Common use of Specific to Medicare Clause in Contracts

Specific to Medicare. The CHC-MCO must operate a CMS-approved D-SNP as provided in this Agreement in each zone. The D-SNP must enter into a MIPPA Agreement with the Department. The MIPPA Agreement will address the eight (8) required elements set forth in CMS Medicare Managed Care Manual, Chapter 16b, § 40.5.1 (Rev. Nov. 28, 1014), Available at: xxxxx://xxx.xxx.xxx/Regulations-and- Guidance/Guidance/Manuals/Downloads/mc86c16b.pdf, and will include additional requirements to ensure the greatest possible coordination between the CHC-MCO and the D-SNP, including but not limited to the following: 1. The goal of the CHC-MCO and its companion D-SNP is to provide a coordinated experience from the perspective of Dual Eligible Participants who enroll in both. This includes but is not limited to an integrated assessment and care coordination process that spans all MA and Medicare services, including behavioral health services. 2. Administrative integration is expected to evolve over the life of CHC. The CHC-MCO will cooperate fully with the Department and CMS in their ongoing efforts to streamline administration of the two programs, which may include, but is not limited to, coordinated readiness reviews, monitoring, enrollment, Participant materials and appeals processes.

Specific to Medicare. ‌ The CHC-MCO must operate a CMS-approved D-SNP as provided in this Agreement in each zone. For the SW Zone, the D-SNP must be in process in July 2017 to have a D-SNP operating and must have a CMS-approved D-SNP operating by January 1, 2018. For other zones, the CHC-MCO must have a D- SNP operating at the time of implementation for the zone. The D-SNP must enter into a MIPPA Agreement with the Department. The MIPPA Agreement will address the eight (8) required elements set forth in CMS Medicare Managed Care Manual, Chapter 16b, § 40.5.1 (Rev. Nov. 28, 1014), Available at: xxxxx://xxx.xxx.xxx/Regulations-and- xxxx://xxx.xxx.xxx/Regulations-and- Guidance/Guidance/Manuals/Downloads/Downloads/ mc86c16b.pdf, and will include additional requirements to ensure the greatest possible coordination between the CHC-MCO and the D-SNP, including but not limited to the following: 1. The goal of the CHC-MCO and its companion D-SNP is to provide a coordinated experience from the perspective of Dual Eligible Participants who enroll in both. This includes but is not limited to an integrated assessment and care coordination process that spans all MA and Medicare services, including behavioral health services. 2. Administrative integration is expected to evolve over the life of CHC. The CHC-MCO will cooperate fully with the Department and CMS in their ongoing efforts to streamline administration of the two programs, which may include, but is not limited to, coordinated readiness reviews, monitoring, enrollment, Participant materials and appeals processes.

Specific to Medicare. The CHC-MCO must operate a CMS-approved D-SNP as provided in this Agreement in each zone. For the SW Zone, the D-SNP must be in process in July 2017 to have a D-SNP operating and must have a CMS-approved D-SNP operating by January 1, 2018. For other zones, the CHC-MCO must have a D- SNP operating at the time of implementation for the zone. The D-SNP must enter into a MIPPA Agreement with the Department. The MIPPA Agreement will address the eight (8) required elements set forth in CMS Medicare Managed Care Manual, Chapter 16b, § 40.5.1 (Rev. Nov. 28, 1014), Available at: xxxxx://xxx.xxx.xxx/Regulations-and- xxxx://xxx.xxx.xxx/Regulations-and- Guidance/Guidance/Manuals/Downloads/Downloads/ mc86c16b.pdf, and will include additional requirements to ensure the greatest possible coordination between the CHC-MCO and the D-SNP, including but not limited to the following: 1. The goal of the CHC-MCO and its companion D-SNP is to provide a coordinated experience from the perspective of Dual Eligible Participants who enroll in both. This includes but is not limited to an integrated assessment and care coordination process that spans all MA and Medicare services, including behavioral health services. 2. Administrative integration is expected to evolve over the life of CHC. The CHC-MCO will cooperate fully with the Department and CMS in their ongoing efforts to streamline administration of the two programs, which may include, but is not limited to, coordinated readiness reviews, monitoring, enrollment, Participant materials and appeals processes.