Dual Eligible Special Needs Plans Sample Clauses

Dual Eligible Special Needs Plans. (D-SNPs) Requirements The Contractor shall have Centers for Medicare & Medicaid Services (CMS) approval to operate a statewide Dual Eligible Special Needs Plan (D-SNP) by April 1, 2022. The Contractor seeking D-SNP status for the first time shall be aware of the following general timeline as it intersects with the Hoosier Care Connect program. CMS continues to develop this timeline therefore it is subject to change without notice to the State. CMS will provide more specific due dates as it gets closer to the time period in the general timeline described below. The Contractor is responsible for monitoring CMS information regarding dates of submission for D-SNP related documentation. The Remainder Of This Page Has Deliberately Been Left Blank
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Dual Eligible Special Needs Plans. (D-SNPs) Requirements The Contractor shall have Centers for Medicare & Medicaid Services (CMS) approval to operate a statewide Dual Eligible Special Needs Plan (D-SNP) by April 1, 2022. The Contractor seeking D-SNP status for the first time shall be aware of the following general timeline as it intersects with the Hoosier Care Connect program. CMS continues to develop this timeline therefore it is subject to change without notice to the State. CMS will provide more specific due dates as it gets closer to the time period in the general timeline described below. The Contractor is responsible for monitoring CMS information regarding dates of submission for D-SNP related documentation. THE REMAINDER OF THIS PAGE HAS DELIBERATELY BEEN LEFT BLANK EXHIBIT 1 SCOPE OF WORK 2020, Nov Contractor submits Notice of Intent to Apply (NOIA) to CMS for CY 2022 2021, Jan-Feb Contractor submits the following to CMS:  MA and Part D application  Initial SNP application  Model of Care 2021, Apr 1 Hoosier Care Connect contracts implemented 2021, May CMS/NCQA issues MOC renewal terms of one, two, or three years 2021, Jun Contractor submits the following to CMS for 2022:  Plan Benefit Package (PBP)  Completed Bid Pricing Tool (PBT) to CMS for the upcoming year Both should be consistent with State requirements 2021, July Contractor submits its State Medicaid Agency Contract (SMAC) to CMS for CY 2022. Contract must include the following. New Provisions (due to be implemented CY 2021): • Provision of Medicaid LTSS and/or Medicaid behavioral health benefits either directly with the legal entity providing the D-SNP, with the parent organization of the D-SNP, or with a subsidiary owned and controlled by the parent organization of the D-SNP; OR  Process to share information with the State or the State’s designee (such as a Medicaid managed care organization or Medicaid care manager), on hospital and SNF admissions of high-risk individuals who are enrolled in the D-SNP. In addition to the minimum requirements per 42 CFR 422.107:  The D-SNP’s responsibility, including financial obligations, to provide or arrange for Medicaid benefits.  The categories of dually eligible beneficiaries eligible to be enrolled under the SNP (e.g., full benefit, Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB), etc.).  The Medicaid benefits covered under the SNP.  The cost sharing protections covered under the SNP.  The requirements to identify and share info...
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Dual Eligible Special Needs Plans. (D-SNPs) Requirements The Contractor—if currently operating a statewide Dual Eligible Special Needs Plan (D- SNP)—shall cease operating a D-SNP within the State beginning 1/1/2025 unless the Contractor’s parent company will also operate a managed Long-term Services and Supports Plan (MLTSS) in the State. If the Contractor will not operate a MLTSS plan in the State, the Contractor, at their option, can operate their current statewide D-SNP for the duration of CY2024 at a capped enrollment not to exceed the members who were enrolled in that D-SNP for CY2023. This capped enrollment shall not include any members enrolled for CY2024 open enrollment.
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Related to Dual Eligible Special Needs Plans

  • Special Eligibility The following employees also receive an Employer Contribution:

  • Medical Flexible Spending Arrangement A. During January 2020 and again in January 2021, the Employer will make available two hundred fifty dollars ($250) in a medical flexible spending arrangement (FSA) account for each bargaining unit member represented by a Union in the Coalition described in RCW 41.80.020(3), who meets the criteria in Subsection 28.7(B) below.

  • Flexible Spending Accounts Employees in the unit shall have access to the County’s flexible spending account program, which provides employees with the options of dependent care assistance benefits with a calendar year maximum of $5,000, and medical expense reimbursement benefits with a calendar year maximum of $2,400. The County shall maintain this plan in compliance with IRC §125. Employee premiums for flexible spending account benefits shall be deducted on a pre-tax basis from employee pay.

  • Service Eligibility A bonus authorized by subsection (a) may be paid to a person or offi- cer only if the person or officer agrees under subsection (d)—

  • Innovative/Flexible Scheduling Where the Hospital and the Union agree, arrangements regarding Innovative Scheduling/Flexible Scheduling may be entered into between the parties on a local level. The model agreement with respect to such scheduling arrangements is set out below: MODEL AGREEMENT WITH RESPECT TO INNOVATIVE SCHEDULING/FLEXIBLE SCHEDULING MEMORANDUM OF AGREEMENT Between: The Hospital - And: The Ontario Public Service Employees Union (and its Local ) This Model Agreement shall be part of the Collective Agreement between the parties herein, and shall apply to the employees described in Article 1 of the Model Agreement.

  • Special Needs Any Passenger with mobility, communication or other impairments, or other special or medical needs that may require medical care or special accommodations during the cruise or CruiseTour, including but not limited to the use of any service animal, must notify the Carrier of any such condition at the time of booking. Xxxxxxxxx agrees to accept responsibility and reimburse Carrier for any loss, damage or expense whatsoever related to the presence of any service animal brought on board the Vessel or Transport. Passengers acknowledge and understand that certain international safety requirements, shipbuilding standards, and/or applicable regulations involving design, construction or operation of the Vessel may restrict access to facilities or activities for persons with mobility, communication or other impairments or special needs. Passengers requiring the use of a wheelchair must provide their own wheelchair (that must be of a size and type that can be accommodated on the Vessel) as wheelchairs carried on board are for emergency use only.

  • Flexible Spending Account The parties agree that the State shall have the right to use State Employee Health Plan funds to cover the administrative costs of operating the medical and dependent care flexible spending account programs.

  • Spousal Eligibility a. For employees hired on or after August 1, 2003: If the spouse of an employee is covered by any PEBTF health care plan, and he/she is eligible for coverage under another employer’s plan(s), the spouse shall be required to enroll in each such plan, which shall be the spouse’s primary coverage, as a condition of the spouse’s eligibility for coverage by the PEBTF plan(s), without regard to whether the spouse’s plan requires cost sharing or to whether the spouse’s employer offers an incentive to the spouse not to enroll.

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