Deemed Eligibility. Full-time and regular part-time employees of the Employer who are within two (2) months of graduating with a University degree or College diploma (e.g. M.L.S., Baccalaureate or Library Techniques diploma) will be considered eligible to apply for posted positions which require the respective qualifications. Failure to obtain those qualifications and to submit proof of same to the Employer within two (2) months of appointment to the position shall result in the employee being returned to her former position as set out in Article 12.07.
Deemed Eligibility. The determination to continue to provide care for an individual who no longer meets the State eligibility criteria for enrollment into a One Care Plan, as long as the individual can reasonably be expected to regain One Care eligibility in accordance with the State critera within a period of time not to exceed two (2) months. Demonstration — See Capitated Financial Alignment Model. Demonstration Year — Demonstration Year 1 runs from the first Effective Enrollment Date through December 31, 2014; Demonstration Year 2 runs from January 1, 2015 through December 31, 2015; Demonstration Year 3 runs from January 1, 2016 through December 31, 2016; Demonstration Year 4 runs from January 1, 2017 through December 31, 2017; Demonstration Year 5 runs from January 1, 2018 through December 31, 2018; Demonstration Year 6 runs from January 1, 2019 through December 31, 2019; Demonstration Year 7 runs from January 1, 2020 through December 31, 2020; Demonstration Year 8 runs from January 1, 2021 through December 31, 2021; Demonstration Year 9 runs from January 1, 2022 through December 31, 2022; and Demonstration Year 10 runs from January 1, 2023 through December 31, 2023. Department of Mental Health (DMH) Community‑Based Services – DMH non‑acute mental health care services provided to DMH clients, such as community aftercare, housing and support services, and non‑acute residential services. Effective Enrollment Date — The first calendar day of the month following receipt of Enrollee’s enrollment into a One Care Plan by EOHHS or CMS, or their designee. Eligible Beneficiary — For the purpose of this contract, and as laid out in Section III.C.1 of the Memorandum of Understanding between CMS and the Commonwealth of Massachusetts dated August 22, 2012 (MOU), a Consumer who is eligible to enroll in the Demonstration but has not yet done so. This includes individuals who are enrolled in Medicare Part A and B and eligible for and receiving MassHealth Standard or CommonHealth, have no other comprehensive private or public health coverage, and who meet all other Demonstration eligibility criteria. Individuals who turn sixty‑five (65) while enrolled in the Demonstration may remain enrolled as long as they continue to be enrolled in Medicare Parts A and B and eligible for Medicare Part D and MassHealth Standard or MassHealth CommonHealth, and have no other comprehensive private or public health insurance. Emergency Condition — A medical condition, whether physical or mental, that manifest...
Deemed Eligibility. The determination to continue to provide care for an individual who no longer meets the State eligibility criteria for enrollment into a One Care Plan, as long as the individual can reasonably be expected to regain One Care eligibility in accordance with the State critera within a period of time not to exceed two (2) months.
Deemed Eligibility. The process described below shall be utilized if a current PACE member’s functional screen results in a non-nursing home level of care and the PO requests DHS to deem the member eligible.
a. The PO contacts the contract coordinator to request the ineligible member be deemed eligible.
b. The contract coordinator reviews the records and information provided by the PO. The contract coordinator may request additional information if warranted.
c. The contract coordinator decides whether to deem the member eligible based on the following standards: The member would be reasonably expected to become eligible at nursing home level of care within 6 months in absence of continued coverage of service, AND The member’s medical record and plan of care support deemed continued eligibility.
d. If the contract coordinator decides the member does not meet the standards to be deemed eligible, the contract coordinator will inform the PO of this decision in writing.
e. If the contract coordinator deems the member eligible, the contract coordinator shall inform the PO of this decision and contact the section chief overseeing the functional screen.
f. The screen team works with the PO screen liaison to continue eligibility for the member.
g. The member will be deemed functionally eligible for PACE as the functional screen will show a nursing home level of care.
Deemed Eligibility. The determination to continue to provide care for an individual who no longer meets the State eligibility criteria for enrollment into a SCO Plan, as long as the individual can reasonably be expected to regain SCO eligibility in accordance with the State criteria within a specified period of time.
Deemed Eligibility. The determination to continue to provide care for an individual who no longer meets the State eligibility criteria for enrollment into a SCO Plan, as long as the individual can reasonably be expected to regain SCO eligibility in accordance with the State criteria within a specified period of time. Default Enrollment - An enrollment process that allows a Medicare Advantage (MA) organization, following approval by the state and CMS, to enroll – unless the Member chooses otherwise – a Member of an affiliated MassHealth health plan into its Medicare Dual Eligible Special Needs Plan (D-SNP) when that Member becomes newly eligible for Medicare. This process is only permissible in circumstances where the Member enrolls with the SCO plan offered by their MassHealth health plan upon receiving Medicare eligibility. The only default enrollment effective date possible is the date an individual is initially eligible for Medicare (i.e., when an individual has both Medicare Part A and Part B for the first time). Department of Mental Health (DMH) Community-based Services – DMH non-acute mental health care services provided to DMH clients, such as ACCS, community aftercare, housing and support services, and non-acute residential services. Discharge Planning - The evaluation of an Enrollee’s medical and Behavioral Health care needs and coordination of any other support services in order to arrange for safe and appropriate care and living situation after discharge from one care setting (e.g., acute hospital, inpatient behavioral health facility) to another care setting (e.g., rehabilitation hospital, group home), including referral to and coordination of appropriate services.
