Examples of Dual Eligible Member in a sentence

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 Health Plan that is contracted with HHSC and receives Medicaid -for-service model.
HHSC will pay the MA Health Plan a per Dual Eligible Member monthly capitated payment providers.

More Definitions of Dual Eligible Member

Dual Eligible Member means a Dual Eligible who is eligible to participate in, and voluntarily enrolled in, the MA Health Plans MA Product. Medicare Advantage Agreement (MA Agreement) means the Medicare Advantage Plan Agreement between the MA Health Plan and CMS to provide an MA Product. Medicare Advantage Product (MA Product) means the Medicare Part C and other health plan services provided to members pursuant to an MA Agreement.

Dual Eligible Member means a Dual Eligible who is eligible to participate in, and voluntarily enrolled in, the MA Health Plans MA Product.

Dual Eligible Member means a Dual Eligible who is eligible to participate in, and voluntarily enrolled in, the MA Dual SNP’s MA Product. Long-Term Services and Supports (LTSS) has the meaning assigned in 42 C.F.R § 438.2. LTSS under Medicaid may include but are not limited to: assistance with Activities of Daily Living (ADLs); attendant services; nursing; occupational/speech/physical therapies; homemaker services; home modifications; adaptive aids; adult day care; and other rehabilitative and habilitative services and supports that help individuals maximize their independence.

Dual Eligible Member means a Dual Eligible who is eligible to participate in, and voluntarily enrolled in, the MA Health Plan’s MAPD Plan. Dual Special Needs Plan or D-SNP means a specialized MAPD Plan for special needs individuals who are entitled to medical assistance under a state plan under Title XIX of the Social Security Act that satisfies the requirements for such plans at 42 C.F.R. § 422.2. Full Benefit Dual Eligible Members (FBDE aka Medicaid only) means an individual who does not meet the income or resource criteria for QMB or SLMB but is eligible for Medicaid either categorically or through optional coverage groups such as medically needy, or special income levels for institutionalized, or home and community-based waivers. FBDEs are eligible for Medicaid payment of Medicare premiums, deductibles, coinsurance, and co-payments (except for Medicare Part D) as well as Full Medicaid benefits.

Dual Eligible Member. A member who is eligible for both Medicare and Medicaid. There are two types of Dual Eligible Members: a Qualified Medicare Beneficiary (QMB) Dual Eligible Member (a QMB Plus or a QMB Only), and a Non-QMB Dual Eligible Member (a Specified Low-Income Beneficiary [SLMB] Plus Member or an Other Full Benefit Dual Eligible) Member.

Dual Eligible Member means a Dual Eligible who is eligible to participate in, and voluntarily enrolled in, Health Risk Assessment (HRA) means an assessment used to assess the psychosocial and functional needs of Dual Eligible Members and Other Dual SNP Members, and the basis for developing an individualized care plan for each. HRA domains also include information on housing stability, food security, and access to transportation.

Dual Eligible Member means a Member who is simultaneously eligible for Medicaid and Medicare benefits. Emergency Medical Condition is defined in 42 USC 1395dd (e) and 42 CFR 438.114 and means: