Payments to Federally Qualified Health Centers and Rural Health Centers Sample Clauses

Payments to Federally Qualified Health Centers and Rural Health Centers. The Contractor shall ensure that its payments to Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) for services to Enrollees are greater than or equal to the payment amounts described in 42 USC § 1396a(bb). In order to comply with this requirement, the Contractor shall pay FQHCs and RHCs at least the amount MassHealth would pay for such services on a fee-for-service basis as specified in 114.3 CMR 4.00, et seq., excluding any supplemental rate paid by MassHealth to FQHCs or RHCs. Accreditation The Contractor shall inform the State whether it has been accredited by a private independent accrediting entity, including but not limited to NCQA accreditation. If the Contractor has received accreditation by a private independent accrediting entity, the Contractor must authorize that accrediting entity to provide the State a copy of its most recent accreditation review, including: Its accreditation status, survey type, and level (if applicable); Recommended actions or improvements, corrective action plans, and summaries of findings; and The expiration date of the accreditation. Program Integrity, Fraud and Abuse Prevention, Detection and Reporting General Provisions The Contractor shall: Comply with all applicable federal and state program integrity laws and regulations regarding fraud, waste and abuse, including but not limited to, the Social Security Act and 42 CFR Parts 438, 455, and 456. Have adequate Massachusetts-based staffing and resources to assist the Contractor in preventing and detecting potential fraud, waste and abuse. Staff conducting program integrity activities for the Contractor shall be familiar with MassHealth and state and federal regulations on fraud, waste and abuse. Have written internal controls and policies and procedures in place that are designed to prevent, detect , reduce, investigate, correct and report known or suspected fraud, waste and abuse activities. In accordance with Section 6032 of the federal Deficit Reduction Act of 2005, make available written fraud and abuse policies to all employees. If the Contractor has an employee handbook, the Contractor shall include specific information about Section 6032, the Contractor’s policies, and the rights of employees to be protected as whistleblowers. Meet with EOHHS at least quarterly to discuss fraud, waste and abuse, audits, and overpayment issues. At EOHHS’ discretion, implement certain program integrity requirements for providers, as specified by EOHHS, incl...
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Payments to Federally Qualified Health Centers and Rural Health Centers. The Contractor shall ensure that its payments to Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) for services to Enrollees are greater than or equal to the payments amounts described in 42 USC § 1396a(bb). In order to comply with this requirement, the Contractor shall pay FQHCs and RHCs at least the amount MassHealth would pay for such services on a fee-for-service basis as specified in 114.3 CMR 4.00, et seq., excluding any supplemental rate paid by MassHealth to FQHCs or RHCs.

Related to Payments to Federally Qualified Health Centers and Rural Health Centers

  • Extended Health Care Plan (a) The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable Extended Health Care Plan.

  • BUY AMERICA REQUIREMENT (Applies only to Federally Funded Highway and Transit Projects) With respect to products purchased by Customer for use in federally funded highway projects, Contractor shall comply with all federal procurement laws and regulations with respect to such projects, including the Buy American provisions set forth in 23 U.S.C. Section 313, 23 C.F.R. Section 635.410, as amended, and the Steel and Iron Preference provisions of Texas Transportation Code Section 223.045, to the extent applicable. Contractor agrees to provide all certifications required by Customer regarding such programs. With respect to products purchased by Customer for use in federally funded transit projects, Contractor shall comply with all federal procurement laws and regulations with respect to such projects, including the Buy American provisions set forth in 49 U.S.C. Section 5323(j)(1), 49 C.F.R. Sections 661.6 or 661.12, to the extent applicable. Contractor agrees to provide all certifications required by Customer regarding such programs.

  • Mental Health Services This agreement covers medically necessary services for the treatment of mental health disorders in a general or specialty hospital or outpatient facilities that are: • reviewed and approved by us; and • licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a general or specialty hospital or outpatient facility. We review network and non-network programs, hospitals and inpatient facilities, and the specific services provided to decide whether a preauthorization, hospital or inpatient facility, or specific services rendered meets our program requirements, content and criteria. If our program content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below.

  • Extended Health Care i) Effective July 1, 2004 the annual Extended Health Care deductible will be increased to fifty dollars ($50.00) for single or family coverage.

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. Inpatient This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. Residential Treatment Facility This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. Intermediate Care Services This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Please see the current Washtenaw Community College catalog for up-to-date program requirements Secondary / Post-Secondary Program Alignment Welding HIGH SCHOOL COURSE SEQUENCE 9th Grade 10th Grade 11th Grade 12th Grade English 9 Algebra I World History/Geography Biology World Language Phys Ed/Health English 10 Geometry U.S. History/Geography Physics or Chemistry World Language Visual/Performing/Applied Arts English 11 Algebra II Civics/Economics Welding English 12 Math Credit Science Credit Welding WASHTENAW COMMUNITY COLLEGE Welding Associate in Applied Science Semester 1 Math Elective(s)* 3 WAF 105 Introduction to Welding Processes 2 WAF 111 Oxy-fuel Welding 4 WAF 112 Shielded Metal Arc Welding 4 Semester Total 13 Semester 2 Speech Elective(s) 3 WAF 106 Blueprint Reading for Welders 3 WAF 123 Advanced Oxy-fuel Welding 4 WAF 124 Advanced Shielded Metal Arc Welding 4 Semester Total 14 Semester 3 Arts/Human. Elective(s) 3 Computer Lit. Elective(s) 3 WAF 215 Advanced Gas Tungsten Arc Welding 4 WAF 288 Gas Metal Arc Welding 4 Semester Total 14 Semester 4 WAF 200 Layout Theory Welding 3 WAF 210 Welding Metallurgy 3 Soc. Sci. Elective(s) 3 WAF 226 Specialized Welding Procedures 4 Semester Total 13 Semester 5 Nat. Sci. Elective(s) 4 WAF 227 Basic Fabrication 3 WAF 229 Shape Cutting Operations 3 Writing Elective(s) 3 Semester Total 13 Program Totals 67

  • Health Services At the time of employment and subject to (b) above, full credit for registered professional nursing experience in a school program shall be given. Full credit for registered professional nursing experience may be given, subject to approval by the Human Resources Division. Non-degree nurses shall be placed on the BA Track of the Teachers Salary Schedule and shall be ineligible for movement to any other track.

  • Extended Health Care Benefits 12.02(a) The City will provide for all employees by contract through an insurer selected by the City an Extended Health Care Plan which will provide extended health care benefits. The City shall pay one hundred per cent (100%) of the premiums, which will include any premiums payable under The Health Insurance Act, R.S.O. 1990, as amended. Eligible Expenses (Benefit year January 1 – December 31)

  • Health Spending Account contributions by the Executive will cease on the Effective Date. The Executive may submit claims against the balance accrued to the Effective Date, until the end of the calendar year in which the Effective Date occurs.

  • Outpatient emergency and urgicenter services within the service area The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.

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