BENEFICIARY ELIGIBILITY. Contractor shall maintain and implement policies and procedures to ensure a client is a Yolo County Medi-Cal beneficiary, track authorizations, and include only those service units with authorized daily transactions together with the client name for those units eligible for reimbursement. Contractor shall determine Medi-Cal eligibility and report any obligation and payment made of share of cost. Contractor shall provide copies of Medi-Cal swipes documenting beneficiary eligibility with monthly claims. Beneficiaries will be checked weekly by Contractor to verify they are still entitled to Medi-Cal services. If a beneficiary is no longer authorized for service but is in an approved course of treatment, then Contractor shall notify the County in writing immediately. Service may be rendered on a one-time-only basis if the beneficiary’s status has changed since the last service. Additional services may be provided only with the Director’s written authorization based on individual case treatment/service needs.
BENEFICIARY ELIGIBILITY. This Agreement is not intended to change the determination of Medi-Cal eligibility for beneficiaries in any manner. However, in the event the California State Legislature or Congress of the United States enacts a statute, which redefines Medi-Cal eligibility so as to affect the provision of acute psychiatric inpatient hospital services under this Agreement, this new definition shall apply to the terms of this Agreement.
BENEFICIARY ELIGIBILITY. Except as otherwise provided by the Sec- retary, an individual shall only be eligible to receive benefits under the program under sec- tion 1395cc–1 of this title (in this section re- ferred to as the ‘‘demonstration program’’) if such individual—
BENEFICIARY ELIGIBILITY. On a monthly basis, the State will identify which beneficiaries meet the eligibility criteria to receive health home services (See III.B for additional detail).
BENEFICIARY ELIGIBILITY. Contractor shall maintain and implement policies and procedures to ensure a client is eligible to receive Drug Medi-Cal program services. In order to be eligible, a client (a) must have been determined eligible for Medi-Cal; (b) is not institutionalized; (c) has a substance-related disorder per the “Diagnostic and Statistical Manual of Mental Disorders IV Text Revision (DSM IV-TR) criteria,” and/or DSM IV criteria; and (d) meets the admission criteria to receive DMC services. The requirement as to the use of the specific versions of DSM may be changed during the term of this contract. As changes occur, Contractor shall comply with the changed requirements accordingly. Covered services shall be provided to beneficiaries without regard to the beneficiaries’ county of residence. Contractor shall determine Drug Medi-Cal eligibility and report any obligation and payment made of share of cost. Contractor shall provide copies of Drug Medi-Cal swipes documenting beneficiary eligibility with monthly claims. Beneficiaries will be checked weekly by Contractor to verify they are still entitled to Medi-Cal services. If a beneficiary is no longer authorized for service but is in an approved course of treatment, then Contractor shall notify the County in writing immediately. Service may be rendered on a one-time-only basis if the beneficiary’s status has changed since the last service. Additional services may be provided only with the Director’s written authorization based on individual case treatment/service needs.
BENEFICIARY ELIGIBILITY. In order for a beneficiary to be eligible for the Medicare Part B premium reduction, the beneficiary must be enrolled in an M + C plan that offers the Medicare Part B premium reduction as an addi- tional benefit.
BENEFICIARY ELIGIBILITY. 1. In the case of a Sub-project under Part B(1), B(2) or B(3)(a) of the Project, the Beneficiary is a household which:
BENEFICIARY ELIGIBILITY. County shall maintain and implement policies and procedures to ensure a client is a Yolo County Medi-Cal beneficiary, and will provide copies of clients’ Medi-Cal swipes to Contractor with initial referral information. Contractor shall provide copies of Medi-Cal swipes documenting beneficiary eligibility with monthly claims. If a beneficiary is deemed no longer authorized for service but client is in an approved course of treatment, then service may be rendered as pre- approved by County. These services may be provided only with the Director’s written authorization based on individual case treatment/service needs.
BENEFICIARY ELIGIBILITY
