Medicare Part D. The Medicare prescription drug program authorized under the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), effective January 1, 2006, and the regulations issued pursuant thereto or as thereafter amended.
Medicare Part D a. The Medicare Part D baseline for the Part D Direct Subsidy will be set at the Part D national average monthly bid amount (NAMBA) for the calendar year. CMS will estimate an average monthly prospective payment amount for the low income cost-sharing subsidy and Federal reinsurance amounts; these payments will be reconciled after the end of each payment year in the same manner as for all Part D sponsors. The CY 2013 Part D NAMBA is $79.64.
Medicare Part D. In order for POs to continue to meet the statutory requirement of providing prescription drug coverage to their enrollees, and to ensure that they receive adequate payment for the provision of Part D drugs, beginning January 1, 2006, POs began to offer qualified prescription drug coverage to their enrollees who are Part D eligible individuals. The MMA did not impact the manner, in which POs are paid for the provision of outpatient prescription drugs to non-part D eligible PACE participants. POs are required to annually submit two Part D bids: one for a Plan Benefit Package (PBP) for dually eligible enrollees and one for a PBP for Medicare-only enrollees. The Part D payment to POs comprises several pieces, including the risk adjusted direct subsidy, reinsurance payments, and risk sharing. With a few exceptions, Part D payments are made to POs in the same manner as to MA-PD and standalone PDP plans. The direct subsidy is risk adjusted. Payments for eligible enrollees of either PBP will include a low-income premium subsidy and a low-income cost- sharing subsidy for basic Part D benefits. Payments for dually eligible enrollees will also include an additional amount to cover nominal cost sharing amounts (“2% capitation”), and an additional premium payment in situations where the PO’s basic Part D beneficiary premium is greater than the regional low-income premium subsidy amount. Description of Rate (ex. Dual Eligible, Medicaid Only)Amount of Rate (LTC + Acute care = Total) Dual Eligible $3,956.32 Medicaid Only $5,825.03 APPENDIX N: STATE ENROLLMENT/DISENROLLMENT RECONCILIATION METHODOLOGY A description of the State's procedures for the enrollment and disenrollment of participants into the state system, including procedures for any adjustment to account for the difference between the estimated number of participants on which the prospective monthly payment was based and the actual number of participants in that month as required at 42 CFR §460.182(d). Oregon’s PACE payment is prospective, based on actual numbers that are entered into the state system prior to the participant’s start date or reassessment date. The SAA conducts a monthly reconciliation based on the PACE organization’s enrollment/disenrollment list and the state’s Remittance Advice for the PACE capitation payment. This reconciliation process captures enrollments that may have been missed after the system compute deadline for enrollment, as well as capturing the date of death entered into the system...
Medicare Part D. College acknowledges that Company provides pharmacy services to Medicare Part D plans (“Part D Plans”) and their members under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (“Medicare Part D”) and that Company must comply with the provisions set forth in Exhibit C attached to this Agreement, which is incorporated herein by this reference. As applicable to the functions performed by Students related to Part D Plans, College agrees, and will require Students to agree to the provisions set forth in Exhibit C.
Medicare Part D. The Plan shall cooperate with Medicare Part D prescription drug plans (and Covered Individuals who are enrolled in such plans) with respect to coordination of benefits between the Plan and the Medicare Part D plan, including the provision of information to the Medicare Part D plan (or the Covered Individuals) regarding the benefits provided under the Plan for costs covered by the Medicare Part D plan. Covered Individuals enrolled in Medicare Part D plans shall cooperate with the Plan so that the Plan may perform its obligations under this subsection.
Medicare Part D. Resident authorizes Amsterdam or its agent (vendor pharmacy) to bill Medicare Part D, and retain any funds received from such billing, for all Medicare Part D eligible services that Resident receives. Resident, Resident Representative and/or Sponsor agree to pay (in accordance with the terms of this Agreement), or have Resident’s Medicaid, Medigap or other third party insurance carrier pay, all applicable Medicare Part D deductibles and co-insurancecharges.
Medicare Part D. The Plan Administrator is responsible for all aspects of ensuring that the Group Health Plan is in compliance with the requirements of the Medicare Modernization Act and the regulations implementing the new Medicare Part D drug benefit found at 42 C.F.R. Part 423, including but not limited to the requirement that group health plan sponsors (i) provide notices of creditable coverage to Medicare eligible Members informing them whether their prescription drug coverage under the Group Health Plan is actuarially equivalent to the Medicare Part D benefit and (ii) notify the Centers for Medicare & Medicaid Services of the creditable coverage status of the Group Health Plan’s prescription drug coverage.
Medicare Part D. Seller will continue to obtain Medicare Part D rebate information on a quarterly basis for rebates due for sales of Fareston under Seller’s label. Seller shall be responsible for all payments due through 12/31/12 pursuant to Section 9.8 of the Agreement. Subsequent to 12/31/12, Seller will pay these rebates and invoice Purchaser for reimbursement or forward this information to Purchaser for payment (as agreed upon by the parties). Purchaser should add Fareston to their own coverage gap agreement for Fareston sold under Purchaser’s label.
Medicare Part D. The Company does not sponsor a Medicare Part D Plan. The Company provides services as a subcontractor to a Medicare Part D Plan sponsored by a Person unaffiliated with the Company. The Company is in compliance with its subcontractor obligations in respect of such services and is in compliance with all Laws applicable to the services provided to such Medicare Part D Plan sponsor.
