Eligibility and Risk Screening
Eligibility and Risk Screening Sample Clauses
Related to Eligibility and Risk Screening
Eligibility and Enrollment 2.3.1 The State of Georgia has the sole authority for determining eligibility for the Medicaid program and whether Medicaid beneficiaries are eligible for Enrollment in GF. DCH or its Agent will determine eligibility for PeachCare for Kids® and will collect applicable premiums. DCH or its agent will continue responsibility for the electronic eligibility verification system (EVS).
ELIGIBILITY and COVERAGE 3.1.0 The following ETFO represented employees are eligible to receive benefits through this Trust:
Eligibility Verification (a) HHSC will verify Medicaid eligibility for Dual Eligible Members by the fifth business day of the month following the receipt of the MA Dual SNP’s monthly enrollment file, in accordance with Section 3.02(b).
Eligibility and Contributions a. All employees of the District are eligible to contribute to the Bank.
Eligibility Exclusions Subject to Clause 2.5 of this Schedule 1, an individual is not eligible for training subsidised through the Skills First Program under this VET Funding Contract if the individual is: a student enrolled in a school (excluding a school based Apprentice/Trainee). This includes: any government, non-government, independent or Catholic school; or a student registered for home schooling in Victoria. Government schools are responsible for funding these opportunities for VET within the school curriculum through their Student Resource Package (SRP) allocation, including targeted VET in schools funding. Non-government schools make similar decisions for students on the basis of the resources available to them; within the meaning of the Corrections Act 1986 (Vic), a prisoner held at a prison, including: Xxxxxxx Correctional Centre (Ararat); Barwon Prison; Beechworth Correctional Centre; Dame Xxxxxxx Xxxxx Centre; Dhurringile Prison; Langi Kal Kal Prison; Loddon Prison Precinct; Marngoneet Correctional Centre; Tarrengower Prison; Metropolitan Remand Centre; Melbourne Assessment Prison; Fulham Correctional Centre; Port Xxxxxxx Prison; or Karrenga Annex; a person who is detained under the Mental Health Act 2014 (Vic), or the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 (Vic) or the Sentencing Act 1991 (Vic) at the Xxxxxx Xxxxxxx Hospital; or a person who is detained (other than on weekend detention) under the Children, Youth and Families Act 2005 (Vic) or the Sentencing Act 1991 (Vic) or who is held on remand in one or more of the following youth justice facilities: Malmsbury Youth Justice Centre; Parkville Youth Residential Centre; or Melbourne Youth Justice Centre. The exclusions described in Clauses 2.4(b), (c) and (d) of this Schedule 1 do not apply to: young people on community based orders made under the Children, Youth and Families Act 2005 (Vic); or individuals held in Xxxx Xxxxxxx Transition Centre, who, subject to otherwise complying with the requirements in this Clause 2, may be eligible for training subsidised through the Skills First Program as they are able to physically access training outside of a custodial setting without supervision.
Health Screening The Contractor shall conduct a Health Needs Screen (HNS) for new members that enroll in the Contractor’s plan. The HNS will be used to identify the member’s physical and/or behavioral health care needs, special health care needs, as well as the need for disease management, care management and/or case management services set forth in Section 3.8. The HNS may be conducted in person, by phone, online or by mail. The Contractor shall use the standard health screening tool developed by OMPP, i.e., the Health Needs Screening Tool, but is permitted to supplement the OMPP Health Needs Screening Tool with additional questions developed by the Contractor. Any additions to the OMPP Health Needs Screening Tool shall be approved by OMPP. The HNS shall be conducted within ninety (90) calendar days of the Contractor’s receipt of a new member’s fully eligible file from the State. The Contractor is encouraged to conduct the HNS at the same time it assists the member in making a PMP selection. The Contractor shall also be required to conduct a subsequent health screening or comprehensive health assessment if a member’s health care status is determined to have changed since the original screening, such as evidence of overutilization of health care services as identified through such methods as claims review. Non-clinical staff may conduct the HNS. The results of the HNS shall be transferred to OMPP in the form and manner set forth by OMPP. As part of this contract, the Contractor shall not be required to conduct HNS for members enrolled in the Contractor’s plan prior to January 1, 2017 unless a change in the member’s health care status indicates the need to conduct a health screening. For purposes of the HNS requirement, new members are defined as members that have not been enrolled in the Contractor’s plan in the previous twelve (12) months. Data from the HNS or NOP form, current medications and self-reported medical conditions will be used to develop stratification levels for members in Hoosier Healthwise. The Contractor may use its own proprietary stratification methodology to determine which members should be referred to specific care coordination services ranging from disease management to complex case management. OMPP shall apply its own stratification methodology which may, in future years, be used to link stratification level to the per member per month capitation rate. The initial HNS shall be followed by a detailed Comprehensive Health Assessment Tool (CHAT) by a health care professional when a member is identified through the HNS as having a special health care need, as set forth in Section 4.2.4, or when there is a need to follow up on problem areas found in the initial HNS. The detailed CHAT may include, but is not limited to, discussion with the member, a review of the member’s claims history and/or contact with the member’s family or health care providers. These interactions shall be documented and shall be available for review by OMPP. The Contractor shall keep up-to-date records of all members found to have special health care needs based on the initial screening, including documentation of the follow-up detailed CHAT and contacts with the member, their family or health care providers.
General Eligibility i. A teacher who received an evaluation rating of ineffective or improvement necessary in the prior school year is not eligible for any salary increase and remains at their prior year salary.
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion First Tier Participants:
Overtime Eligibility and Compensation Employees are eligible for overtime compensation under the following circumstances:
Accreditation of Public Schools and Adoption and Implementation of School Plans The District will implement a system of accrediting all of its schools, as described in section 22-11- 307, C.R.S., which may include measures specifically for those schools that have been designated as Alternative Education Campuses, in accordance with the provisions of 1 CCR 301-57. The District will ensure that plans are implemented for each school in compliance with the requirements of the State Board pursuant to 1 CCR 301-1.
