Common use of Cost-Sharing and Residents of Nursing Facility Clause in Contracts

Cost-Sharing and Residents of Nursing Facility. For MSC+ Enrollees, upon notification to the MCO that a Medical Assistance Enrollee has been a resident of a Nursing Facility for thirty (30) days or more, the MCO shall ensure that its Providers do not require the Enrollee to pay any cost-sharing, and shall reimburse its Providers any cost-sharing amount paid. The MCO may submit an invoice and a data certification to the STATE for all cost-sharing the MCO has reimbursed to its Providers in the previous quarter, no more often than quarterly. The STATE shall verify the Medical Assistance Enrollee’s living arrangement, and date of service on the encounter claim, prior to payment to the MCO for the amounts the MCO claims to have reimbursed to its Providers.

Cost-Sharing and Residents of Nursing Facility. ‌ For MSC+ Enrollees, upon notification to the MCO that a Medical Assistance Enrollee has been a resident of a Nursing Facility for thirty (30) days or more, the MCO shall ensure that its Providers do not require the Enrollee to pay any cost-sharing, and shall reimburse its Providers any cost-cost- sharing amount paid. The MCO may submit an invoice and a data certification to the STATE for all cost-sharing the MCO has reimbursed to its Providers in the previous quarter, no more often than quarterly. The STATE shall verify the Medical Assistance Enrollee’s living arrangement, and date of service on the encounter claim, prior to payment to the MCO for the amounts the MCO claims to have reimbursed to its Providers.

Cost-Sharing and Residents of Nursing Facility. For MSC+ Enrollees, upon Upon notification to the MCO that a Medical Assistance Enrollee has been a resident of a Nursing Facility or ICF/DD for thirty (30) days or more, the MCO shall ensure that its Providers do not require the Enrollee to pay any cost-sharing, and shall reimburse its Providers any cost-sharing amount paid. The MCO may submit an invoice in a format approved by the STATE, and a data certification to the STATE for all cost-sharing the MCO has reimbursed to its Providers in the previous quarter, quarter no more often than quarterly. The STATE shall verify the Medical Assistance Enrollee’s living arrangement, and date of service on the encounter claim, prior to payment to the MCO for the amounts the MCO claims to have reimbursed to its Providers.

Cost-Sharing and Residents of Nursing Facility. For MSC+ Enrollees, upon ‌ Upon notification to the MCO that a Medical Assistance Enrollee has been a resident of a Nursing Facility or ICF/DD for thirty (30) days or more, the MCO shall ensure that its Providers do not require the Enrollee to pay any cost-sharing, and shall reimburse its Providers any cost-sharing amount paid. The MCO may submit an invoice in a format approved by the STATE, and a data certification to the STATE for all cost-sharing the MCO has reimbursed to its Providers in the previous quarter, quarter no more often than quarterly. The STATE shall verify the Medical Assistance Enrollee’s living arrangement, and date of service on the encounter claim, prior to payment to the MCO for the amounts the MCO claims to have reimbursed to its Providers.

Cost-Sharing and Residents of Nursing Facility. For MSC+ Enrollees, upon notification to the MCO that a Medical Assistance Enrollee has been a resident of a Nursing Facility for thirty (30) days or more, the MCO shall ensure that its Providers do not require the Enrollee to pay any cost-sharing, and shall reimburse its Providers any cost-sharing amount paid. The MCO may submit an invoice and a data certification to the STATE for all cost-sharing the MCO has reimbursed to its Providers in the previous quarter, no more often than quarterly. The STATE shall verify the Medical Assistance Enrollee’s living arrangement, and date of service on the encounter claim, prior to payment to the MCO for the amounts the MCO claims to have reimbursed to its Providers.Providers.‌

Cost-Sharing and Residents of Nursing Facility. For MSC+ Enrollees, upon ‌‌‌ Upon notification to the MCO that a Medical Assistance Enrollee has been a resident of a Nursing Facility or ICF/DD for thirty (30) days or more, the MCO shall ensure that its Providers do not require the Enrollee to pay any cost-sharing, and shall reimburse its Providers any cost-sharing amount paid. The MCO may submit an invoice in a format approved by the STATE, and a data certification to the STATE for all cost-sharing the MCO has reimbursed to its Providers in the previous quarter, quarter no more often than quarterly. The STATE shall verify the Medical Assistance Enrollee’s living arrangement, and date of service on the encounter claim, prior to payment to the MCO for the amounts the MCO claims to have reimbursed to its Providers.

Cost-Sharing and Residents of Nursing Facility. For MSC+ Enrollees, upon ‌ Upon notification to the MCO that a Medical Assistance Enrollee has been a resident of a Nursing Facility or ICF/DD for thirty (30) days or more, the MCO shall ensure that its Providers do not require the Enrollee to pay any cost-sharing, and shall reimburse its Providers any cost-sharing amount paid. The MCO may submit an invoice in a format approved by the STATE, and a data certification to the STATE for all cost-sharing the MCO has reimbursed to its Providers in the previous quarter, quarter no more often than quarterly. The STATE shall verify the Medical Assistance Enrollee’s living arrangement, and date of service on the encounter claim, prior to payment to the MCO for the amounts the MCO claims to have reimbursed to its Providers.Providers.‌‌‌

Cost-Sharing and Residents of Nursing Facility. For MSC+ Enrollees, upon Upon notification to the MCO that a Medical Assistance Enrollee has been a resident of a Nursing Facility or ICF/DD for thirty thirty‌ (30) days or more, the MCO shall ensure that its Providers do not require the Enrollee to pay any cost-sharing, and shall reimburse its Providers any cost-sharing amount paid. The MCO may submit an invoice in a format approved by the STATE, and a data certification to the STATE for all cost-sharing the MCO has reimbursed to its Providers in the previous quarter, quarter no more often than quarterly. The STATE shall verify the Medical Assistance Enrollee’s living arrangement, and date of service on the encounter claim, prior to payment to the MCO for the amounts the MCO claims to have reimbursed to its Providers.