Cost Sharing Obligations definition

Cost Sharing Obligations found in Article II, Definitions, is hereby amended and restated in its entirety to read as follows: 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. 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. For purposes of 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 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

• SDOH is not financially responsible for Cost-Sharing Obligations and Medicaid Benefits for those Dual Eligible Beneficiaries enrolled in an Integrated Medicaid Product which may include Medicaid Advantage Plus, IB-Dual and certain Managed Long Term Care Partial programs.

• SDOH shall receive, process, and adjudicate claims for Cost-Sharing Obligations and Medicaid Benefits from Health Plan providers through the fee-for-service payment system, in accordance with SDOH’s processes and procedures for claims administration.

• Pursuant to New York’s Medicaid Plan, SDOH will remain financially responsible for Cost-Sharing Obligations and Medicaid Benefits for certain Dual Eligible Beneficiaries, as set forth in Attachment A, who are Members of Health Plan’s D-SNP(s) that enroll Fee-For-Service Medicaid enrollees.

• The MA Health Plan shall track and pay all eligible providers the Cost-Sharing Obligations incurred on behalf of Dual Eligible Members with applicable Medicaid eligibility categories covered under this Agreement.

More Definitions of Cost Sharing Obligations

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 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, Categories of Dual-Eligible Beneficiaries. Such financial payment obligations shall not include premiums or cost-sharing relating to Medicare Part D benefits.

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.

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