Monitoring Cost Share or Patient Liability Sample Clauses

Monitoring Cost Share or Patient Liability. The MCO is responsible for the ongoing monitoring of the cost share or patient liability amounts of its members. The MCO is also responsible for knowing what the member’s ongoing medical/remedial expenses are and reporting changes in those amounts to the income maintenance agency. The MCO is also responsible to report changes in other circumstances of members that may affect the amount of cost share or patient liability to the income maintenance agency within ten (10) calendar days of the MCO becoming aware of the change.
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Monitoring Cost Share or Patient Liability. When the Department grants a cost share reduction due to financial hardship, the Department will provide the MCO with a copy of the member’s cost share reduction award letter. Annually thereafter, if the reduction is still in effect, the MCO shall verify whether the member continues to experience a financial hardship. The MCO shall conduct this verification during the member’s annual reassessment. If the member indicates that they continue to experience a financial hardship and therefore need a cost share reduction, the MCO’s enrollment/eligibility staff shall verify whether the member’s income and monthly necessary living expenses necessitate the continuation of their cost share reduction. MCO staff may request any documentation needed to verify whether an ongoing hardship exists. If the member indicates that they no longer need a cost share reduction or the MCO is unable to verify that an ongoing financial hardship exists, the MCO must ensure that this change is reported to the local IM agency. The MCO is responsible for the ongoing monitoring of the cost share or patient liability amounts of its members. The MCO is also responsible for knowing what the member’s ongoing medical/remedial expenses are and reporting changes in those amounts to the income maintenance agency. The MCO is also responsible to report changes in other circumstances of members that may affect the amount of cost share or patient liability to the income maintenance agency within ten (10) calendar days of the MCO becoming aware of the change. Room and Board‌ Members shall use their own income to pay for the cost of room and board. Any MCO contribution to member room and board obligation from capitation revenue shall not be considered a countable expense in developing MCO capitation rates. For each member who resides in community-based residential care as defined in Addendum VI.A.15, the MCO is responsible for all of the following tasks: The MCO determines the member's room and board obligation in the facility in which the member resides, excluding members who reside in subsidized housing. MCOs must update member room and board obligations annually on February 1st or upon member request. The member's room and board obligation is the lesser of: • The prior calendar year's HUD FMR rental amounts, based on residential type by county, plus the prior calendar year's maximum Supplemental Nutrition Assistance Allocation for one person; o HUD FMR amounts: HUD FMR rents are set at the 40% perce...
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Monitoring Cost Share or Patient Liability. The MCO is responsible for the ongoing monitoring of the cost share or patient liability amounts of its members. The MCO is also responsible for knowing what the member’s ongoing medical/remedial expenses are and reporting changes in those amounts to the income maintenance agency. The MCO is also responsible to report changes in other circumstances of members that may affect the amount of cost share or patient liability to the income maintenance agency within ten (10) calendar days of the MCO becoming aware of the change. Members shall use their own income to pay for the cost of room and board. Any MCO contribution to member room and board obligation from capitation revenue shall not be considered a countable expense in developing MCO capitation rates. For each member who resides in community-based residential care as defined in Addendum VII.A.17, the MCO is responsible for all of the following tasks: The MCO determines the member’s room and board obligation in the facility in which the member resides. The MCO shall use one method for all its members. It shall select one of the three following methods: Actual Cost Methodology This method requires calculation of actual room and board costs for each community residential facility with which the MCO contracts. Facility- specific costs are split between care and supervision on the one hand and room and board on the other. Total costs attributable to room and board are divided by the number of residents licensed or certified for the living arrangement to get a room and board rate. Costs attributable to Room and Board: Rent, mortgage payments, title insurance, mortgage insurance Property and casualty insurance Building and grounds maintenance costs Residents’ food Household supplies and equipment necessary for the room and board of the individual Furnishings used by the individual (does not include office furnishings)
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Monitoring Cost Share or Patient Liability. When the Department grants a cost share reduction due to financial hardship, the Department will provide the MCO with a copy of the member’s cost share reduction award letter.
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Monitoring Cost Share or Patient Liability. The PO is responsible for the ongoing monitoring of the cost share or patient liability amounts of its members.
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Monitoring Cost Share or Patient Liability. When the Department grants a cost share reduction due to financial hardship, the Department will provide the PO with a copy of the member’s cost share reduction award letter. Annually thereafter, if the reduction is still in effect, the PO shall verify whether the member continues to experience a financial hardship. The PO shall conduct this verification during the member’s annual reassessment. If the member indicates that they continue to experience a financial hardship and therefore need a cost share reduction, the PO’s enrollment/eligibility staff shall verify whether the member’s income and monthly necessary living expenses necessitate the continuation of their cost share reduction. PO staff may request any documentation needed to verify whether an ongoing hardship exists. If the member indicates that they no longer need a cost share reduction or the PO is unable to verify that an ongoing financial hardship exists, the PO must ensure that this change is reported to the local IM agency. The PO is responsible for the ongoing monitoring of the cost share or patient liability amounts of its members. The PO is also responsible for knowing what the member’s ongoing medical/remedial expenses are and reporting changes in those amounts to the income maintenance agency. The PO is also responsible to report changes in other circumstances of members that may affect the amount of cost share or patient liability to the income maintenance agency within ten (10) calendar days of the PO becoming aware of the change. Members shall use their own income to pay for the cost of room and board. Any PO contribution to member room and board obligation from capitation revenue shall not be considered a countable expense in developing capitation rates. For each member who resides in community-based residential care as defined in Addendum VIII.A.16, the PO is responsible for all of the following tasks: The PO determines the member’s room and board obligation in the facility in which the member resides, excluding members who reside in subsidized housing. POs must update member room and board obligations annually on February 1st or upon member request. The member’s room and board obligation is the lesser of: • The prior calendar year’s HUD FMR rental amounts, based on residential type by county, plus the prior calendar year’s maximum Supplemental Nutrition Assistance Allocation for one person; ▪ HUD FMR amounts - HUD FMR rents are set at the 40% percentile of surveyed rental costs r...
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Monitoring Cost Share or Patient Liability. The MCO is responsible for the ongoing monitoring of the cost share or patient liability amounts. The IHCP is responsible for reporting medical remedial expenses (MRE) information to the MCO. The MCO is responsible for knowing what the member’s ongoing medical/remedial expenses are and reporting changes in those amounts to the income maintenance agency. The Indian Health Care Provider (IHCP) is responsible to report changes in other circumstances of members that may affect the amount of cost share or patient liability to the MCO within three (3) calendar days of the Indian Health Care Provider (IHCP) becoming aware of the change.
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Monitoring Cost Share or Patient Liability a. When the Department grants a cost share reduction due to financial hardship, the Department will provide the PO with a copy of the member’s cost share reduction award letter. Annually thereafter, if the reduction is still in effect, the PO shall verify whether the member continues to experience a financial hardship. The PO shall conduct this verification during the member’s annual reassessment. If the member indicates that they continue to experience a financial hardship and therefore need a cost share reduction, the PO’s enrollment/eligibility staff shall verify whether the member’s income and monthly necessary living expenses necessitate the continuation of their cost share reduction. PO staff may request any documentation needed to verify whether an ongoing hardship exists. If the member indicates that they no longer need a cost share reduction or the PO is unable to verify that an ongoing financial hardship exists, the PO must ensure that this change is reported to the local IM agency. The PO is responsible for the ongoing monitoring of the cost share or patient liability amounts of its members. The PO is also responsible for knowing what the member’s ongoing medical/remedial expenses are and reporting changes in those amounts to the income maintenance agency. The PO is also responsible to report changes in other circumstances of members that may affect the amount of cost share or patient liability to the income maintenance agency within ten (10) calendar days of the PO becoming aware of the change. Amend Article III. E. to read:
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Related to Monitoring Cost Share or Patient Liability

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  • Future Treatment of Unallowable Costs Unallowable Costs shall be separately determined and accounted for by Defendants, and Defendants shall not charge such Unallowable Costs directly or indirectly to any contracts with the United States or any State Medicaid program, or seek payment for such Unallowable Costs through any cost report, cost statement, information statement, or payment request submitted by Defendants or any of their subsidiaries or affiliates to the Medicare, Medicaid, TRICARE, or FEHBP Programs.

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