Coordination with Medicare Generally Sample Clauses

Coordination with Medicare Generally. The Contractor shall coordinate all Medicare and Medicaid services for its full-benefit dually-eligible members. To the greatest extent possible, this shall include all reasonable efforts to coordinate care for dually-eligible members regardless of Medicare service delivery system or Medicare plan benefit package—this includes traditional Medicare, unaligned Medicare Advantage plans, Chronic Conditions Special Needs Plans (C-SNPs), and Institutional Special Needs Plans (I-SNPs). The Contractor shall ensure that services covered and provided pursuant to this contract are delivered without charge to members who are dually-eligible for Medicare and Medicaid services. The Contractor is responsible for providing medically necessary Medicaid covered services to members who are also eligible for Medicare if the service is not covered by Medicare. The Contractor shall engage with Medicare payers, Medicare Advantage plans, and Medicare providers as appropriate to coordinate the care and benefits of dually- eligible members. The Contractor shall coordinate with all relevant state and social service agencies and community-based organizations (CBOs) as needed to better identify and address both the medical and social needs of the member. The Contractor shall establish systems and processes to effectively refer and connect members to these agencies. The Contractor shall provide continued member, provider, and staff education and assistance pertaining to Medicare and Medicaid and their interaction; available Medicare and Medicaid partners and resources; and the care experience of dually - eligible members. This should include, but is not limited to: 1. Member education and resources such as: ▪ An explanation of all Medicare and Medicaid benefits available to the member; ▪ Assistance in coordinating the Medicare and Medicaid services that are available to the member; ▪ The benefit of enrolling in a Medicare Part D plan with a zero copay; ▪ A dedicated helpline to take member phone calls and answer member questions about Medicare coverage, including those related to the contractor’s aligned D-SNP plan. 2. Provider education that covers at a minimum: ▪ Dual-eligibility in Indiana for Medicare and Medicaid ▪ The care experience of dually-eligible members in Indiana ▪ Coordination of services and benefits for dually-eligible members, which should include, but is not limited to, billing and claim submission requirements