Common use of Annual Re-Determination Clause in Contracts

Annual Re-Determination. An annual re-determination of level of care shall be completed within 365 days of the most recent functional screen. The member must receive a nursing home level of care to remain functionally eligible for Partnership or PACE. The member must receive a nursing home or non-nursing home level of care to remain functionally eligible for Family Care. If the level of care re-determination is not completed in the designated timeframe, the MCO is required to inform the income maintenance agency of the lack of functional eligibility determination according to change reporting requirements identified in Article IV, Enrollment and Disenrollment, page 44. (The member will lose eligibility if the re- determination is not done timely.)

Annual Re-Determination. An annual re-determination of level of care shall be completed within 365 days of the most recent functional screen. The member must receive a nursing home level of care to remain functionally eligible for Partnership or PACE. The member must receive a nursing home or non-nursing home level of care to remain functionally eligible for Family Care. If the level of care re-determination is not completed in the designated timeframe, the MCO is required to inform the income maintenance agency of the lack of functional eligibility determination according to change reporting requirements identified in Article IV, Enrollment and Disenrollment, page 4441. (The member will lose eligibility if the re- determination is not done timely.)

Annual Re-Determination. An annual re-determination of level of care shall be completed within 365 days of the most recent functional screen. The member must receive a nursing home level of care to remain functionally eligible for Partnership or PACE. The member must receive a nursing home or non-nursing home level of care to remain functionally eligible for Family Care. If the level of care re-determination is not completed in the designated timeframe, the MCO is required to inform the income maintenance agency of the lack of functional eligibility determination according to change reporting requirements identified in Article IV, Enrollment and Disenrollment, page 4438. (The member will lose eligibility if the re- determination is not done timely.)

Annual Re-Determination. An annual re-determination of level of care shall be completed within 365 days of the most recent functional screen. The member must receive a nursing home level of care to remain functionally eligible for Partnership or PACE. The member must receive a nursing home or non-nursing home level of care to remain functionally eligible for Family Care. If the level of care re-determination is not completed in the designated timeframe, the MCO is required to inform the income maintenance agency of the lack of functional eligibility determination according to change reporting requirements identified in Article IV, Enrollment and Disenrollment, page 4445. (The member will lose eligibility if the re- determination is not done timely.)