Medicaid Advantage Plus Benefit Package definition

Medicaid Advantage Plus Benefit Package means the services and benefits described in Appendix K-2 of this Agreement, plus the CMS approved Medicare supplemental premium for the Medicare Part C benefits described in Appendix K-1 of this Agreement, if any, included in the Capitation Rate paid to the MCO by the State.
Sample 1

Examples of Medicaid Advantage Plus Benefit Package in a sentence

  • Such consultation shall not be required in cases where it is clear that the Contractor was not a risk for the provision of the Medicaid Advantage Plus Benefit Package for any portion of the retroactive period.

  • The Contractor is responsible for payment of those services as covered by the Contractor’s Combined Medicare Advantage and Medicaid Advantage Plus Benefit Package, even when provided by Non-Participating Providers.

  • The Contractor shall provide any Medicare and Medicaid Advantage Plus Benefit Package services to Enrollees as ordered by a court of competent jurisdiction, regardless of whether such services are provided by a Participating Provider or by a Non-Participating Provider.

  • Combined Medicare Advantage and Medicaid Advantage Plus Benefit Package for Behavioral Health Services with Joint OMH and OASAS Oversight OMH and OASAS Service OMH/OASASRegulation Medicaid Coverage (Before Jan 2023) Medicaid Coverage (Beginning Jan 2023) Medicare CoverageHospital *Community Oriented Recovery and Empowerment (CORE) Services were implemented February 1, 2022.

  • The Contractor shall cooperate with LDSS in the implementation of 18 NYCRR Part 457 and any subsequent amendments thereto with regard to medically necessary health and mental health services and all Court Ordered Services for adults to the extent such services are included in the Contractor’s Combined Medicare Advantage and Medicaid Advantage Plus Benefit Package as described in Appendix K of this Agreement.

  • Except as otherwise provided in applicable sections of this Agreement the Contractor shall provide the Combined Medicare Advantage and Medicaid Advantage Plus Benefit Package to all Enrollees in the same manner, in accordance with the same standards, and with the same priority as Enrollees of the Contractor enrolled under any other contracts.

  • As the mass-production process has extended into the social and political domains, so the individual is indoctrinated into and internalises the rationality of that system in place of their own critical agency.

  • The Contractor agrees to provide the Combined Medicare Advantage and Medicaid Advantage Plus Benefit Package, as described in Appendix K-1 of this Agreement, to Enrollees of the Contractor’s Medicaid Advantage Plus Product subject to any exclusions or limitations imposed by Federal or State law during the period of this Agreement.

  • The Contractor is responsible for court-ordered services to the extent that such court-ordered services are included in the Contractor’s Combined Medicare Advantage and Medicaid Advantage Plus Benefit Package as described in Appendix K-1 of this Agreement.

  • The Contractor is responsible for payment of those services as covered by the Combined Medicare Advantage and Medicaid Advantage Plus Benefit Package, even when provided by Non- Participating Providers.

Related to Medicaid Advantage Plus Benefit Package

  • Medicare Advantage plan means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:

  • Medicare Advantage The Medicare managed care options that are authorized under Title XVIII as specified at Part C and 42 C.F.R. § 422.

  • Relevant Benefits means any pension, annuity, lump sum, gratuity or other like benefit given or to be given on retirement or death, or in anticipation of retirement.

  • Public benefit means making capital available, or facilitating the availability of capital, to businesses in this state that have 750 or fewer employees, the intent of which is to create or retain employment opportunities for residents of this state, stabilize or increase the tax base of this state, or support the redevelopment of facilities for use by small businesses.

  • Death master file match means a search of the death master file that results in a match of the social security number or the name and date of birth of an insured, an annuity owner or a retained asset account holder.[PL 2017, c. 129, §1 (NEW).]

  • Basic Plan means as to any Member or Vested Former Member the defined benefit pension plan of the Company or an Affiliated Employer intended to meet the requirements of Code Section 401(a) pursuant to which retirement benefits are payable to such Member or Vested Former Member or to the Surviving Spouse or designated beneficiary of a deceased Member or Vested Former Member.

  • Basic health benefit plan means any plan offered to an individual, a small group,

  • Medical benefit plan means a plan established and maintained by a carrier, a voluntary employees' beneficiary association described in section 501(c)(9) of the internal revenue code of 1986, 26 USC 501, or by 1 or more public employers, that provides for the payment of medical benefits, including, but not limited to, hospital and physician services, prescription drugs, and related benefits, for public employees or elected public officials. Medical benefit plan does not include benefits provided to individuals retired from a public employer or a public employer's contributions to a fund used for the sole purpose of funding health care benefits that are available to a public employee or an elected public official only upon retirement or separation from service.

  • Medicare benefit means the Medicare benefit payable within the meaning of Part II of the Health Insurance Act 1973 with respect to a professional service.

  • Health Benefits means health maintenance organization, insured or self-funded medical, dental, vision, prescription drug and behavioral health benefits.

  • Retiree Health Plan means an "employee welfare benefit plan" within the meaning of Section 3(1) of ERISA that provides benefits to individuals after termination of their employment, other than as required by Section 601 of ERISA.

  • Retirement Plans means the retirement income, supplemental executive retirement, excess benefits and retiree medical, life and similar benefit plans providing retirement perquisites, benefits and service credit for benefits at least as great in value in the aggregate as are payable thereunder prior to a Change in Control.

  • Gap medical benefits means the benefits (if any) payable in respect of medical expenses that are less than, greater than or equal to the schedule fee, provided always that the medical expenses relate to a professional service that:

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Potential Enrollee means a Medical Assistance Recipient who may voluntarily elect to enroll in a given managed care program, but is not yet an Enrollee of an MCO.

  • Pharmacy benefit manager means a person, business or other

  • Medical Benefits Schedule means the Medicare Schedule of Benefits produced by the Department of Health to which all fees and benefits relate for inpatient hospital services.

  • Health and Welfare Benefits means any form of insurance or similar benefit programs, which may include but not be limited to, medical, hospitalization, surgical, prescription drug, dental, optical, psychiatric, life, or long-term disability.

  • Non-U.S. Benefit Plan has the meaning set forth in Section 3.20(a).

  • COBRA means the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended.

  • Child welfare agency means a child-placing agency, child-caring institution or independent foster

  • Retiree means any person who has begun accruing a retirement

  • Health benefit plan means a policy, contract, certificate or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services.

  • Medical Benefits means the monthly fair market value of benefits provided to the Employee and the Employee’s dependents under the major medical, dental and vision benefit plans sponsored and maintained by the Company, at the level of coverage in effect for such persons immediately prior to the Employee’s termination of employment date. The “monthly fair market value” of such benefits shall be equal to the monthly cost as if such persons elected COBRA continuation coverage at such time at their own expense.

  • Subsidy means the difference between the amount of periodic

  • superannuation benefit means any payment, other than a refund of contributions, made to a dentist by virtue of the application of the (a) National Health Service Pension Scheme Regulations 1995; or (b) the National Health Service Superannuation Scheme (Scotland) Regulations 1995 or (c) the corresponding provisions of the law in force in Northern Ireland; as a result of his providing general dental services;