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.
Sample 1Sample 2Sample 3See All (9)
AutoNDA by SimpleDocs
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. Room and Board Members shall use their own income to pay for the cost of room and board. Any MCO supplementation of member payment of room and board 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 VIII.A.16, the MCO is responsible for all of the following tasks: Determining Cost The MCO determines the cost of room and board 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)
Sample 1Sample 2See All (6)
Monitoring Cost Share or Patient Liability a. When DHS grants a cost share reduction due to financial hardship, DHS 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 IDT 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 IDT must notify the PO’s Room and Board‌ enrollment/eligibility staff. 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: Determining the Member’s Room and Board Obligation 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...
Sample 1See All (4)
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.
Sample 1Sample 2
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:
Sample 1
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.
Sample 1
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.
Sample 1
AutoNDA by SimpleDocs

Related to Monitoring Cost Share or Patient Liability

  • Treatment of Unallowable Costs Previously Submitted for Payment Arthrex further agrees that within 90 days of the Effective Date of this Agreement it shall identify to applicable Medicare and TRICARE fiscal intermediaries, carriers, and/or contractors, and Medicaid and FEHBP fiscal agents, any Unallowable Costs (as defined in this paragraph) included in payments previously sought from the United States, or any State Medicaid program, including, but not limited to, payments sought in any cost reports, cost statements, information reports, or payment requests already submitted by Arthrex or any of its subsidiaries or affiliates, and shall request, and agree, that such cost reports, cost statements, information reports, or payment requests, even if already settled, be adjusted to account for the effect of the inclusion of the Unallowable Costs. Arthrex agrees that the United States, at a minimum, shall be entitled to recoup from Arthrex any overpayment plus applicable interest and penalties as a result of the inclusion of such Unallowable Costs on previously-submitted cost reports, information reports, cost statements, or requests for payment. Any payments due after the adjustments have been made shall be paid to the United States pursuant to the direction of the Department of Justice and/or the affected agencies. The United States reserves its rights to disagree with any calculations submitted by Arthrex or any of its subsidiaries or affiliates on the effect of inclusion of Unallowable Costs (as defined in this paragraph) on Arthrex or any of its subsidiaries or affiliates’ cost reports, cost statements, or information reports.

  • Future Treatment of Unallowable Costs Unallowable Costs shall be separately determined and accounted for in nonreimbursable cost centers 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.

  • Indemnity Limitation for TIPS Sales Texas and other jurisdictions restrict the ability of governmental entities to indemnify others. Vendor agrees that if any "Indemnity" provision which requires the TIPS Member to indemnify Vendor is included in any TIPS sales agreement/contract between Vendor and a TIPS Member, that clause must either be stricken or qualified by including that such indemnity is only permitted, "to the extent permitted by the laws and constitution of [TIPS Member's State]” unless the TIPS Member expressly agrees otherwise. Any TIPS Sale Supplemental Agreement containing an "Indemnity" clause that conflicts with these terms is rendered void and unenforceable.

  • Medical Expenses 1. Employees exposed to hazardous physical, biological, or chemical agents shall be provided, at no cost to the employee, with medical examinations or evaluations required by VOSHA regulations. If there are no specific VOSHA regulations or standards for the agent in question, recommendations of the National Institute of Occupational Safety and Health or other generally recognized expert organization shall be used, as determined by the Commissioner of Health.

Time is Money Join Law Insider Premium to draft better contracts faster.