under the contract in the event that the -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- POHC-2002-D-0003 PAGE 20 OF 23 -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- CONTRACT MODIFICATION - M0001 DCHFP SUMMARY SHEET -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- CONTRACT SECTION CHANGED FROM CHANGED TO -------------------------------------------------------------------------------- Contractor fails to receive payment from DC; . the cost of items and services covered under the contract if a provider participating in the Contractor's provider network fails to receive payments from the Contractor; or . payments to a provider that furnishes items and services covered under the contract to an enrolled individual under a contractual, referral, or other arrangement with the Contractor in excess of the amount that would be owed by the enrolled individual if the Contractor had furnished such items or services directly. --------------------------------------------------------------------------------
INSERT NEW SECTION H. If more than one MCO is claiming payment for a newborn, MAA will only pay the MCO that demonstrates services rendered to the newborn. The MCO must submit written notification to MAA of the following information: . Newborn's name; . Newborn's Medicaid number; . Newborn's Date of birth; . Date of service; . Diagnosis treatment; . Provider of service; and . Provider's address and telephone number.