Cost Sharing Obligations definition

Cost Sharing Obligations found in Article II, Definitions, is hereby amended and restated in its entirety to read as follows: premiums that HHSC is required to pay under the Texas State Plan on behalf of Dual Eligible Members or other Dual SNP Members; (2) Deductibles, Coinsurance, and Co-payments for the Medicare Part A and Part B programs with respect to Other Dual SNP Members; (3) wrap-around services that are covered by Medicaid, and (4) Coinsurance for Part A-like services provided during a Dual Eligible Member's Medicare-covered stay in a skilled nursing facility when the member is also enrolled in STAR+PLUS for their Medicaid services. Payment of coinsurance to the skilled nursing facility for a Part A skilled stay is covered by the STAR+PLUS MCO.

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Cost Sharing Obligations mean those financial payment obligations to be paid by SDOH in satisfaction of Deductibles, Coinsurance, and Co-payments for Medicare Part A and Medicare Part B services with respect to certain Dual Eligible Beneficiaries and as defined for certain Dual Eligible Beneficiaries with full Medicaid benefits, as defined in New York’s Medicaid Plan. Such financial payment obligations shall not include premiums or Cost-Sharing relating to Medicare Part D benefits.

Cost Sharing Obligations means the sum of the HIPP member’s in-network costs for deductible(s), co-payment(s), and co-insurance for medical care billed by other health coverage to the policyholder.

Examples of Cost Sharing Obligations in a sentence

Cost Sharing Obligations mean those financial payment obligations incurred by HHSC in satisfaction of the Deductibles, Coinsurance, and Co-payments for the Medicare Part A and Part B programs with respect to Dual Eligible Members.
Neither the MA Dual SNP nor its Network Providers will seek additional payment from HHSC, Dual Eligible Members, or healthcare providers for such Cost Sharing Obligations.
If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNP: (1) will lose the opportunity to receive the per member per month capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.
Pursuant to the Texas State Plan, HHSC is financially responsible for the Cost Sharing Obligations attributable to Dual Eligible Members enrolled in the MA Dual SNP’s Medicare Advantage Product.
Nothing in this Agreement precludes the MA Dual SNP from entering into agreements with Network Providers or out-of-network providers that vary the amount or method of payment for the Cost Sharing Obligations or from utilizing the MA Dual SNP’s coordination of benefits procedures.
This Agreement is subject to, and conditioned upon, CMS’ approval of a Texas State Plan Amendment governing the use of a capitated fee arrangement with MA Dual SNPs to satisfy HHSC’s Cost Sharing Obligations.
HHSC will pay the MA Dual SNP a per dual eligible member monthly capitated payment in exchange for the MA Dual SNP’s payment of Cost Sharing Obligations to healthcare service providers.
Effective January 1, 2020, Cost Sharing Obligations include co-insurance provided during a Dual Eligible Member’s Medicare-covered stay in a skilled nursing facility when the Dual Eligible Member is enrolled in a MA Dual SNP that is contracted with HHSC and receives Medicaid services under the State’s fee-for-service model.
Except as provided in Section 3.03(b), the amount or method of payment for Cost Sharing Obligations included in the agreements with Network Providers or out-of-network providers may differ between agreements.
The MA Dual SNP must provide HHSC with the actuarial value for Medicare Cost Sharing Obligations for the projection period consistent with the CMS bid submission.

More Definitions of Cost Sharing Obligations

Cost Sharing Obligations mean those financial payment obligations to be paid by the Agency in satisfaction of (i) deductibles, coinsurance, and co-payments for the Medicare Part A and Medicare Part B programs with respect to certain dual eligible beneficiaries, as set forth in Exhibit A. Such financial payment obligations shall not include premiums or cost-sharing relating to Medicare Part D benefits.

Cost Sharing Obligations means those financial payment obligations incurred by HCA in satisfaction of the deductibles, coinsurance, and co-payments for the Medicare Part A and Part B programs with respect to Dual Eligible Members. For purposes of this SMAC, Cost Sharing Obligations do not include: (1) Medicare premiums that HCA is required to pay under the Washington State Plan on behalf of qualified Dual Eligible Beneficiaries, or (2) wrap-around services that are covered by Medicaid. Covered Services

Cost Sharing Obligations has the meaning set forth in Section 2.4(b).

Cost Sharing Obligations found in Article II, Definitions, is hereby amended and restated in its entirety to read as follows: this Agreement, Cost Sharing Obligations do not include: (1) Medicare premiums that HHSC is required to pay under the Texas State Plan on behalf of Dual Eligible Members or other Dual SNP Members; (2) Deductibles, Coinsurance, and Co-payments for the Medicare Part A and Part B programs with respect to Other Dual SNP Members; (3) wrap-around services that are covered by Medicaid, and (4) Coinsurance for Part A-like services provided during a Dual Eligible Member's Medicare-covered stay in a skilled nursing facility when the member is also enrolled in STAR+PLUS for their Medicaid services. Payment of coinsurance to the skilled nursing facility for a Part A skilled stay is covered by the STAR+PLUS MCO.

Cost Sharing Obligations has the meaning set forth in Section 5.5.

Cost Sharing Obligations means microwave relocation cost-sharing obligations in respect of the PCS Licenses within the meaning of 47 C.F.R. §§ 24.239 through 24.253.