Enrollee Access to Services Sample Clauses

Enrollee Access to Services. A. General
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Enrollee Access to Services. 2.11.1. The Contractor must provide services to Enrollees as follows:
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Enrollee Access to Services. General The Contractor: Must demonstrate its ability to meet the needs of Enrollees competently and promptly; Must offer adequate choice and availability of Providers, and allow each Enrollee to choose his or her Provider to the extent possible and appropriate; Must provide adequate access to Covered Services (listed in Appendix A), including physical and geographic access. Such access must be designed to accommodate the needs of Enrollees who are disabled or non-English speaking, including access to TTY (for the deaf and hard of hearing) and translation services; Must provide all Covered Services in an amount, duration, and scope that is no less than the amount, duration, and scope for the same services provided under MassHealth fee for service. Must provide all Covered Services that are medically necessary pursuant to 130 CMR 450.204, including those Covered Services that: Prevent, diagnose, and treat health impairments; Achieve age-appropriate growth and development; Attain, maintain, or regain functional capacity; and Provide an opportunity for an Enrollee receiving long-term services and supports to have access to the benefits of community living, to achieve person-centered goals, and live and work in the setting of his or choice. Must ensure that all Covered Services are sufficient in an amount, duration, or scope to reasonably achieve the purpose for which the services are furnished; May place appropriate limits on a Covered Service for the purpose of utilization control, provided that: The furnished services can reasonably be expected to achieve their purpose; Services supporting Enrollees with ongoing or chronic conditions or who require LTSS are authorized in a manner that reflects the Enrollee’s ongoing need for such services and supports; and Family planning services are provided in a manner that protects and enables the Enrollee’s freedom to choose the method of family planning to be used. May place appropriate limits on a Covered Service on the basis of Medical Necessity. The Contractor’s Medical Necessity guidelines must, at a minimum, be: Developed with input from practicing physicians throughout the Contractor’s Regions; Developed in accordance with standards adopted by national accreditation organizations where applicable and available; Developed in accordance with the definition of Medical Necessity in this Contract and therefore no more restrictive than MassHealth Medical Necessity guidelines; Updated at least annually or as new treatme...
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Enrollee Access to Services. A. General The Contractor must:
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Enrollee Access to Services 
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Related to Enrollee Access to Services

  • Access to Services 1. Subject to DHCS provider enrollment certification requirements, the Contractor shall maintain continuous availability and accessibility of covered services and facilities, service sites, and personnel to provide the covered services through use of DMC certified providers. Such services shall not be limited due to budgetary constraints.

  • Access to Service You acknowledge that Your ability to access the Service may require the payment of third- party fees (such as telephone toll charges, ISP, or airtime charges) and that You are responsible for paying such fees. The Provider is not responsible for any equipment You may need to be able to access the Service.

  • Network Services Local Access Services In lieu of any other rates and discounts, Customer will pay fixed monthly recurring local loop charges ranging from $1,200 to $2,000 for TDM-based DS-3 Network Services Local Access Services at 2 CLLI codes mutually agreed upon by Customer and Company.

  • Changes to Services The Parties acknowledge and agree that there will be changes to the scope of the Services during the Contract Period. The Customer may amend the Stories that are comprised within the Minimum Marketable Features of a Release at any time during the Release at no additional charge and without adopting the Change Control Procedure set out in Clause 28 above provided that: the Customer shall not be entitled to make any changes to the Stories that form the subject of a Sprint following the mutual agreement by the Parties of the Sprint Plan for that Sprint; new Stories and/or changes to existing Stories may only be introduced if: existing Stories with an equivalent number of Story Points are removed; or existing Stories are reduced in size by the equivalent number of Story Points, such that the total number of Story Points for the Release remains constant throughout the Release. The Supplier shall consider any request by the Customer to increase the number of Story Points for a Release, and may, subject to the Change Control Procedure set out at Clause 28, agree to such request.

  • 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.

  • To Services Company reserves the right at any time to modify or discontinue, temporarily or permanently, the Company Services (or any part thereof) with or without notice. You agree that Company shall not be liable to you or to any third party for any modification, suspension or discontinuance of the Company Services.

  • Access to the Services ID’s for access to Vendor Core Research and Analyst Inquiry may not be shared. Access to the Services is restricted to the number of named individuals (each a “Licensed User”) as identified in the Customer Purchase Order.

  • NYS OFFICE OF INFORMATION TECHNOLOGY SERVICES NOTIFICATION All New York State Agencies must notify the Office of Information Technology Services of any and all plans to procure IT and IT -related products, materials and services meeting required thresholds defined in Technology Policy NYS–P08-001: xxxxx://xxx.xx.xxx/sites/default/files/documents/NYS-P08-001.pdf, as may be amended, modified or superseded. SALES REPORTING REQUIREMENTS Contractor shall furnish OGS with quarterly sales reports utilizing Appendix I - Report of Contract Sales. Purchases by Non- State Agencies, political subdivisions and others authorized by law shall be reported in the same report and indicated as required. All fields of information shall be accurate and complete. OGS reserves the right to unilaterally make revisions, changes and/or updates to Appendix I - Report of Contract Sales or to require sales to be reported in a different format without processing a formal amendment and/or modification. Further, additional related sales information and/or detailed Authorized User purchases may be required by OGS and must be supplied upon request. Reseller Sales Product sold through Reseller(s) must be reported by Contractor in the required Appendix I – Report of Contract Sales. Due Date The Appendix I - Report of Contract Sales will be quarterly (January - March, April - June, July - September and October - December). Reports will be due 1 month after the closing quarter. SERVICE REPORTS FOR MAINTENANCE/SUPPORT AND WARRANTY WORK Service Reports for Authorized User An Authorized User in an RFQ may require compliance with any or all of this section. If requested by the Authorized User, the Contractor shall furnish the Authorized User with service reports for all Maintenance/support and warranty work upon completion of the services. The service reports may include the following information in either electronic or hard copy form as designated by the Authorized User:  Date and time Contractor was notified  Date and time of Contractor’s arrival  Make and model of the Product  Description of malfunction reported by Authorized User  Diagnosis of failure and/or work performed by Contractor  Date and time failure was corrected by Contractor  Type of service – Maintenance/support or warranty  Charges, if any, for the service Service Reports for OGS

  • Access to System If Business Associate needs access to a Covered Entity Information Technology system to comply with its obligations under the Contract or this Agreement, Business Associate shall request, review, and comply with any and all policies applicable to Covered Entity regarding such system including, but not limited to, any policies promulgated by the Office of Information Technology and available at xxxx://xxx.xxxxx.xx.xx/about/policies.

  • Data Services In lieu of any other rates or discounts, the Customer will receive discounts ranging from 25% to 55% for the following Data Services: Access: Standard VBSII Guide local loop charges for DS-3 Network Services Local Access Services.

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