Common use of Cost Sharing Protections for Dual Eligible Members Clause in Contracts

Cost Sharing Protections for Dual Eligible Members. (a) The MA Dual SNP must notify its Network Providers (via a provider manual, provider bulletin, or other contractual document) that Network Providers: (1) must not hold a Dual Eligible Member liable for the Cost Sharing Obligations; and (2) must accept as payment in full the MA Dual SNP’s payment of the Cost Sharing Obligations and must not seek additional payment from HHSC or a Dual Eligible Member for healthcare services covered under the MA Product offered by the MA Dual SNP and provided to the Dual Eligible Member. The MA Dual SNP must provide the HHSC point-of-contact identified in Section 9.06 with a copy of such written notice. (b) The MA Dual SNP and its Network Providers must not impose cost-sharing requirements on a Dual Eligible Member that would exceed the amount permitted under the Texas State Plan for Medical Assistance, per section 1852(a)(7) of the Act and 42 C.F.R. §422.504(g)(1)(iii).