Examples of Dual Eligible Member in a sentence

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.
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 the purposes of this section, timely notification is defined as no later than two business days from which the MA Dual SNP becomes aware that a High Risk Dual Eligible Member has been admitted.
For an Other Full Benefit Dual Eligible Member, AHCCCS does not provide payment for either Medicare Part A or Part B premiums.
For an Other Full Benefit Dual Eligible Member, AHCCCS payments of Medicare coinsurance amounts and Medicare deductibles for Medicare covered services are limited.

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 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 individual who is eligible and voluntarily enrolled in the MA Health Plan. Full Benefit Dual Eligible Members (“FBDE”) means an individual who is entitled to Medicare Part A and/or Part B and are eligible for full Medicaid benefits. 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 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 (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 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, 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. 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.