Adjustments in Service Area or Enrollment Clause Samples

The "Adjustments in Service Area or Enrollment" clause defines the process and conditions under which changes to the geographic area served or the number of individuals covered under an agreement can be made. Typically, this clause outlines the procedures for notifying the other party of proposed adjustments, the timeline for implementing changes, and any limitations or approvals required. For example, if a healthcare provider wishes to expand or reduce the regions it serves or adjust the number of enrolled members, this clause governs how such modifications are handled. Its core function is to provide a clear framework for managing changes in service scope, thereby preventing disputes and ensuring both parties can adapt to evolving needs or circumstances.
Adjustments in Service Area or Enrollment a. If Contractor experiences a Material Change, or is engaged in the termination or loss of a Provider or group or affected by other factors which have significant impact on access in that Service Area and which may result in transferring a substantial number of Members to other Providers employed or subcontracted with Contractor, Contractor shall provide OHA with a (1) If a Provider or group terminates its subcontract or employment with Contractor or if Contractor is affected by circumstances beyond Contractor’s control and the Contractor cannot reasonably provide the required 90 day notice, less than the required notice to OHA may be provided with the approval of OHA. (2) If Contractor cannot demonstrate sufficient Provider capacity, OHA may seek other avenues to provide services to Members. If OHA determines that some or all of the affected Members must be disenrolled from Contractor, the applicable provisions of this Section shall apply. b. If Contractor experiences a Material Change, or is engaged in the termination or loss of a Provider or group or affected by other factors which has significant impact on access in that Service Area and which may result in reducing or terminating Contractor’s Service Area or disenrolling a substantial number of Members from Contractor, Contractor shall provide OHA with a written notice and a plan for implementation (which may include an intent to transfer its Members in the Service Area to a Contractor designated by OHA) at least 90 days prior to the date of such action. Contractor shall remain responsible for providing all Covered Services through the end of the 90 day period, without limitation, for all Members for which the Contractor received a CCO Payment. (1) If Contractor must terminate a Provider or group due to circumstances that could compromise Member care, less than the required notice to OHA may be provided with the approval of OHA. (2) If a Provider or group terminates its Subcontract or employment with Contractor or Contractor is affected by other circumstances beyond Contractor’s control and the Contractor cannot reasonably provide the required 90 day notice, less than the required notice to OHA may be provided with the approval of OHA. (3) If Contractor provides OHA with the required 90 day notice but provides no Letter of Intent to transfer its Members to a designated Contractor within 30 days of the 90 day notice, Members in the affected Service Area will be disenrolled from Contractor and will be ...
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Adjustments in Service Area or Enrollment. The terms and conditions of Section 14, Exhibit B, Part 4 in the Medicaid Contract are incorporated by reference and have the same force and effect as though they are fully set forth herein.
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Adjustments in Service Area or Enrollment a. If Contractor is engaged in the termination or loss of a Provider or group or affected by other factors which have significant impact on access in that Service Area and which may result in transferring a substantial number of Members to other Providers employed or subcontracted with Contractor, Contractor shall provide OHA with a written plan for transferring the Members and an updated DSN Provider Report, Exhibit G, at least 90 days prior to the date of such action. b. If Contractor experiences a change which may result in the reduction or termination of any portion of Contractor’s Service Area or may result in the disenrollment of a substantial number c. OHA will not approve a transfer of Members if the Provider’s contract with the transferring Contractor is terminated for reasons related to quality of care, competency, Fraud or other reasons described in OAR 410-141-3080. d. OHA reserves the right to waive the required notice period in certain circumstances, including but not limited to: (1) i. If Contractor must terminate a Provider or group due to circumstances that could compromise Member care; (2) ii. If a Provider or group terminates its subcontract or employment with Contractor or if Contractor is affected by circumstances beyond Contractor’s control and the Contractor cannot reasonably provide the required 90 day notice; or,
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Adjustments in Service Area or Enrollment a. If RAE reasonably anticipates losing a substantial number of Members from its enrollment, or experiencing a reduction in its network or capacity due to: (i) the occurrence of a Material Change or other significant change; (ii) engaging in the termination or loss of Participating Providers; or (iii) decreased access in RAE’s Service Area, RAE shall notify TCMC at least 120 days, or as soon as reasonably practicable, prior to the date of such anticipated loss or reduction. b. In such an event, RAE shall cooperate with and assist TCMC to develop a written plan for removing or reassigning the Members, and to cooperate and assist in the preparation of any written reports required by the Core Contract or the OHA related to the removal or reassignment. ▇. ▇▇▇ shall remain responsible for maintaining sufficient capacity and solvency, and providing Covered Care Services through such 120-day period, without limitation, for all Members for which RAE received Compensation. d. If RAE cannot demonstrative sufficient capacity to provide Covered Services to Members during such 120-day period, TCMC may seek other avenues to provide Covered Services to Members. Part 5 – Health Equity and Elimination Health Disparities
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Adjustments in Service Area or Enrollment a. If RAE reasonably anticipates losing a substantial number of Members from its enrollment, or experiencing a reduction in its network or capacity due to: (i) the occurrence of a Material Change or other significant change; (ii) engaging in the termination or loss of Participating Providers; or (iii) decreased access in RAE’s Service Area, RAE shall notify TCMC at least 120 days, or as soon as reasonably practicable, prior to the date of such anticipated loss or reduction. b. In such an event, RAE shall cooperate with and assist TCMC to develop a written plan for removing or reassigning the Members, and to cooperate and assist in the preparation of any written reports required by the Core Contract or the OHA related to the removal or reassignment. ▇. ▇▇▇ shall remain responsible for maintaining sufficient capacity and solvency, and providing Covered Care Services through such 120-day period, without limitation, for all Members for which RAE received Compensation. d. If RAE cannot demonstrative sufficient capacity to provide Covered Services to Members during such 120-day period, TCMC may seek other avenues to provide Covered Services to Members. Part 5 – Health Equity and Elimination Health Disparities
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Related to Adjustments in Service Area or Enrollment

  • Payment and Year-End Adjustment Amounts accrued pursuant to this Agreement shall be payable to the Adviser as of the last day of each month. If necessary, on or before the last day of the first month of each fiscal year, an adjustment payment shall be made by the appropriate party in order that the actual Fund Operating Expenses of a Fund for the prior fiscal year (including any reimbursement payments hereunder with respect to such fiscal year) do not exceed the Maximum Annual Operating Expense Limit.

  • Reporting Total Compensation of Recipient Executives 1. Applicability and what to report. You must report total compensation for each of your five most highly compensated executives for the preceding completed fiscal year, if— i. the total Federal funding authorized to date under this award is $25,000 or more; ii. in the preceding fiscal year, you received— (A) 80 percent or more of your annual gross revenues from Federal procurement contracts (and subcontracts) and Federal financial assistance subject to the Transparency Act, as defined at 2 CFR 170.320 (and subawards); and (B) $25,000,000 or more in annual gross revenues from Federal procurement contracts (and subcontracts) and Federal financial assistance subject to the Transparency Act, as defined at 2 CFR 170.320 (and subawards); and iii. The public does not have access to information about the compensation of the executives through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986. (To determine if the public has access to the compensation information, see the U.S. Security and Exchange Commission total compensation filings at ▇▇▇▇://▇▇▇.▇▇▇.▇▇▇/answers/execomp.htm.) 2. Where and when to report. You must report executive total compensation described in paragraph b.1. of this award term: i. As part of your registration profile at ▇▇▇▇▇://▇▇▇.▇▇▇.gov. ii. By the end of the month following the month in which this award is made, and annually thereafter.

  • SALARY DETERMINATION FOR EMPLOYEES IN ADULT EDUCATION PCA Article B.3 does not apply in School District No. 34 (Abbotsford).

  • Adjustment of Minimum Quarterly Distribution and Target Distribution Levels (a) The Minimum Quarterly Distribution, First Target Distribution, Second Target Distribution, Third Target Distribution, Common Unit Arrearages and Cumulative Common Unit Arrearages shall be proportionately adjusted in the event of any distribution, combination or subdivision (whether effected by a distribution payable in Units or otherwise) of Units or other Partnership Securities in accordance with Section 5.10. In the event of a distribution of Available Cash that is deemed to be from Capital Surplus, the then applicable Minimum Quarterly Distribution, First Target Distribution, Second Target Distribution and Third Target Distribution, shall be adjusted proportionately downward to equal the product obtained by multiplying the otherwise applicable Minimum Quarterly Distribution, First Target Distribution, Second Target Distribution and Third Target Distribution, as the case may be, by a fraction of which the numerator is the Unrecovered Capital of the Common Units immediately after giving effect to such distribution and of which the denominator is the Unrecovered Capital of the Common Units immediately prior to giving effect to such distribution. (b) The Minimum Quarterly Distribution, First Target Distribution, Second Target Distribution and Third Target Distribution, shall also be subject to adjustment pursuant to Section 6.9.

  • What Forms of Distribution Are Available from a ▇▇▇▇▇▇▇▇▇ Education Savings Account Distributions may be made as a lump sum of the entire account, or distributions of a portion of the account may be made as requested.