Health Care Services Agreement - Free Download | Page 2
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ABC HEALTH PROVIDERs
Family Planning One 2
NOW, THEREFORE, in consideration of the mutual covenants and agreements hereinafter
contained, the parties hereto agree as follows:
Agreement. The "Agreement" shall mean this contract and all attachments hereto.
Authorized Specialty Services. "Authorized Specialty Services" shall mean Specialty Services
authorized pursuant to Section 3.4 hereof.
Capitated Rate. "Capitated Rate" shall mean the fixed monthly amount per Enrollee, as set forth on
Exhibit A attached hereto, which is payable to HC for the provision of Primary Care Services provided in
accordance with the terms of this Agreement, the MEDICAID Agreement, and the applicable Member
Child Health Plus Enrollee or CHP Enrollee. “Child Health Plus Enrollee” or “CHP Enrollee” shall
mean an Enrollee who receives services under ABCHP’s Child Health Plus program, in accordance with
the CHP Agreement and applicable Benefit Plan.
CHP Agreement. The “CHP Agreement” is the contract entered into by ABCHP with the DOH,
and all exhibits, attachments, amendments and addenda thereto, to administer the Child Health Plus
program, a child health insurance plan to provide primary and preventive health insurance coverage for
children within specific geographical areas. The CHP Agreement is hereby incorporated by reference as if
specifically set forth herein.
Covered Services. "Covered Services" shall mean those medical and other health care services and
benefits to which Enrollees are entitled under the terms of the MEDICAID Agreement and the applicable
HC. "HC" shall mean the Participating Community Health Center identified on page 1 which is a
party to this Agreement and its employees and independent contractors authorized to provide health care
services to Enrollees.
DOH. "DOH" shall mean the New York State Department of Health.
Eligible Person. "Eligible Person" shall mean a person determined by the HRA to be eligible for
Medicaid consistent with the requirements of the DSS.