End-Stage Renal Disease (ESRD) Sample Clauses

End-Stage Renal Disease (ESRD). Notwithstanding the forgoing, individuals with ESRD shall not be eligible for Medicare Supplemental Insurance during the first 30 months of the individual’s ESRD-based Medicare eligibility or entitlement, unless the individual was entitled to Medicare due to age or disability on a primary basis at the time he or she becomes eligible for ESRD-based Medicare.

End-Stage Renal Disease (ESRD). (Partnership Only) The following eligibility criteria apply to individuals with a diagnosis of ESRD: Individuals who are dual eligible and have a diagnosis of ESRD at the time of application are not eligible to enroll unless the MCO has secured the appropriate Medicare ESRD waiver from CMS.‌‌ If a dual eligible individual is diagnosed with ESRD while enrolled in Partnership the individual is eligible to remain enrolled. If a Medicaid-only eligible individual becomes a dual eligible after enrollment, then is diagnosed as ESRD, the member must enroll in the MCO’s Special Needs Plan. Individuals who are eligible for Medicaid only and have a diagnosis of ESRD at the time of application are eligible to enroll. MCO Specific Eligibility Criteria Each MCO may have geographical criteria limiting eligibility for enrollment established in Article XIX, MCO Specific Contract Terms.

End-Stage Renal Disease (ESRD). MCO members receiving services for end-stage renal disease (ESRD) are covered under fee-for-service Medicaid for the entire duration of their treatment. The MCO shall have the ability to notify the State of any past, present, or future transplant recipient and request transfer to fee-for-service Medicaid. The Department will coordinate with Utilization Management vendor and Medicaid Management Information Systems (MMIS) vendor to transition members to the fee- for-service system and coordinate care at that time. The member will be covered under fee-for-service retroactively to the beginning of the month that the MCO notifies the State. Capitation will be recouped for this month. Any claims paid during the month by the MCO may be reversed and directed to the fiscal agent for payment.

End-Stage Renal Disease (ESRD). (Partnership Only) The following eligibility criteria apply to individuals with a diagnosis of ESRD:

End-Stage Renal Disease (ESRD). Payments. For MSHO Enrollees identified by CMS as having ESRD, the MCO shall receive an adjusted Medicare Payment rate for Medicare Parts A and B that shall be determined by CMS. The MCO shall continue to receive the Medicaid Basic Care, Nursing Facility Add-On and Elderly Waiver rate components as appropriate for these Enrollees.