Medicaid Program Clause Samples

Medicaid Program. The South Carolina medical assistance plan under Title XIX of the Social Security Act. For purposes of this Appendix, Medicaid Program may refer to the government agency responsible for administering the Medicaid Program (SCDHHS) and may also be read to include other government oversight agencies including, as applicable, the South Carolina Department of Insurance and the Centers for Medicare and Medicaid Services (“CMS”).

Medicaid Program. The State of New Mexico’s Medicaid managed care program operated under section 1115(a) of the Social Security Act waiver authority as of the Effective Date hereof that is administered by HCA/MAD. SAMPLE U. Medical Necessity. Medically Necessary Services are clinical and rehabilitative physical, mental or Behavioral Health services that: (a) are essential to prevent, diagnose or treat medical conditions or are essential to enable the Member to attain, maintain or regain the Member’s optimal functional capacity; (b) are delivered in the amount, duration, scope, and setting that are both sufficient and effective to reasonably achieve their purposes and clinically appropriate to the specific physical and Behavioral Health care needs of the Member; (c) are provided within professionally accepted standards of practice and national guidelines; and (d) are required to meet the physical and Behavioral Health needs of the Member; and (e) are not primarily for the convenience of the Member, the provider or BCSBNM; and (f) are reasonably expected to achieve appropriate growth and development as directed by HCA.

Medicaid Program. The state Medicaid program which pays for services furnished to the Medicaid Member not enrolled in a Medicaid managed care plan, in accordance with the Medicaid State Plan’s fee- for-service methodology.

Medicaid Program. If CCPN or any subsidiary established for such purpose applies for and is accepted for participation in the Medicaid Program and enters into an agreement with the State of North Carolina or other entity acting on behalf of the State of North Carolina, Practice shall: 3.11.1 Meet all requirements of the State of North Carolina or other entity acting on behalf of the State of North Carolina; and 3.11.2 Comply with, and shall ensure each of its Providers complies with, the terms of the agreement between CCPN and the State of North Carolina or other entity acting on behalf of the State of North Carolina, and with each applicable law, statute, regulation or requirement related to the Medicaid Program, as required by the State of North Carolina.

Medicaid Program. Promote provision of immunizations for Medicaid clients at their medical homes, including Healthy Options, whenever possible.* • Promote collaboration with MAA for Medicaid eligibles to increase immunization levels through specific program initiatives.* • Provide technical support for local health jurisdictions and health care providers that treat Medicaid eligibles on vaccine and immunization practice issues.* • Determine what proportion of the state distributed vaccine was purchased for Title XIX clients.* • Promote assessment activities for Medicaid eligible children.* • Participate in meetings with DSHS-MAA to review and assess progress toward year 2000 goals.**