Scope of Exhibit. Business Associate acknowledges and agrees that all PHI that is created or received by Covered Entity and disclosed or made available in any form, including paper record, oral communication, audio recording and electronic display, by Covered Entity or its operating units to Business Associate, or is created or received by Business Associate on Covered Entity’s behalf, shall be subject to this Exhibit.
Scope of Exhibit. 1.01 This Exhibit specifies the terms and conditions, including compensation, under which BellSouth and DeltaCom will compensate each other for Intercompany Settlements (ICS) messages.
Scope of Exhibit. 1.01 This exhibit specifies the terms and conditions, including compensation, under which BellSouth shall provide message distribution service to Carrier. As described herein, message distribution service includes the following:
Scope of Exhibit. The provisions of this Exhibit apply to Covered Services rendered to BJC Medicaid Members, regardless of whether such BJC Medicaid Members receive Covered Services from BJC Providers, Participating Providers or non-Participating Providers within or outside of BJC's Service Sites or within or outside of Plan's Service Area.
Scope of Exhibit. The rates, terms, and conditions contained within this Exhibit shall only apply when WinStar is occupying the Collocation Space as a sole occupant or as a Host within a Premises location pursuant to Section 4. This Exhibit is applicable to Premises owned or leased by BellSouth. However, if the Premises occupied by BellSouth is leased by XxxxXxxxx from a third party, special considerations and intervals may apply in addition to the terms and conditions of this Exhibit. All the negotiated rates, terms and conditions set forth in this Exhibit pertain to collocation and the provisioning of Collocation Space.
Scope of Exhibit. This Scope of Work is part of a Contract to provide risk-based managed care services to Medicaid beneficiaries enrolled in the State of Indiana’s Healthy Indiana Plan (HIP) program. The State is looking to contract on a statewide basis with managed care entities (MCEs) with a demonstrated capacity to actively manage care for a low-income population. Because HIP is financed in part by federal Medicaid funds, Contractors shall meet all applicable requirements of Medicaid managed care organizations under Section 1903(m) and 1932 of the Social Security Act, as well as the implementing regulations set forth in 42 CFR 438, which defines requirements for Medicaid managed care programs. Contractors shall also ensure that its network providers, including out-of-state providers, enroll in the Indiana Health Coverage Programs (IHCP) before they begin providing health care services to members. Unless otherwise indicated, the requirements set forth in this Scope of Work apply to the Contractor’s responsibilities under the HIP program.
Scope of Exhibit. ▪ Engage in provider and member outreach regarding preventive care, wellness and a holistic approach. The Healthy Indiana Plan (HIP) is a program created to provide health care coverage to low- income adults. Indiana offers HIP members a comprehensive benefit package through a high deductible health plan paired with a personal health care account called a POWER (Personal Wellness and Responsibility) Account. The health plan is subject to a $2,500 deductible and includes “first dollar” coverage for ACA required preventive services. Services considered preventive but not required by the ACA may be provided at $500 first dollar coverage per year. For purposes of clarification, MCEs may cap first dollar preventive services at $500 per year, but shall provide all required ACA preventive services first dollar as required by the ACA. The preventive services benefit is designed to help eliminate barriers to obtaining preventive care. Indiana offers HIP members comprehensive benefits in several benefit packages (HIP Plus, HIP Basic, HIP State Plan, and HIP Maternity) as described in Section 3.0 and Section 12.0. A description of the HIP covered services is set forth in Exhibit 3 of the Contract. The POWER Account is modeled in the spirit of a traditional Health Savings Account (HSA) and is funded with state and individual contributions. Employers and other third parties may also contribute. Members use POWER Account funds to meet the $2,500 deductible. POWER Accounts are funded with post-tax dollars and are not considered HSAs or other health spending accounts (e.g., Flexible Spending Accounts, Health Reimbursement Accounts, etc.) under federal law. Therefore, they are not subject to regulation under the U.S. Tax Code as such. Members who consistently make required contributions to their POWER account will maintain access to the “HIP Plus” benefit plan that includes enhanced benefits such as dental, vision, and chiropractic manipulation coverage. Members with income at or below one hundred percent (100%) of the federal poverty level (FPL)2 who do not to make monthly POWER account contributions will be placed in the “HIP Basic” plan, a more limited benefit plan. The HIP Basic plan maintains essential benefits but incorporates reduced benefit coverage and a more limited pharmacy benefit. The HIP Basic plan will require co-payments for most services rather than the monthly POWER account contributions required of the HIP Plus plan. Except in limited circumstances, memb...
Scope of Exhibit. The Contractor shall comply with all applicable Federal and State laws and regulations including Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972 (regarding education programs and activities); the Age Discrimination Act of 1975; the Rehabilitation Act of 1973 (regarding education programs and activities), and the Americans with Disabilities Act of 1990 as amended; section 1557 of the Patient Protection and Affordable Care Act per 42 CFR 438.3(f)(1) and 42 CFR 438.100(d).
Scope of Exhibit operations conducted outside of the State of Indiana and shall be prepared to discuss these operations with FSSA upon request, including during unannounced FSSA site visits. Except in the circumstance of the unforeseeable loss of a key staff member’s services, the Contractor shall provide written notification to FSSA of anticipated vacancies of key staff within five (5) business days of receiving the key staff person’s notice to terminate employment or five (5) business days before the vacancy occurs, whichever occurs first. At that time, the Contractor shall present FSSA with an interim plan to cover the responsibilities created by the key staff vacancy. Likewise, the Contractor shall notify FSSA in writing within five (5) business days after a candidate’s acceptance to fill a key staff position or five (5) business days prior to the candidate’s start date, whichever occurs first. In addition to attendance at vendor meetings, all key staff shall be accessible to FSSA and its other program subcontractors via telephone, voicemail and electronic mail systems. As part of its annual and quarterly reporting, the Contractor shall submit to FSSA an updated organizational chart including e-mail addresses and phone numbers for key staff. FSSA reserves the right to approve or deny the individuals filling the key staff positions set forth below. FSSA also reserves the right to require a change in key staff as part of a corrective action plan should performance concerns be identified. The key staff positions required under the Contract include: Chief Executive Officer, President, or Executive Director – The Chief Executive Officer or Executive Director has full and final responsibility for plan management and compliance with all provisions of the Contract.
Scope of Exhibit. Medicaid product lines. The Utilization Management Manager shall, at a minimum, be responsible for directing the activities of the utilization management staff. With direct supervision by the Medical Director, the Utilization Management Manager shall direct staff performance regarding prior authorization, medical necessity determinations, concurrent review, retrospective review, appropriate utilization of health care services, continuity of care, care coordination and other clinical and medical management programs. The Utilization Management Manager shall work with the Special Investigation Unit (SIU) Manager to assure that service billing and utilization issues are documented and reported to the SIU, and matters requiring SIU review or investigation shall be timely submitted within five (5) business days to enable recovery of overpayments or other appropriate action. For more information regarding the utilization management requirements, see Section 6.3.
