Ex Parte Determinations and other Processes Sample Clauses

Ex Parte Determinations and other Processes. After 7-1-11 for Childless Adult Members Who Are No Longer Eligible as Childless Adults and for Children Aging Out of 1931, SOBRA Child, YATI and KidsCare • On June 28, 2011, and every month thereafter, any Childless Adult who is age 65 and older, or who is under age 65 and has Medicare, who is eligible as a Childless Adult for the following month will be transferred to the SSI MAO program and will be redetermined under that category. These members will be identified in our PMMIS system and their eligibility key codes will be changed from Childless Adult to SSI MAO-Aged or SSI MAO-Disabled. We have an automated process from PMMIS to post this change back into DES’ AZTECS system and AHCCCS’ ACE system to close the Childless Adult case. There will be no break in coverage for these members. If they lose coverage for Childless Adults for any other eligibility reason, i.e., excess income, loss of residency, etc, they will not be moved to SSI MAO. AHCCCS and DES may become aware of these other reasons for losing eligibility for the Childless Adults program through a variety of means, such as, redetermination, self reporting (all Medicaid members are required to report changes in their circumstances), or PARIS updates (which is a data system that allows state Medicaid agencies across the country to share data regarding state residency and other issues). AHCCCS will look for individuals who are age 65 and older, and for individuals under age 65 with Medicare every month subsequent to June 28, 2011. This process will ensure that individuals turning 65 or individuals under age 65 receiving Medicare are moved to SSI MAO. The same process described for June 28, 2011 will be followed each month. By transferring these individuals prior to our month end processing, we will get them into the correct capitation rate category prior to paying monthly capitation to our contractors for the following month. These individuals will be scheduled for a redetermination based on their next redetermination due date for AHCCCS Care. AHCCCS makes a file available monthly to all of its contracted health plans, Indian Health Services and 638 tribal contractors that identifies AHCCCS members with redeterminations due in the next 60 days. This file can be sorted by zip code and eligibility category. The 270/271 eligibility and enrollment verification will include redetermination due dates for each member effective June 19, 2011. The 270/271 file is available on line (AHCCCS On Line), throug...
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Related to Ex Parte Determinations and other Processes

  • Litigation and Other Proceedings Except as disclosed in the SEC Documents, there are no lawsuits or proceedings pending or, to the knowledge of the Company, threatened, against the Company or any subsidiary, nor has the Company received any written or oral notice of any such action, suit, proceeding or investigation, which could reasonably be expected to have a Material Adverse Effect. Except as set forth in the SEC Documents, no judgment, order, writ, injunction or decree or award has been issued by or, to the knowledge of the Company, requested of any court, arbitrator or governmental agency which could result in a Material Adverse Effect.

  • VERIFICATION OF LICENSES, CREDENTIALS AND OTHER DOCUMENTS CONTRACTOR shall submit to LEA a staff list, and copies of all current licenses, certifications, credentials, permits and/or other documents which entitle the holder to provide special education and/or related services by CONTRACTOR and all individuals employed, contracted, and/or otherwise hired or sub-contracted by CONTRACTOR. CONTRACTOR shall ensure that all licenses, certifications, credentials, permits or other documents are on file at the office of the County Superintendent of Schools. CONTRACTOR shall notify LEA in writing within thirty (30) days when personnel changes occur which may affect the provision of special education and/or related services to students as specified in the LEA procedures. CONTRACTOR shall provide the LEA with the verified dates of fingerprint clearance, Department of Justice clearance and Tuberculosis Test clearance for all employees, approved subcontractors and/or volunteers prior to such individuals starting to work with any student. CONTRACTOR shall monitor the status of licenses, credentials, certifications, permits and/or other documents for all individuals employed, contracted, and/or otherwise hired by CONTRACTOR. CONTRACTOR shall notify LEA and CDE in writing within thirty (30) days when personnel changes occur which may affect the provision of special education and/or related services to LEA students. CONTRACTOR shall notify LEA within thirty (30) days if any such licenses, certifications or waivers are expired, suspended, revoked, rescinded, challenged pursuant to an administrative or legal complaint or lawsuit, or otherwise nullified during the effective period of this Master Contract. The LEA shall not be obligated to pay for any services provided by a person whose such licenses, certifications or waivers are expired, suspended, revoked, rescinded, or otherwise nullified during the period during which such person is providing services under this Master Contract. Failure to notify the LEA and CDE of any changes in credentialing/licensed staff may result in suspension or revocation of CDE certification and/or suspension or termination of this Master Contract by the LEA.

  • Ownership of Documents, Reports and Other Products All documents, reports and any other products developed and/or delivered to the Authority under this Agreement shall become and be the property of the Authority.

  • Definitions and Other Provisions of General Application SECTION 101.

  • FACILITIES, EQUIPMENT AND OTHER MATERIALS Except as otherwise specifically provided in this Agreement, CONTRACTOR shall, at its sole cost and expense, furnish all facilities, equipment, and other materials which may be required for performing services pursuant to this Agreement. At COUNTY’s discretion, COUNTY may make equipment or facilities available to CONTRACTOR for CONTRACTOR’s use in furtherance of this Agreement only where a COUNTY Facility or Equipment exhibit is attached to this Agreement identifying the equipment or facilities to be used by CONTRACTOR’s personnel. If COUNTY funds equipment as part of this contract, COUNTY will retain Equipment.

  • Assignment and other dealings (a) The Supplier may at any time assign, mortgage, charge, subcontract, delegate, declare a trust over or deal in any other manner with any or all of its rights and obligations under the Contract.

  • TECHNOLOGICAL AND OTHER CHANGES 29.01 Without restricting its right to determine the methods by which municipal services are to be provided, the Corporation agrees that no employee shall be laid off or have his employment terminated as a result of a technological change in methods.

  • Utilities and Other Services 4.4.1 The Tenant shall arrange, at its own cost and expense, for the installation, connection and supply of all utilities and any other services required by it at or in relation to the Premises.

  • GOVERNING LAW AND OTHER REPRESENTATIONS: DIR Customer [ ] Unit of Texas Local Government hereby certifying that is has statutory authority to perform its duties hereunder pursuant to Chapter , Texas Code. [X] Non-Texas State agency or unit of local government of another state hereby certifying that it has statutory authority to enter in to this Interlocal Agreement and perform its duties hereunder pursuant to the Colorado Judicial Department Purchasing Fiscal Rules.

  • Unlawful Internet Gambling and Other Illegal Activities You agree that you are not engaged in unlawful internet gambling or any other illegal activity. You agree that you will not use any of your accounts, access devices or services for unlawful internet gambling or other illegal activities. We may terminate your account relationship if you engage in unlawful internet gambling or other illegal activities.

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