Exclusively Aligned definition

Exclusively Aligned means a D-SNP enrolling only full benefit Dual-Eligible Beneficiaries who are also enrolled in an Integrated Medicaid Product offered by SDOH, including but not limited to Medicaid Advantage Plus (“MAP”), that is offered by the Medicare Advantage Organization, its parent organization (directly or indirectly), or another entity owned and controlled by its parent organization.
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Examples of Exclusively Aligned in a sentence

  • The following are applicable only to Health Plan’s operation of Exclusively Aligned D-SNPs.

  • The counties within an Exclusively Aligned D-SNP’s Service Area shall be aligned with the service area of its Integrated Medicaid Product.

  • Health Plan’s Exclusively Aligned HIDE D-SNP shall implement a unified grievance and appeal system and process grievances and appeals in compliance with the terms of 42 CFR §§ 422.629 – 634, 438.210, 438.400 & 438.402.

  • MCO understands that this designation as a Highly Integrated D-SNP (HIDE SNP) includes that its integrated SNP enrollment will be Exclusively Aligned, and agrees to align administrative systems including beneficiary communication materials, enrollment, communications, grievances and appeals processes, and quality improvement, to improve efficiency and beneficiary experience.

  • Health Plan’s Exclusively Aligned FIDE or HIDE D-SNP shall implement a unified grievance and appeal system and process grievances and appeals in compliance with the terms of 42 CFR §§ 422.629 – 634, 438.210, 438.400 & 438.402.

  • The Contractor shall operate a SCO Plan that meets the requirements of a Medicare Advantage Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP), and shall provide Exclusively Aligned Enrollment for Dual Eligible individuals as follows: Eligible individuals choosing to participate in SCO shall enroll for both their Medicare and their MassHealth coverage through a single SCO Plan, and Dual Eligible individuals may not be enrolled in a SCO Plan for only their Medicare or their MassHealth coverage.