Restriction Program definition

Restriction Program means the program required by 42 CFR 431.54(e) and 42 CFR 456.3 that provides safeguards against inappropriate and excessive use of Medicaid services. Risk Contract means a contract under which the contractor assumes risk for the cost of the services covered under the contract; and incurs loss if the cost of furnishing the services exceeds the payments under the contract. Risk Corridor means a risk sharing mechanism in which the Department and the Contractor may share in profits and losses under the Contract outside of a predetermined threshold amount.
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Restriction Program means the Federally mandated program (42 CFR 431.54(e)) for Medicaid clients who over-utilize Medicaid services. If the DEPARTMENT in conjunction with the CONTRACTOR finds that an Enrollee has utilized Medicaid services at a frequency or amount that is not Medically Necessary, as determined in accordance with utilization guidelines adopted by the DEPARTMENT, the DEPARTMENT may place the Enrollee under the Restriction Program for a reasonable period of time to obtain Medicaid services from designated providers only.
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Restriction Program means the program mandated by 42 CFR 431.54(e) for Medicaid Eligible Individuals who over-utilize Medicaid services. Retention Covered Service means orthodontic retention including the removal of orthodontic appliances and the creation and fitting of a retainer. Risk Contract means a contract under which the Contractor assumes risk for the cost of the services covered under the contract; and incurs loss if the cost of furnishing the services exceeds the payments under the contract. ▇▇▇ means the System for Award Management database.
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Examples of Restriction Program in a sentence

  • The Department has the sole authority to restrict Recipients and has oversight responsibility of the PH-MCO’s Recipient Restriction Program.

  • The PH-MCO agrees to maintain a Recipient Restriction Program to interface with the Department’s Recipient Restriction Program, to provide for appropriate professional resources to manage the Program and to cooperate with the Department in all procedures necessary to restrict Members.

  • The first shall be an Employee and Executive Incentive Compensation Restriction Program as described below in Section A.

  • Contractor may restrict an Enrollee for a reasonable period of time to a designated PCP, WHCP or Provider of pharmacy services when: (i) the Department indicates the Enrollee was included in the Department’s Recipient Restriction Program pursuant to 89 Ill.

  • The PH-MCO will maintain a Recipient Restriction Program to interface with the Department’s Recipient Restriction Program, will provide for appropriate professional resources to manage the Program and to cooperate with the Department in all procedures necessary to restrict Recipients.

  • The PH-MCO will maintain a Recipient Restriction Program to interface with the Department’s Recipient Restriction Program, will provide for appropriate professional resources to manage the Program and to cooperate with the Department in all procedures necessary to restrict Members.

  • The CHC-MCO will maintain a Participant Restriction Program to interface with the Department’s Recipient Lock-in Program, and will provide for appropriate professional resources to manage the CHC-MCO program and to cooperate with the Department in all procedures necessary to restrict Participants.

  • Recipient Restriction Program — The program to Lock-In Participants for a period of time.

  • Administrative processes that include, but are not limited to: COB, Participant Restriction Program, and Encounter Data reporting.

  • In addition to the Prescription Restriction Program, individual MTF sites may have specific utilization and prescription monitoring programs, such as Warrior Transition Units, where military personnel may be enrolled for a limited duration.


More Definitions of Restriction Program

Restriction Program means the program required by 42 CFR § 431.54(e) and 42 CFR § 456.3 that provides safeguards against unnecessary or inappropriate use of Medicaid services and against excess payments.
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Related to Restriction Program

  • Compliance Program means the program established by CNYCC to prevent, detect, and address compliance issues that arise with respect to PPS operations, projects or activities.

  • Award Transfer Program means any program instituted by the Committee which would permit Participants the opportunity to transfer any outstanding Awards to a financial institution or other person or entity approved by the Committee.

  • Notice Program means the methods provided for in this Agreement for giving the Notice and consists of Email Notice, Postcard Notice, and Long Form Notice, which shall be substantially in the forms as the exhibits attached to this Agreement.

  • Restriction of Use means, in respect of any day, any difference from the normal capability of all or any part of the Routes (where the normal capability of the Routes is expressed in the Applicable Timetable Planning Rules relevant to that day notified to each Timetable Participant on or before D-26) which results in:

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