Additional Eligibility Parameters Clause Samples

Additional Eligibility Parameters. Enrollees who elect to enroll in the Hospice program while enrolled are not required to disenroll from the MCO’s SNBC SNP product. End Stage Renal Disease. SNBC SNP Enrollees who are identified by CMS as having ESRD after enrollment are not required to disenroll from the MCO’s SNBC SNP product. Individuals who develop ESRD while enrolled in a health plan (for example, a commercial or group health plan, or a Medicaid plan) offered by the MCO are eligible to elect the Medicare Advantage plan offered by that MCO. In order to be eligible, there must be no break in coverage between enrollment in the MCO, and the start of coverage in the Medicare Advantage plan offered by the same MCO. An individual who elects the SNBC SNP plan and who is medically determined to first have ESRD after the date on which the enrollment form is signed (or receipt date stamp if no date is on the form), but before the effective date of coverage under the SNBC SNP plan is still eligible to elect the SNBC SNP plan. Spenddown. SNBC SNP and SNBC non-SNP Enrollees who are enrolled into SNBC prior to acquiring a Medical Spenddown are not required to disenroll from SNBC provided the Enrollee agrees to pay the Medical Spenddown to the STATE on a monthly basis. Until further notice, the STATE will not enroll new Enrollees with Medical Spenddowns into SNBC. However, Potential Enrollees residing in a nursing facility and coded with a Medical (rather than Institutional) Spenddown because they have elected Hospice may be enrolled. Enrollees with a Medical Spenddown who are already enrolled in the MCO as of the effective date of this Contract are not required to disenroll from SNBC, subject to the payment of spenddown described in section 3.2.2(A)(5).

Additional Eligibility Parameters. ‌ 3.1.7.1 Hospice. Enrollees who elect to enroll in the Hospice program while enrolled are not required to disenroll from the MCO’s SNBC SNP product.

Additional Eligibility Parameters