Dual Eligible Special Needs Plans Sample Clauses

Dual Eligible Special Needs Plans. (D-SNPs) Requirements The Contractor shall have Centers for Medicare & Medicaid Services (CMS) approval to operate a statewide Dual Eligible Special Needs Plan (D-SNP) by April 1, 2022. The Contractor seeking D-SNP status for the first time shall be aware of the following general timeline as it intersects with the Hoosier Care Connect program. CMS continues to develop this timeline therefore it is subject to change without notice to the State. CMS will provide more specific due dates as it gets closer to the time period in the general timeline described below. The Contractor is responsible for monitoring CMS information regarding dates of submission for D-SNP related documentation. The Remainder Of This Page Has Deliberately Been Left Blank
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Dual Eligible Special Needs Plans. (D-SNPs) Requirements The Contractor shall have Centers for Medicare & Medicaid Services (CMS) approval to operate a statewide Dual Eligible Special Needs Plan (D-SNP) by April 1, 2022. The Contractor seeking D-SNP status for the first time shall be aware of the following general timeline as it intersects with the Hoosier Care Connect program. CMS continues to develop this timeline therefore it is subject to change without notice to the State. CMS will provide more specific due dates as it gets closer to the time period in the general timeline described below. The Contractor is responsible for monitoring CMS information regarding dates of submission for D-SNP related documentation. THE REMAINDER OF THIS PAGE HAS DELIBERATELY BEEN LEFT BLANK EXHIBIT 1 SCOPE OF WORK 2020, Nov Contractor submits Notice of Intent to Apply (NOIA) to CMS for CY 2022 2021, Jan-Feb Contractor submits the following to CMS:  MA and Part D application  Initial SNP application  Model of Care 2021, Apr 1 Hoosier Care Connect contracts implemented 2021, May CMS/NCQA issues MOC renewal terms of one, two, or three years 2021, Jun Contractor submits the following to CMS for 2022:  Plan Benefit Package (PBP)  Completed Bid Pricing Tool (PBT) to CMS for the upcoming year Both should be consistent with State requirements 2021, July Contractor submits its State Medicaid Agency Contract (SMAC) to CMS for CY 2022. Contract must include the following. New Provisions (due to be implemented CY 2021): • Provision of Medicaid LTSS and/or Medicaid behavioral health benefits either directly with the legal entity providing the D-SNP, with the parent organization of the D-SNP, or with a subsidiary owned and controlled by the parent organization of the D-SNP; OR  Process to share information with the State or the State’s designee (such as a Medicaid managed care organization or Medicaid care manager), on hospital and SNF admissions of high-risk individuals who are enrolled in the D-SNP. In addition to the minimum requirements per 42 CFR 422.107:  The D-SNP’s responsibility, including financial obligations, to provide or arrange for Medicaid benefits.  The categories of dually eligible beneficiaries eligible to be enrolled under the SNP (e.g., full benefit, Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB), etc.).  The Medicaid benefits covered under the SNP.  The cost sharing protections covered under the SNP.  The requirements to identify and share info...
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Related to Dual Eligible Special Needs Plans

  • Flexible Spending Plan As of the Employment Commencement Date, the Seller shall transfer, or use commercially reasonable efforts to cause to be transferred, from the Employee Plans that are medical and dependent care account plans (each, a “Seller FSA Plan”) to one or more medical and dependent care account plans established or designated by Buyer (collectively, the “Buyer FSA Plan”) the account balances (positive or negative) of Transferred Employees, and Buyer shall be responsible for the obligations of the Seller FSA Plans to provide benefits to the Transferred Employees with respect to such transferred account balances at or after the Employment Commencement Date (whether or not such claims are incurred prior to, on or after such date). Each Transferred Employee shall be permitted to continue to have payroll deductions made as most recently elected by him or her under the applicable Seller FSA Plan. As soon as reasonably practicable following the end of the plan year for the Buyer FSA Plan, including any grace period, Buyer shall promptly reimburse Seller for benefits paid by the Seller FSA Plans to any Transferred Employee prior to the Employment Commencement Date to the extent in excess of the payroll deductions made in respect of such Transferred Employee at or prior to the Employment Commencement Date but only to the extent that such Transferred Employee continues to contribute to the Buyer FSA Plan the amount of such deficiency. This Section 8.07 shall be interpreted and administered in a manner consistent with Rev. Rul. 2002-32.

  • Lesson Plans Each teacher shall develop lesson plans for the instruction of students enrolled in his/her classroom. The primary purpose of lesson plans is to assist the classroom teacher with instruction. It also provides the basis to ensure that the state/county curriculum is being presented.

  • Effective Date of Coverage An eligible employee is entitled to benefits provided he is actively at work on the first day the Long Term Disability Benefit Plan becomes effective. An eligible employee absent from work due to sickness or accident at the effective date of the Plan, shall only be eligible for Long Term Disability Plan benefits upon the return to continuous active full-time employment for a period of more than four consecutive weeks. The Company shall have the right to give medical examinations to employees returning from such lay-off to determine their eligibility under the Plan.

  • Special Eligibility The following employees also receive an Employer Contribution:

  • Flexible Spending Accounts Employees in the unit shall have access to the County’s flexible spending account program, which provides employees with the options of dependent care assistance benefits with a calendar year maximum of $5,000, and medical expense reimbursement benefits with a calendar year maximum of $2,400. The County shall maintain this plan in compliance with IRC §125. Employee premiums for flexible spending account benefits shall be deducted on a pre-tax basis from employee pay.

  • Continuing Eligibility To continue health benefits, a permanent intermittent employee must be credited with a minimum of 480 paid hours in a control period or 960 paid hours in two consecutive control periods.

  • Flexible Spending Account The parties agree that the State shall have the right to use State Employee Health Plan funds to cover the administrative costs of operating the medical and dependent care flexible spending account programs.

  • Dependent Eligibility To be eligible to enroll as a Covered Dependent, a person must be:

  • Incentive, Savings and Retirement Plans During the Employment Period, the Executive shall be entitled to participate in all incentive, savings and retirement plans, practices, policies and programs applicable generally to other peer executives of the Company and its affiliated companies, but in no event shall such plans, practices, policies and programs provide the Executive with incentive opportunities (measured with respect to both regular and special incentive opportunities, to the extent, if any, that such distinction is applicable), savings opportunities and retirement benefit opportunities, in each case, less favorable, in the aggregate, than the most favorable of those provided by the Company and its affiliated companies for the Executive under such plans, practices, policies and programs as in effect at any time during the 120-day period immediately preceding the Effective Date or if more favorable to the Executive, those provided generally at any time after the Effective Date to other peer executives of the Company and its affiliated companies.

  • Special Parental Allowance for Totally Disabled Employees (a) An employee who:

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