Cost Sharing Protections for Dual Eligible Members. (a) The MA Dual SNP must notify its Network Providers (via a provider manual, provider bulletin, or other contractual document) that Network Providers:
Cost Sharing Protections for Dual Eligible Members. (a) The MA Health Plan must notify its Network Providers (via a provider manual, provider bulletin, or other contractual document) that Network Providers:
Cost Sharing Protections for Dual Eligible Members. Group and Participating Group Physicians acknowledge and agree that Medicare Members who are also enrolled in a State Medicaid plan (“Dual Eligible Members”) are not responsible for paying to Provider any Copayments, Coinsurance or Deductibles for Medicare Part A and Part B services (“Cost Sharing Amounts”) when the State Medicaid plan is responsible for paying such Cost Sharing Amounts. They further agree that they will not collect Cost Sharing Amounts from Dual Eligible Members when the State is responsible for paying such Cost Sharing Amounts, and will, instead, either accept the Company’s payment for Covered Services as payment in full for Covered Services and applicable Cost Sharing Amounts, or xxxx the applicable State Medicaid plan for the appropriate Cost Sharing Amounts owed by the State Medicaid plan. Dual Eligible Members in Capitated Financial Alignment Demonstration Plans are not responsible for Cost Sharing Amounts for Medicare Parts A and B services. To protect Members, Group and Participating Group Physicians agree not to seek or accept or rely upon waivers of the Member protections provided by this Section 4.3.
