Covered Service Components Clause Samples

The "Covered Service Components" clause defines which specific parts, features, or elements of a service are included under the agreement. It typically lists or describes the functionalities, modules, or deliverables that the provider is obligated to supply and support, such as software modules, hardware, or support services. By clearly outlining what is and is not covered, this clause ensures both parties have a mutual understanding of the scope of services, thereby reducing the risk of disputes over unanticipated exclusions or misunderstandings about service obligations.
Covered Service Components. Without limiting the generality of Contractor’s obligation to provide integrated care and coordination for Covered Services, the following responsibilities are required by law, and must be implemented in conjunction with its integrated care and coordination responsibilities stated above.
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Covered Service Components. Other Services
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Covered Service Components. Other Services a. Care Coordination (1) Contractor shall provide Care Coordination to all members consistent with OARs 410- 141-3860, 410-141-3865, and 410-141-3870 and 42 CFR § 438.208. (2) Contractor shall maintain Care Coordination (CC) policies and procedures that comply with OARs 410-141-3860, 410-141-3865, and 410-141-3870. Contractor shall submit its CC policies and procedures to OHA, via Administrative Notice, for review and approval as follows: (i) by January 31 of each Contract Year; (ii) upon any material change to such policies and procedures; and (iii) within five Business Days of request, as made by OHA from time to time. Contractor shall not implement changes in its CC policies and procedures until approved in writing by OHA. If no changes have been made to Contractor’s CC policies and procedures since last approved by OHA, Contractor may, for its annual January 31 submission, submit to OHA via Administrative Notice, an Attestation stating that no changes have been made. OHA will notify Contractor within thirty (30) days from the due date, or within thirty (30) days from the received date if after the due date, of the approval status of its CC policies and procedures; OHA will notify Contractor within the same period if additional time is needed for review. In the event OHA determines Contractor’s CC policies and procedures do not comply with the criteria set forth herein, Contractor shall follow the process set forth in Sec. 5 of Ex. D. (3) Contractor shall submit to OHA, via Administrative Notice, a bi-annual report on its Care Coordination activities no later than forty-five (45) days following the end of each six- month period. The report shall demonstrate Contractor’s ability to fulfill the Care Coordination activities and requirements outlined in OARs 410-141-3860, 410-141-3865, and 410-141-3870. Contractor shall use the reporting template provided by OHA on the CCO Contract Forms Website.
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Covered Service Components. Exhibit B, Part 2, Section 6 of the Core Contract shall be Delegated to RAE.
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Covered Service Components. Other Services a. (1) Contractor shall provide Care Coordination to all members consistent with OARs 410- 141-3860, 410-141-3865, and 410-141-3870 and 42 CFR § ▇▇▇.▇▇▇.▇▇ addition to
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Covered Service Components. Other Services a. Intensive Care Coordination (1) Making available Trauma Informed, Culturally and Linguistically Appropriate Intensive Care Coordination Services, without the requirement of an assessment, to Members who are expressly identified in OAR 410-141-3170(2)(a)-(o) and those identified in Exhibit B, Part 4, Sec. 10, Para. a, Sub. Para. (1)(a) of this Contract. (2) Providing Trauma Informed, Culturally and Linguistically Appropriate Intensive Care Coordination Services and Behavioral Health Services to children and adolescent Members according to presenting needs. (3) Providing Trauma Informed, Culturally and Linguistically Appropriate Intensive Care Coordination Services to Members receiving Medicaid funded home or Community Based Settings for Long Term Care Services and Supports under the State’s 1915(i) or 1915(k) State Plan Amendments or the 1915(c) HCBS Waiver. (4) Offering Trauma Informed, Culturally and Linguistically Appropriate Intensive Care Coordination Services if qualified by an assessment. (5) Responding to requests for Intensive Care Coordination services with an initial response by the next Business Day following the request. (6) Periodically informing all Participating Providers of the availability of Intensive Care Coordination services, providing training to PCPCHs and other PCPs staff regarding the Intensive Care Coordination services and other support services available to Members. (7) Ensuring that a Member’s DHS Area Agency on Aging/Aging and People with Disabilities, Office of Developmental Disability Services, Long Term Care, or Long Term Services and Supports case manager, have a direct method to contact the Member’s ICC Care Coordination team. (8) Ensuring that the Member’s case manager’s name and telephone number are available to agency staff and Members or Member Representatives when Intensive Care Coordination services are provided to the Member. (9) Making Intensive Care Coordination services available to Members who exhibit inappropriate, disruptive, or threatening behaviors in a Practitioner's office or clinic or other health care setting. (10) Providing prioritized Intensive Care Coordination services to Members who are children and adolescents in the custody of DHS as provided for in Ex. B, Part 4, Sec. 10, Para. a., Sub. Para. (1)(a) of this Contract. (11) Additional Intensive Care Coordination responsibilities are set forth Sec. 10, para. a, of Ex. B, Part 4, and Exhibit M of this Contract.
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Covered Service Components. Other Services a. Intensive Care Coordination24 (1) In addition to providing general Coordinated Care Services, Contractor is responsible for assessing, making available, and providing Intensive Care Coordination services in accordance with the requirements set forth in (i) OAR 410-141-3870; (ii) this Para. a., Sec. 8, Ex. B, Part 2; (iii) Sec. 9, Para. b, Ex. B, Part 4; (iv)
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Covered Service Components. Other Services‌ a. Intensive Care Coordination (1) In addition to providing general Coordinated Care Services, Contractor is responsible for assessing, making available, and providing Intensive Care Coordination services in accordance with the requirements set forth in (i) OAR 410-141-3870, (ii) this Para. a., Sec. 8, Ex. B, Part 2, (iii) Sec. 10, Para. b, Ex. B, Part 4, Exhibit M, and (iv) as may be provided for elsewhere in this Contract. Without limiting the foregoing, Contractor shall: (a) Without requiring a referral, automatically assess all Members of Prioritized Populations for ICC services. Contractor shall make Trauma Informed, Culturally and Linguistically Appropriate ICC services available to all Members of Prioritized Populations who qualify, as a result of such assessment, for such services. (b) Provide Trauma Informed, Culturally and Linguistically Appropriate ICC services and Behavioral Health Services to children and adolescent Members according to presenting needs. (c) Provide Trauma Informed, Culturally and Linguistically Appropriate ICC services to Members receiving Medicaid-Funded Long Term Services and Supports including those receiving services in home or community based settings under the State’s 1915(i) or 1915(k) State Plan Amendments or the 1915(c) HCBS Waiver or those in Long Term Care settings. (d) Assess all Members not identified in SubParas (a)-(c) above of this SubPara (1), Para. a, Sec. 8, Ex. B, Part 2, for ICC services when referred by any of the referrers listed below and make Trauma Informed, Culturally and Linguistically Appropriate ICC services available to all referred Members who qualify for such services as a result of the screening. i. The Member themselves, ii. The Member’s Representative, iii. A Provider, including, without limitation, an HCBS Provider or other LTSS Provider, and
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Related to Covered Service Components

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

  • Required Services Consultant agrees to perform the services, and deliver to City the “Deliverables” (if any) described in the attached Exhibit A, incorporated into the Agreement by this reference, within the time frames set forth therein, time being of the essence for this Agreement. The services and/or Deliverables described in Exhibit A shall be referred to herein as the “Required Services.”

  • Product NYISO will provide Energy Resource Interconnection Service and Capacity Resource Interconnection Service to Developer at the Point of Interconnection.

  • Product Testing No later than [**] prior to a scheduled Delivery ARIAD US shall send to ARIAD SWISSCO the Delivery Documents for review. Following such review, unless within [**] of receipt of the Delivery Documents ARIAD SWISSCO gives written notice of rejection of the Product to be delivered, stating the reasons for such rejection, the Delivery shall proceed, and both Parties shall organize the same. Upon arrival at ARIAD SWISSCO nominated site it shall visually inspect the shipment of the Product to identify any damage to the external packaging. ARIAD SWISSCO may reject any shipment (or portion thereof) of the Product that is damaged by providing to ARIAD US reasonable evidence of damage within [**] after Delivery of such Product. If ARIAD SWISSCO does not so reject any shipment (or portion thereof) of the Product within [**] of Delivery of such Product, ARIAD SWISSCO shall be deemed to have accepted such shipment of the Product; provided, however, that in the case of the Product having any Latent Defect, ARIAD SWISSCO shall notify ARIAD US promptly once it becomes aware that a Product contains a Latent Defect and subsequently may reject such Product by giving written notice to ARIAD US of ARIAD SWISSCO’s rejection of such Product and shipping a representative sample of such Product or other evidence of Non-Conformance to ARIAD US within [**] after becoming aware of such Latent Defect, which notice shall include a description of the Latent Defect.

  • Non-Covered Services The Contractor shall refer Members to Providers enrolled in the Medicaid Fee-for- Service delivery system for all Medically Necessary Services not covered by the Contractor under the MississippiCAN Program. The Contractor shall have written policies and procedures for the referral of Members for non-covered services, which shall provide for the smooth transition to Out-of-network Providers and assistance to Members in obtaining a new PCP, if appropriate. These procedures shall be applicable to the referral of Members to Out-of- network Providers, as necessary, upon Disenrollment, regardless of the reasons for Disenrollment.