Sharing Obligations definition
Examples of Sharing Obligations in a sentence
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.
Neither the MA Dual SNP nor its Network Providers will seek additional payment from HHSC, Dual Eligible Members, or healthcare providers for such Cost Sharing Obligations.
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.
Pursuant to the Texas State Plan, HHSC is financially responsible for the Cost Sharing Obligations attributable to Dual Eligible Members enrolled in the MA Dual SNP’s Medicare Advantage Product.
This Agreement is subject to, and conditioned upon, CMS’ approval of a Texas State Plan Amendment governing the use of a capitated fee arrangement with MA Dual SNPs to satisfy HHSC’s Cost Sharing Obligations.
Nothing in this Agreement precludes the MA Dual SNP from entering into agreements with Network Providers or out-of-network providers that vary the amount or method of payment for the Cost Sharing Obligations or from utilizing the MA Dual SNP’s coordination of benefits procedures.
HHSC will pay the MA Dual SNP a per dual eligible member monthly capitated payment in exchange for the MA Dual SNP’s payment of Cost Sharing Obligations to healthcare service providers.
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.
Except as provided in Section 3.03(b), the amount or method of payment for Cost Sharing Obligations included in the agreements with Network Providers or out-of-network providers may differ between agreements.
The MA Dual SNP must provide the actuarial value for Medicare Cost Sharing Obligations for the projection period consistent with the CMS bid submission.