Common use of Participating Plan Service Capacity Clause in Contracts

Participating Plan Service Capacity. CMS and the Commonwealth shall contract with Participating Plans that demonstrate the capacity to provide, directly or by subcontracting with other qualified entities, the full continuum of Medicare and Medicaid covered services to Enrollees, in accordance with this MOU, CMS guidance, and the three-way contract. Medicare covered benefits shall be provided in accordance with 42 CFR 422 and 42 CFR 423 et seq. Medicaid covered benefits shall be provided in accordance with the requirements in the approved Medicaid State Plan, including any applicable State Plan Amendments, the 1115(a) MassHealth Demonstration, and in accordance with the requirements specified in the Commonwealth RFR and this MOU. In accordance with the three-way contract and this MOU, CMS and the Commonwealth may choose to allow for greater flexibility in offering supplemental benefits that exceed those currently covered by either Medicare or Medicaid, as discussed in Appendix 7. CMS, the Commonwealth, and Participating Plans will ensure that beneficiaries have access to an adequate network of medical, drug, behavioral health, and supportive service providers that are appropriate and

Participating Plan Service Capacity. CMS and the Commonwealth shall contract with Participating Plans that demonstrate the capacity to provide, directly or by subcontracting with other qualified entities, the full continuum of Medicare and Medicaid covered services to Enrollees, in accordance with this MOU, CMS guidance, and the three-way contract. Medicare covered benefits shall be provided in accordance with 42 CFR 422 and 42 CFR 423 et seq. Medicaid covered benefits shall be provided in accordance with the requirements in the approved Medicaid State Plan, including any applicable State Plan Amendments, the 1115(a) MassHealth Demonstration, and in accordance with the requirements specified in the Commonwealth RFR and this MOU. In accordance with the three-way contract and this MOU, CMS and the Commonwealth may choose to allow for greater flexibility in offering supplemental benefits that exceed those currently covered by either Medicare or Medicaid, as discussed in Appendix 7. CMS, the Commonwealth, and Participating Plans will ensure that beneficiaries have access to an adequate network of medical, drug, behavioral health, and supportive service providers that are appropriate andand capable of addressing the needs of this diverse population, as discussed in more detail in Appendix 7.