Fully Dual Eligible definition
Examples of Fully Dual Eligible in a sentence
Prescription drugs and drug classes covered by Medicare Part D for Fully Dual Eligible Members are not a Covered Service.
To effectively integrate and coordinate health care and care management for Fully Dual Eligible Members, Contractor shall demonstrate its ability to provide Medicare benefits to Fully Dual Eligible Members.
In order to be included in Contractor’s Provider Directory, Contractor’s Providers, whether under contract directly with, or Subcontracted by, Contractor, must have agreed to provide the Covered Services or items to its Medicaid and Fully Dual Eligible Members.
Contractors that are affiliated with or contracted with an entity that provides services as a Medicare Advantage plan serving Fully Dual Eligible Members for Medicare and Medicaid may not impose cost-sharing requirements on Fully Dual Eligible Members and QMB that would exceed the amounts permitted by OHP if the Member is not enrolled in the Contractor’s Medicare Advantage plan.
Contractor shall furnish to each of its Members a Member handbook that contains all of the information specified in Exhibit J, consistent with the requirements of 42 CFR 438.10(h), if applicable, within a reasonable time after the Contractor received notice of the recipient’s Enrollment from OHA or for clients who are Fully Dual Eligible, within the time period required by Medicare.
Contractor shall pay for Covered Services for Members who are Fully Dual Eligible in accordance with applicable contractual requirements that include CMS and OHA.
Any director may resign effective on giving written notice to the chairman of the board, the president/chief executive officer, the secretary or the board of directors, unless the notice specifies a later time for that resignation to become effective.
For those Contractors affiliated with or contracted with an entity that provides services as a Medicare Advantage plan serving Fully Dual Eligibles, Contractor shall demonstrate on a yearly basis that its Provider Network is adequate to provide both the Medicare and the Medicaid Covered Services to its Fully Dual Eligible population.
In order to be included in Contractor’s Provider Directory, Contractor’s Provider, whether under contract directly with, or Subcontracted by, Contractor must have agreed to provide the Covered Services or items to its Medicaid and Fully Dual Eligible Members.
Furnish to each of its Members the information specified in 42 CFR 438.10(f)(6) and 42 CFR 438.10(g), if applicable, within a reasonable time after the Contractor received notice of the Member’s Enrollment from OHA or for clients who are Fully Dual Eligible, within the time period required by Medicare.