Common use of Enrollee Liability for Payment Clause in Contracts

Enrollee Liability for Payment. (a) The MA Health Plan and its contracted providers are prohibited from imposing cost- sharing requirements on Dual Eligible Members that would exceed the amounts permitted under the Rhode Island State Plan for Medical Assistance, per section 1852(a)(7) of the Act and 42 CFR§422.504(g)(1)(iii). (b) Section 1902(n)(3)(B) of the Social Security Act prohibits a Medicare provider from billing a Dual Eligible Member with QMB benefits for Medicare cost sharing amounts, including deductibles, coinsurance, and copayments. A Dual Eligible Member with QMB benefits has no legal obligation to make further payment to a provider or to the MA Health Plan for Medicare Part A or Part B cost sharing amounts. The MA Health Plan’s provider agreements shall specify that a contracted Medicare provider agrees to accept the MA Health Plan’s Medicare reimbursement as payments in full for services rendered to Dual Eligible Members, or to bill EOHHS as applicable for any additional Medicare payments that may be reimbursed by Medicaid. Dual Eligible Members shall be responsible for any applicable Medicaid copayments.

Enrollee Liability for Payment. (a) The MA Health Plan and its contracted providers are prohibited from imposing cost- sharing requirements on Dual Eligible Members members that would exceed the amounts permitted under the Rhode Island State Plan for Medical Assistance, per section 1852(a)(7) of the Act and 42 CFR§422.504(g)(1)(iiiCFR §422.504(g)(1)(iii). (b) Section 1902(n)(3)(B) of the Social Security Act prohibits a Medicare provider from billing a Dual Eligible Member member with QMB benefits for Medicare cost sharing amounts, including deductibles, coinsurance, and copayments. A Dual Eligible Member member with QMB benefits has no legal obligation to make further payment to a provider or to the MA Health Plan for Medicare Part A or Part B cost sharing amounts. The MA Health Plan’s provider agreements shall specify that a contracted Medicare provider Medicareprovider agrees to accept the MA Health Plan’s Medicare reimbursement as payments in full for services rendered to Dual Eligible Members, or to bill xxxx EOHHS as applicable for any additional Medicare payments that may be reimbursed by Medicaid. Dual Eligible Members members shall be responsible for any applicable Medicaid copayments.

Enrollee Liability for Payment. (a) The MA Health Plan and its contracted providers are prohibited from imposing cost- sharing requirements on Dual Eligible Members that would exceed the amounts permitted under the Rhode Island State Plan for Medical Assistance, per section 1852(a)(7) of the Act and 42 CFR§422.504(g)(1)(iiiCFR §422.504(g)(1)(iii). (b) Section 1902(n)(3)(B) of the Social Security Act prohibits a Medicare provider from billing a Dual Eligible Member with QMB benefits for Medicare cost sharing amounts, including deductibles, coinsurance, and copayments. A Dual Eligible Member with QMB benefits has no legal obligation to make further payment to a provider or to the MA Health Plan for Medicare Part A or Part B cost sharing amounts. The MA Health Plan’s provider agreements shall specify that a contracted Medicare provider agrees to accept the MA Health Plan’s Medicare reimbursement as payments in full for services rendered to Dual Eligible Members, or to bill xxxx EOHHS as applicable for any additional Medicare payments that may be reimbursed by Medicaid. Dual Eligible Members shall be responsible for any applicable Medicaid copayments.

Enrollee Liability for Payment. (a) The MA Health Plan and its contracted providers are prohibited from imposing cost- cost-sharing requirements on Dual Eligible Members that would exceed the amounts permitted under the Rhode Island State Plan for Medical Assistance, per section 1852(a)(7) of the Act and 42 CFR§422.504(g)(1)(iiiCFR §422.504(g)(1)(iii). (b) Section 1902(n)(3)(B) of the Social Security Act prohibits a Medicare provider from billing a Dual Eligible Member with QMB benefits for Medicare cost sharing amounts, including deductibles, coinsurance, and copayments. A Dual Eligible Member with QMB benefits has no legal obligation to make further payment to a provider or to the MA Health Plan for Medicare Part A or Part B cost sharing amounts. The MA Health Plan’s provider agreements shall specify that a contracted Medicare provider agrees to accept the MA Health Plan’s Medicare reimbursement as payments in full for services rendered to Dual Eligible Members, or to bill EOHHS as applicable for any additional Medicare payments that may be reimbursed by Medicaid. Dual Eligible Members shall be responsible for any applicable Medicaid copayments.

Enrollee Liability for Payment. (a) The MA Health Plan and its contracted providers are prohibited from imposing cost- sharing requirements on Dual Eligible Members members that would exceed the amounts permitted under the Rhode Island State Plan for Medical Assistance, per section 1852(a)(7) of the Act and 42 CFR§422.504(g)(1)(iii). (b) Section 1902(n)(3)(B) of the Social Security Act prohibits a Medicare provider from billing a Dual Eligible Member member with QMB benefits for Medicare cost sharing amounts, including deductibles, coinsurance, and copayments. A Dual Eligible Member member with QMB benefits has no legal obligation to make further payment to a provider or to the MA Health Plan for Medicare Part A or Part B cost sharing amounts. The MA Health Plan’s provider agreements shall specify that a contracted Medicare provider agrees to accept the MA Health Plan’s Medicare reimbursement as payments in full for services rendered to Dual Eligible Members, or to bill EOHHS as applicable for any additional Medicare payments that may be reimbursed by Medicaid. Dual Eligible Members members shall be responsible for any applicable Medicaid copayments.

Enrollee Liability for Payment. (a) The MA Health Plan and its contracted providers are prohibited from imposing cost- sharing requirements on Dual Eligible Members that would exceed the amounts permitted under the Rhode Island State Plan for Medical Assistance, per section 1852(a)(7) of the Act and 42 CFR§422.504(g)(1)(iiiCFR §422.504(g)(1)(iii). (b) Section 1902(n)(3)(B) of the Social Security Act prohibits a Medicare provider from billing a Dual Eligible Member with QMB benefits for Medicare cost sharing amounts, including deductibles, coinsurance, and copayments. A Dual Eligible Member with QMB benefits has no legal obligation to make further payment to a provider or to the MA Health Plan for Medicare Part A or Part B cost sharing amounts. The MA Health Plan’s provider agreements shall specify that a contracted Medicare provider agrees to accept the MA Health Plan’s Medicare reimbursement as payments in full for services rendered to Dual Eligible Members, or to bill EOHHS as applicable for any additional Medicare payments that may be reimbursed by Medicaid. Dual Eligible Members shall be responsible for any applicable Medicaid copayments.

Enrollee Liability for Payment. (a) The MA Health Plan and its contracted providers are prohibited from imposing cost- sharing requirements on Dual Eligible Members members that would exceed the amounts permitted under the Rhode Island State Plan for Medical Assistance, per section 1852(a)(7) of the Act and 42 CFR§422.504(g)(1)(iiiCFR §422.504(g)(1)(iii). (b) Section 1902(n)(3)(B) of the Social Security Act prohibits a Medicare provider from billing a Dual Eligible Member member with QMB benefits for Medicare cost sharing amounts, including deductibles, coinsurance, and copayments. A Dual Eligible Member member with QMB benefits has no legal obligation to make further payment to a provider or to the MA Health Plan for Medicare Part A or Part B cost sharing amounts. The MA Health Plan’s provider agreements shall specify that a contracted Medicare provider Medicareprovider agrees to accept the MA Health Plan’s Medicare reimbursement as payments in full for services rendered to Dual Eligible Members, or to bill EOHHS as applicable for any additional Medicare payments that may be reimbursed by Medicaid. Dual Eligible Members members shall be responsible for any applicable Medicaid copayments.