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Provider Regulatory Requirements Senior Care Plus
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This section is to provide our preferred providers and their office staff with details on the structure and policies and procedures of SCP products as they relate to CMS regulatory requirements . Hometown Health requires that SCP providers and their office staff read , abide by , and reference this manual as necessary .
Hometown Health contracted providers agree to comply with all state or federal laws and regulations and CMS regulatory requirements applicable to SCP products in providing or arranging for services to any Member .
In addition , the obligations of each participating provider that are specifically applicable to SCP enrollees are detailed in the provider agreement with Hometown Health .
Hometown Health offers SCP , a Medicare Advantage Plan with prescription drug coverage ( MAPD ), available to anyone with both Medicare Parts A and B . A member must be a resident of Washoe , Carson City , Clark , or Nye Counties in Nevada and continue to pay his or her Medicare Part B premiums .
Through a contract with CMS , the U . S . government agency that administers Medicare , SCP coordinates Medicare benefits and offers additional coverage .
SCP members effectively assign their Medicare benefits to Hometown Health and SCP assumes total responsibility for meeting the covered health needs of the enrolled Medicare beneficiaries .
To implement the various statutes on which the CMS contracts are based , CMS issues regulations under authority granted by the Secretary of the Department of Health and Human Services and related provisions of the Social Security Act . CMS also issues various manuals , memoranda and statements necessary to administer the programs . Each MAO must comply with these requirements . CMS conducts routine regulatory audits to review the MAO ’ s procedures and to ensure compliance with federal regulations .
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