SPECIFIC PLAN OFFERINGS Sample Clauses

SPECIFIC PLAN OFFERINGS. MAO shall operate one (1) Dual Eligible Special Needs Plans under CMS contract number H5587. MAO shall enroll individuals into offered Plan Benefit Packages (PBPs) in accordance with federal and state guidelines, and the terms of this Agreement. A Full Benefit Dual Eligible Member’s eligibility for each particular plan benefit package (PBP) is described below: 4.6.1. H5587-002 (HIDE SNP status) is a Dual Eligible Subset plan open to only those individuals eligible to enroll pursuant to the following eligibility requirements: 4.6.1.1. The individual must be currently enrolled in the AHCCCS Complete Care (ACC) companion program in accordance with paragraph 4.1.1 and Attachment 7; Participant Health Choice Arizona, Inc. d/b/a Health Choice Pathway AHCCCS AGREEMENT # YH23-0010-03 4.6.1.2. The individual must live within the appropriate county that corresponds with the specific service area of their AHCCCS Complete Care (ACC) companion program enrollment in accordance with paragraph 4.1.2; 4.6.1.3. The individual must be entitled to participate in Medicare; and 4.6.1.4. The individual must reside within the CMS-approved service area county for this PBP in accordance with paragraph 4.5.1. Participant Health Choice Arizona, Inc. d/b/a Health Choice Pathway AHCCCS AGREEMENT # YH23-0010-03 5. NAME OF MAO: Health Choice Arizona, Inc. d/b/a Health Choice Pathway 6. ARIZONA SYSTEM HEALTH CARE COST CONTAINMENT [ THIS PAGE INTENTIONALLY LEFT BLANK ] ATTACHMENT 1: CHART OF DELIVERABLES Area Timeframe Report When Due Agreement Section Agreement Paragraph Reference/ Policy Send To Submitted Via MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 2 – AHCCCS COVERED SERVICES – PHYSICAL HEALTH SERVICES (pages 40-42) MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 3 – AHCCCS COVERED SERVICES - BEHAVIORAL HEALTH SERVICES (pages 43-45) Title XIX Title XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND Title XIX Title XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND Title XIX Title XIX MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND ATTACHMENT 4 – ALTCS ELDERLY and PHYSICALLY DISABLED COVERED MLTSS (pages 46- 48) ALTERNATIVE RESIDENTIAL SETTINGS MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND HOSPICE SERVICES HOME AND COMMUNITY BASED SERVICES MEDICARE ADVANTAGE ...

SPECIFIC PLAN OFFERINGS. MAO shall operate one (1) Dual Eligible Special Needs Plan under CMS contract number H5587. MAO shall enroll individuals into offered Plan Benefit Packages (PBPs) in accordance with federal and state guidelines, and the terms of this Agreement. A Dual Eligible Member’s eligibility for each particular plan benefit package (PBP) is described below: 4.6.1. H5587-002 (HIDE SNP status) is a Dual Eligible Subset plan open to only those individuals eligible to enroll pursuant to the following eligibility requirements: 4.6.1.1. The individual must be currently enrolled in the AHCCCS Complete Care (ACC) companion program in accordance with paragraph 4.1.1; 4.6.1.2. The individual must live within the appropriate county that corresponds with the specific service area of their AHCCCS Complete Care (ACC) companion program enrollment in accordance with paragraph 4.1.2; 4.6.1.3. The individual must be entitled to participate in Medicare; and 4.6.1.4. The individual must reside within the CMS-approved service area county for this PBP in accordance with paragraph 4.5.1. 4.6.2. H55287-002 (HIDE SNP status) is a Dual Eligible Subset plan open to only those individuals eligible to enroll pursuant to the following eligibility requirements: 4.6.2.1. The individual must be currently enrolled in the Integrated RBHA companion program in accordance with paragraph 4.2.1; 4.6.2.2. The individual must live within the appropriate county that corresponds with the specific service area of their Integrated RBHA companion program enrollment in accordance with paragraph 4.2.2; 4.6.2.3. The individual must be entitled to participate in Medicare; and

SPECIFIC PLAN OFFERINGS. MA-PD SNP Health Plan shall operate two Dual Eligible Special Needs Plans under Hxxxx. MA-PD SNP Health Plan shall enroll individuals into these plans in accordance with federal and state guidelines. Eligibility for each particular plan is described below: 4.7.1. Hxxxx is a Dual Eligible Subset plan open to all individuals eligible to enroll pursuant to the following eligibility requirements: 4.7.1.1. The individual must be enrolled in at least one of the programs defined in Section 4 (AHCCCS Acute Program, ALTCS Developmentally Disabled, Children’s Rehabilitative Services, or Integrated RBHA Maricopa County); 4.7.1.2. The individual must live within the appropriate county that corresponds with the specific service area of the program in which they are enrolled as found in section 4; 4.7.1.3. The individual must be entitled to participate in Medicare; and 4.7.1.4. The individual must reside within the CMS-approved service area for this plan as described in Section 4.6.1. 4.7.2. Hxxxx is a Dual Eligible Subset plan open to all individuals eligible to enroll pursuant to the following: 4.7.2.1. The individual must be a Medicaid recipient currently enrolled with Arizona Physicians IPA, Inc. in one of the Arizona Long-Term Care System (ALTCS) programs defined in Section 4.3 and 4.5 (ALTCS Developmentally Disabled, or ALTCS Elderly and Physically Disabled); 4.7.2.2. The individual must live within the appropriate county that corresponds with the specific ALTCS service area of the program in which they are enrolled as found in section 4; 4.7.2.3. The individual must be entitled to participate in Medicare; and 4.7.2.4. The individual must reside within the CMS-approved service area for this plan as described in Section 4.6.2.

SPECIFIC PLAN OFFERINGS. MA-PD SNP Health Plan shall operate a Dual Eligible Special Needs Plans under H5985. MA-PD SNP Health Plan shall enroll individuals into this plan in accordance with federal and state guidelines. Eligibility is described below: 4.2.1. H5985 is a Dual Eligible Subset plan open to all individuals eligible to enroll pursuant to the following eligibility requirements: 4.2.1.1. The individual must be enrolled in at least one of the programs defined in Section 4 (AHCCCS Acute Program, ALTCS Developmentally Disabled, Children’s Rehabilitative Services, Integrated RBHA Maricopa County, or ALTCS Elderly and Physically Disabled); 4.2.1.2. The individual must live within the appropriate county that corresponds with the specific service area of the program in which they are enrolled as found in section 4; 4.2.1.3. The individual must be entitled to participate in Medicare; and 4.2.1.4. The individual must reside within the CMS-approved service area for this plan as described in Section 4.1.2.

SPECIFIC PLAN OFFERINGS. MAO shall operate one (1) Dual Eligible Special Needs Plan under CMS contract number H8845. MAO shall enroll individuals into offered Plan Benefit Packages (PBPs) in accordance with federal and state guidelines, and the terms of this Agreement. A Dual Eligible Member’s eligibility for each particular plan benefit package (PBP) is described below: 4.6.1. H8845-001 (HIDE SNP status) is a Dual Eligible Subset plan open to only those individuals eligible to enroll pursuant to the following eligibility requirements: 4.6.1.1. The individual must be currently enrolled in the AHCCCS Complete Care (ACC) companion program in accordance with paragraph 4.1.1; 4.6.1.2. The individual must live within the appropriate county that corresponds with the specific service area of their AHCCCS Complete Care (ACC) companion program enrollment in accordance with paragraph 4.1.2; 4.6.1.3. The individual must be entitled to participate in Medicare; and 4.6.1.4. The individual must reside within the CMS-approved service area county for this PBP in accordance with paragraph 4.5.1.