HMO Program definition

HMO Program means a non-governmental, fully insured HMO or Point of Service product that is underwritten based on a community rating methodology (i.e. community rating, community rating by class, adjusted community rating by class). -------------------------------------------------------------------------------------------- Gentiva Homehealth Infusion and DME/HME Capitation Rate PMPM -------------------------------------------------------------------------------------------- All Commercial HMO Capitated Affiliates * -------------------------------------------------------------------------------------------- Capitation Rate Compensation Terms ---------------------------------- The following rates are established for the provision of Home Care Services rendered to Program Participants covered under the HMO and Gatekeeper plans: February 1, 2006 - January 31, 2007 $* per member per month February 1, 2007 - January 31, 2008 $* per member per month February 1, 2008 - January 31, 2009 $* per member per month The capitation rate listed above for each twelve month period is allocated between HMO and Gatekeeper Program participants in accordance with established business practices. On or about December 1 of each year, the parties shall reconcile the allocation and settle any payment difference no later than December 31 of each calendar year. If an outlier calculation for * demonstrates a patient per thousand (PPK) increase in excess of *, (* ppk), then MCA reserves the right to propose an * pmpm outlier adjustment no later than September 1. CIGNA may elect to accept the proposed adjustment or * and * from this agreement. *Confidential treatment requested.
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HMO Program means a non-governmental, fully insured HMO or Point of Service product that is underwritten based on a community rating methodology (i.e. community rating, community rating by class, adjusted community rating by class). Gentiva Homehealth Infusion and DME/HME Capitation Rate PMPM -------------------------------------------------------------------------------- All Commercial HMO Capitated Affiliates EXHIBIT A HMO PROGRAM ATTACHMENT - FEE FOR SERVICE REIMBURSEMENT FOR OTHER SERVICES RATE AREA DESIGNATIONS: STATE RATE AREA RATE DESIGNATION ---------------------------------------------------------------------------------------- Alabama * * Alaska * * Arizona * * Arkansas * * California * * Colorado * * Connecticut * * Delaware * * District of Columbia * * Florida * * Georgia * * Hawaii * * Idaho * * Illinois * * Indiana * * Iowa * * Kansas * * Kentucky * * Louisiana * * Maine * * Maryland * * Massachusetts * * Michigan * * Minnesota * * Mississippi * * Missouri * * Montana * * Nebraska * * Nevada * * New Hampshire * * New Jersey * * New Mexico * * New York * * North Carolina * * North Dakota * * Ohio * * Oklahoma * * Oregon * * Pennsylvania * * Rhode Island * * South Carolina * * South Dakota * * Tennessee * * Texas * * Utah * * Vermont * * Virginia * * Washington * * West Virginia * * Wisconsin * * Wyoming * * *Confidential Treatment Requested TRADITIONAL HOME HEALTH FEE-FOR-SERVICE RATE RATES EFFECTIVE JANUARY 1, 2005 - DECEMBER 31, 2005 THE FOLLOWING TRADITIONAL HOME HEALTH SERVICES HAVE BOTH VISIT AND HOURLY RATES. Notes 1, 2, 3, 4, 5 and 6 apply
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Examples of HMO Program in a sentence

  • In consideration of the need to ensure uninterrupted and continuous HHSC HMO Program performance, time is of the essence in the performance of the Scope of Work under the Contract.

  • For each applicable HMO Program, HHSC will pay the HMO fixed monthly Capitation Payments based on the number of eligible and enrolled Members.

  • The Transition Phase must be completed no later than the agreed upon Operational Start Date(s) for each HMO Program and Service Area.

  • The HMO’s website must comply with the Marketing Policies and Procedures for each applicable HHSC HMO Program.

  • In the first three (3) years of a Medicaid HMO Program operating in a Service Area, the HMO must seek participation in its Network from all Medicaid Significant Traditional Providers (STPs) defined by HHSC in the applicable Service Area for the applicable HMO Program.

  • The HMO must adopt not less than two evidence-based clinical practice guidelines for each applicable HMO Program.

  • The HMO must develop and implement DM services that relate to chronic conditions that are prevalent in HMO Program Members.

  • The Provider Hotline must be staffed with personnel who are knowledgeable about Covered Services and each applicable HMO Program, and for Medicaid, about Non-capitated Services.

  • HHSC retains the right to reject or require changes to any model Provider contract that does not comply with HMO Program requirements or the HHSC-HMO Contract.

  • The Provider Directory for each applicable HMO Program, and any substantive revisions, must be approved by HHSC prior to publication and distribution.

Related to HMO Program

  • AML Program has the meaning ascribed thereto in Schedule 2.1(F)(8) hereof.

  • E-Verify Program above means the employment verification program administered by the United States Department of Homeland Security, the Social Security Administration, or any successor program.

  • Pilot program means a program using a representative sample of residential and small commercial customers to assist in developing and offering customer choice of electricity supply for all residential and commercial customers.

  • Educational program means a program for educating and preparing physician assistants which is approved by the board.

  • CRAF Program means the Civil Reserve Air Fleet Program authorized under 10 U.S.C. Section 9511 et seq. or any similar or substitute program under the laws of the United States.

  • Marketing program means a program established by order of the director pursuant to this act prescribing rules and regulations governing the marketing for processing, distributing, selling, or handling an agricultural commodity produced in this state or agricultural commodity input during a specified period and

  • Program Plan means the tobacco settlement program plan dated February 14, 2001, including exhibits to the program plan, submitted by the authority to the legislative council and the executive council, to provide the state with a secure and stable source of funding for the purposes designated by section 12E.3A and other provisions of this chapter.

  • Program means the statutorily authorized activities of the System Agency under which this Contract has been awarded.

  • Education program means any program that is principally engaged in the provision of education, including, but not limited to, early childhood education, elementary and secondary education, postsecondary education, special education, job training, career and technical education and adult education, and any program that is administered by an educational agency or institution.

  • Child day program means a regularly operating service arrangement for children where, during the absence of a parent or guardian, a person or organization has agreed to assume responsibility for the supervision, protection, and well-being of a child under the age of 13 for less than a 24-hour period.

  • Basic health plan model plan means a health plan as required in RCW 70.47.060(2)(e).

  • Number of Students Who Began Program means the number of students who began the program who are scheduled to complete the program within the reporting calendar year.

  • Loan Program means the State Treasurer’s Interest-Free Loan Program for Colorado School Districts authorized pursuant to the Loan Program Statutes.

  • Number of Students Who Began the Program means the number of students who began a program who were scheduled to complete the program within 100% of the published program length within the reporting calendar year and excludes all students who cancelled during the cancellation period.

  • Approved abuse education training program means a training program using a curriculum approved by the abuse education review panel of the department of public health or a training program offered by a hospital, a professional organization for physicians, or the department of human services, the department of education, an area education agency, a school district, the Iowa law enforcement academy, an Iowa college or university, or a similar state agency.

  • the Programme means the Government programme for delivery of smart metering in Great Britain. The Programme is responsible for overseeing the development and implementation of policy, including establishing the commercial and regulatory framework to facilitate the roll-out;

  • Application Program means a computer program which is intended to be executed for the purpose of performing useful work for the user of the information being processed. Application programs are developed or otherwise acquired by the user of the Hardware/Software system, but they may be supplied by the Contractor.

  • Procurement Plan means the Recipient’s procurement plan for the Project, dated April 2, 2010, and referred to in paragraph 1.16 of the Procurement Guidelines and paragraph 1.24 of the Consultant Guidelines, as the same shall be updated from time to time in accordance with the provisions of said paragraphs.

  • Qualifying Educational Program means a program at a post-secondary school level of not less than three consecutive weeks duration that requires each student taking the program to spend not less than 10 hours per week on courses or work in that program.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Prescription monitoring program means the electronic system within the Department of Health Professions that monitors the dispensing of certain controlled substances.

  • Child Care Program means a person or business that offers child care.

  • Covered Program means an education program or activity over which the College exercised substantial control over both the Respondent and the context in which the sexual harassment occurred.

  • Apprenticeship program means a program registered with the U.S. Department of Labor, Office of Apprenticeship, which includes terms and conditions for the qualification, recruitment, selection, employment, and training of apprentices, including the requirement for a written apprenticeship agreement.

  • Marketing Plan means a plan or system concerning a material aspect of conducting business. Indicia of a marketing plan include any of the following:

  • Training program means an NCA-approved Iowa college, the Iowa law enforcement academy or an Iowa hospital approved by the department to conduct emergency medical care training.