This excerpt taken from the MOH 10-K filed Mar 14, 2007.
Article 2. Definitions
As used in this Contract, the following terms and conditions shall have the meanings assigned below:
[Definition added by Version 1.1]
This excerpt taken from the MOH 10-Q filed May 10, 2006.
Article I - Definitions
For the purpose of the Contract:
A. Action means:
(1) the denial or limited authorization of a requested service, including the type or level of service;
(2) the reduction, suspension, or termination of a previously authorized service;
(3) the denial in whole or in part, of payment for a service and the denial could result in the Enrollee liable for payment;
(4) the failure to provide services in a timely manner, as defined as failure to meet performance standards for appointment waiting times (see Article IX - Contractor Assurances, Section E - Access, Subsection 4.e. - Waiting Time Benchmarks); or
(5) the failure of the CONTRACTOR to act within the time frames established for resolution and notification of grievances and appeals.
B. Advance Directive
C. Appeal means a request for review of an Action.
D. Balance Bill means the practice of billing patients for charges that exceed the amount that the CONTRACTOR will pay.
E. CHEC Eligible means any Medicaid recipient under the age of 21 who is eligible to receive Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services in accordance with 42 CFR Part 441, Subpart B.
F. CHEC Program or Child Health Evaluation and Care program is Utahs version of the federally mandated Early Periodic Screening, Diagnosis and Treatment (EPSDT) program as defined in 42 CFR Part 441, Subpart B. Medicaid recipients who are eligible for the Non-Traditional Medicaid Plan are not eligible to receive EPSDT services. (See Attachment C, Covered Services, U.)
G. Child with Special Health Care Needs means a child under 21 years of age who has or is at increased risk for chronic physical, developmental, behavioral, or emotional conditions and requires health and related services of a type or amount beyond that required by children generally, including a child who, consistent with 1932(a)(2)(A) of the Social Security Act, 42 U.S.C., Section 1396u-2(a)(2)(A):
(1) is blind or disabled or in a related population (eligible for SSI under title XVI of the Social Security Act);
(2) is in foster care or other out-of-home placement;
(3) is receiving foster care or adoption assistance; or
(4) is receiving services through a family-centered, community-based coordinated care system that receives grant funds described in section 501(a)(1)(D) of title V.
This excerpt taken from the MOH 8-K filed Jan 31, 2006.
Unless otherwise defined in the text of this Agreement, capitalized names and terms herein and in the Exhibits and the Disclosure Schedule shall have the meaning ascribed to them in Exhibit A.
This excerpt taken from the MOH DEF 14A filed Mar 28, 2005.
In addition to the terms defined in Section 1 and elsewhere in the Plan, the following are defined terms under this Plan:
(a) Annual Incentive Award means an Award earned based on performance in a Performance Period of one fiscal year or a portion thereof.
(b) Award means the amount of a Participants Award Opportunity in respect of a Performance Period determined by the Committee to have been earned, and the Participants rights to current or future payments in settlement thereof.
(c) Award Opportunity means the Participants opportunity to earn specified amounts based on performance during a Performance Period. An Award Opportunity constitutes a conditional right to receive settlement of an Award.
(d) Cause means cause as defined in an employment agreement between the Company and the Participant in effect at the time of Termination of Employment. If, however, there is no such employment agreement, Cause means an individuals (i) intentional failure to perform reasonably assigned duties, (ii) dishonesty or willful misconduct in the performance of duties, (iii) involvement in a transaction in connection with the performance of duties to the Company or any of its subsidiaries thereof which transaction is adverse to the interests of the Company or any of its subsidiaries and which is engaged in for personal profit, (iv) knowing or grossly negligent misconduct which results in the Company being required to prepare an accounting restatement due to the material noncompliance of the Company with any financial reporting requirement under the securities laws, (v) willful violation of any law, rule or regulation in connection with the performance of duties (other than traffic violations or similar offenses), or (vi) the commission of an act of fraud or intentional misappropriation or conversion of assets or opportunities of the Company or any subsidiary; provided, however, that the Committee may vary the definition of Cause in any agreement or document relating to an Award.
(e) Code means the Internal Revenue Code of 1986, as amended from time to time. References to any provision of the Code include and successor provisions thereto and regulations thereunder.
(f) Committee means the Compensation Committee of the Board of Directors, or such other Board committee as the Board may designate to administer the Plan.
(g) Covered Employee means a person designated by the Committee as likely, with respect to a given fiscal year of the Company, to be the Chief Executive Officer or one of the four other most highly compensated executive officers serving on the last day of such fiscal year. This designation generally is required at the time an Award Opportunity is authorized. The Committee may designate more than five persons as Covered Employees with respect to a given year.
MOLINA HEALTHCARE, INC.
2005 INCENTIVE COMPENSATION PLAN
(h) Disability means Participants inability, because of physical or mental illness or injury, to perform the essential functions of his customary duties of employment, with or without reasonable accommodation, and the continuation of such disabled condition for a period of no less than 12 months.
(i) Participant means an employee participating in this Plan.
(j) Performance Goal means the Company or individual performance objective or accomplishment required as a condition to the earning of an Award Opportunity.
(k) Performance Period means the period, specified by the Committee, over which an Award Opportunity may be earned.
(l) Retirement means Termination of Employment of the Participant at or after the Participant has reached age 65, at or after the Participant has reached age 62 with 10 years of service or upon any other Termination deemed a retirement by the Committee.
(m) Termination of Employment means the termination of a Participants employment by the Company or a subsidiary immediately after which the Participant is not employed by the Company or any subsidiary.