Common use of Member Cost-Sharing Clause in Contracts

Member Cost-Sharing. The Contractor shall adhere to State and Federal law, the State Plan and the requirements set forth in 42 CFR 447.50 through 447.57 when imposing any cost sharing charges on members. Effective July 1, 2010, federal regulations at 42 CFR 447.78 place aggregate limits on cost- sharing and prohibit total member cost-sharing per family from exceeding five percent (5%) of the family’s income, as determined by the State, in a monthly or quarterly period. To ensure a family’s total cost-sharing does not exceed five percent (5%) of the family’s income in a calendar quarter, the Contractor shall accept family income data from the State’s fiscal agent and track the copayments, member debt collected and/or other cost-sharing information available to the Contractor against the total family income data provided by the State. Any service not specifically listed as a covered benefit in the applicable benefit plan may not be applied against the member’s five percent (5%) contribution calculation. The time period for tracking data shall be defined by the State. When a family’s total cost-sharing expenditures come close to exceeding five percent (5%) of the family’s income in the quarterly period, the Contractor shall coordinate with the State and shall notify providers and the family that additional cost sharing during the period is reduced or waived. In monitoring the quarterly 5% member cost-sharing limit, the Contractor shall comply with the policies and procedures set forth in this section, as well as the additional policies and procedures included in the Hoosier Care Connect MCE Policies and Procedures Manual.

Member Cost-Sharing. The Contractor shall adhere to State and Federal law, the State Plan and the requirements set forth in 42 CFR 447.50 through 447.57 when imposing any cost sharing charges on members. Effective July 1, 2010, federal Federal regulations at 42 CFR 447.78 place aggregate limits on cost- cost-sharing and prohibit total member cost-sharing per family from exceeding five percent (5%) of the family’s income, as determined by the State, in a monthly or quarterly period. To ensure a family’s total cost-sharing does not exceed five percent (5%) of the family’s income in a calendar quarter, the Contractor shall accept family income data from the State’s fiscal agent and track the copayments, premiums, member debt collected collected, and/or other cost-sharing information available to the Contractor against the total family income data provided by the State. Any service not specifically listed as a covered benefit in the applicable benefit plan may not be applied against the member’s five percent (5%) contribution calculation. The time period for tracking data shall be defined by the State. When a family’s total cost-sharing expenditures come close to exceeding five percent (5%) of the family’s income in the quarterly period, the Contractor shall coordinate with the State and shall notify providers and the family that additional cost sharing during the period is reduced or waived. In monitoring the quarterly 5% member cost-sharing limit, the Contractor shall comply with the policies and procedures set forth in this section, as well as the additional policies and procedures included in the Hoosier Care Connect MCE Policies and Procedures Manual.

Member Cost-Sharing. The Contractor shall adhere to State and Federal law, the State Plan and the requirements set forth in 42 CFR 447.50 through 447.57 when imposing any cost sharing charges on members. Effective July 1, 2010, federal regulations at 42 CFR 447.78 place aggregate limits on cost- sharing and prohibit total member cost-sharing per family from exceeding five percent (5%) of the family’s income, as determined by the State, in a monthly or quarterly period. To ensure a family’s total cost-sharing does not exceed five percent (5%) of the family’s income in a calendar quarter, the Contractor shall accept family income data from the State’s fiscal agent and track the copayments, member debt collected and/or other cost-sharing information available to the Contractor against the total family income data provided by the State. Any service not specifically listed as a covered benefit in the applicable benefit plan may not be applied against the member’s five percent (5%) contribution calculation. The time period for tracking data shall be defined by the State. When a family’s total cost-sharing expenditures come close to exceeding five percent (5%) of the family’s income in the quarterly period, the Contractor shall coordinate with the State and shall notify providers and the family that additional cost sharing during the period is reduced or waived. In monitoring the quarterly 5% member cost-sharing limit, the Contractor shall comply with the policies and procedures set forth in this section, as well as the additional policies and procedures included in the Hoosier Care Connect MCE Policies and Procedures Manual.. 5.0 Care Coordination

Member Cost-Sharing. The Contractor shall adhere to State and Federal law, the State Plan and the requirements set forth in 42 CFR 447.50 through 447.57 when imposing any cost sharing charges on members. Effective July 1, 2010, federal Federal regulations at 42 CFR 447.78 place aggregate limits on cost- cost-sharing and prohibit total member cost-sharing per family from exceeding five percent (5%) of the family’s income, as determined by the State, in a monthly or quarterly period. To ensure a family’s total cost-sharing does not exceed five percent (5%) of the family’s income in a calendar quarter, the Contractor shall accept family income data from the State’s fiscal agent and track the copayments, premiums, member debt collected collected, and/or other cost-cost- sharing information available to the Contractor against the total family income data provided by the State. Any service not specifically listed as a covered benefit in the applicable benefit plan may not be applied against the member’s five percent (5%) contribution calculation. The time period for tracking data shall be defined by the State. When a family’s total cost-sharing cost -sharing expenditures come close to exceeding five percent (5%) of the family’s income in the quarterly period, the Contractor shall coordinate with the State and shall notify providers and the family that additional cost sharing during the period is reduced or waived. In monitoring the quarterly 5% member cost-sharing limit, the Contractor shall comply with the policies and procedures set forth in this section, as well as the additional policies and procedures included in the Hoosier Care Connect MCE Policies and Procedures Manual.

Member Cost-Sharing. The Contractor shall adhere to State and Federal law, the State Plan and the requirements set forth in 42 CFR 447.50 through 447.57 when imposing any cost sharing charges on members. Effective July 1, 2010, federal regulations at 42 CFR 447.78 place aggregate limits on cost- sharing and prohibit total member cost-sharing per family from exceeding five percent (5%) of the family’s income, as determined by the State, in a monthly or quarterly period. To ensure a family’s total cost-sharing does not exceed five percent (5%) of the family’s income in a calendar quarter, the Contractor shall accept family income data from the State’s fiscal agent and track the copayments, member debt collected and/or other cost-sharing information available to the Contractor against the total family income data provided by the State. Any service not specifically listed as a covered benefit in the applicable benefit plan may not be applied against the member’s five percent (5%) contribution calculation. The time period for tracking data shall be defined by the State. When a family’s total cost-sharing expenditures come close to exceeding five percent (5%) of the family’s income in the quarterly period, the Contractor shall coordinate with the State and shall notify providers and the family that additional cost sharing during the period is reduced or waived. In monitoring the quarterly 5% member cost-sharing limit, the Contractor shall comply with the policies and procedures set forth in this section, as well as the additional policies and procedures included in the Hoosier Care Connect MCE Policies and Procedures Manual.. EXHIBIT 1.M SCOPE OF WORK 5.0 Care Coordination