Dual Eligible Members Sample Clauses

Dual Eligible Members. Participant agrees that in no event, including but not limited to, non- payment by a state Medicaid agency or other applicable regulatory authority, other state source, or breach by Amplifon of the Agreement, shall Participant xxxx, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against any Dual Eligible Member, person acting on behalf of the Dual Eligible Member, or MA Organization (unless notified otherwise) for Medicare Part A and B Cost Sharing. Instead, Participant will either: (a) accept payment made by or on behalf of MA Organization as payment in full; or (b) xxxx the appropriate state source for such Cost Sharing amount. If Participant imposes an excess charge on a Dual Eligible Member, Participant is subject to any lawful sanction that may be imposed under Medicare or Medicaid. This provision does not prohibit Participant and a Dual Eligible Member from agreeing to the provision of services solely at the expense of the Dual Eligible Member, as long as Participant has clearly informed the Dual Eligible Member, in accordance with applicable law, that the Dual Eligible Member’s Benefit Plan may not cover or continue to cover a specific service or services.

Dual Eligible Members. Members covered by Medicare have the right to select the HMO to whom they will be assigned. Failure to select an HMO will result in the clients be defaulted to an HMO. Because the STAR+PLUS HMO is not responsible for primary and acute care services for dual eligible members, requirements related to PCP and OB/GYN selection and default are not applicable.

Dual Eligible Members. Facility acknowledges and agrees that Members who are also enrolled in a State Medicaid plan (“Dual Eligible Members”) are not responsible for paying to Facility any Copayments, Coinsurance or Deductibles for Medicare Part A and Part B services (“Cost Sharing Amounts”) when the State Medicaid plan is responsible for paying such Cost Sharing Amounts. Facility further agrees that they will not collect Cost Sharing Amounts from Dual Eligible Members when the State is responsible for paying such Cost Sharing Amounts, and will, instead, either accept the Company’s payment for Covered Services as payment in full for Covered Services and applicable Cost Sharing Amounts, or, xxxx the applicable State source for the appropriate Cost Sharing Amounts owed by the State Medicaid plan. Dual Eligible Members in Capitated Financial Alignment Demonstration Plans are not responsible for Cost Sharing Amounts for Medicare Parts A and B services. To protect Members, Facility agrees not to seek or accept or rely upon waivers of the Member protections provided by this Section 4.3.

Dual Eligible Members. For all MA Members eligible for both Medicare and Medicaid, MA Members will not be held liable for Medicare Part A and B cost sharing when the State is responsible for paying such amounts. Provider will be informed of Medicare and Medicaid benefits and rules for MA Members eligible for Medicare and Medicaid. Provider may not impose cost-sharing that exceeds the amount of cost-sharing that would be permitted with respect to the individual under title XIX if the individual were not enrolled in such a plan. Provider will (a) accept the Plan payment as payment in full, or (2) bill the appropriate state source. [42 CFR 422.504(i)(3)(i) and 422.504(g)(1)(i)]