Functional Eligibility Sample Clauses

Functional Eligibility. Functional eligibility for Family Care, Partnership and PACE is determined using the Long-Term Care Functional Screen (See Section G., Long-Term Care Functional Screen of this Article). a. In order to be functionally eligible for Partnership or PACE, an otherwise eligible individual must have a nursing home level of care as determined by the Long-Term Care Functional Screen. The benefit package available to a Partnership or PACE member is identified in Addendum VIII.A. and C. b. In order to be functionally eligible for Family Care, an otherwise eligible individual must have either a nursing home level of care or a non-nursing home level of care as determined by the Long-Term Care Functional Screen. i. ii.
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Functional Eligibility. Functional eligibility for Family Care and Partnership is determined using the LTCFS. See Section F., Long Term Care Functional Screen of this Article. In order to be functionally eligible for Partnership, an otherwise eligible individual must have a nursing home level of care as determined by the LTCFS. The benefit package available to a Partnership member is identified in Addendum VI.A. and C, Benefit Package Service Definitions. In order to be functionally eligible for Family Care, an otherwise eligible individual must have either a nursing home level of care or a non-nursing home level of care as determined by the LTCFS.
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Functional Eligibility. Functional eligibility for Family Care, Partnership and PACE is determined using the Long-Term Care Functional Screen (See Section G., Long-Term Care Functional Screen of this Article). a. In order to be functionally eligible for Partnership or PACE, an otherwise eligible individual must have a nursing home level of care as determined by the Long-Term Care Functional Screen. The benefit package available to a Partnership or PACE member is identified in Addendum XII.A. and C. b. In order to be functionally eligible for Family Care, an otherwise eligible individual must have either a nursing home level of care or a non-nursing home level of care as determined by the Long-Term Care Functional Screen. i. The benefit package available to a Family Care member who has a nursing home level of care is identified in Addendum XII.A. and B. ii. The benefit package available to a Family Care member who has a non-nursing home level of care is identified in Addendum XII.B.
Sample 1Sample 2Sample 3
Functional Eligibility. Functional eligibility for Family Care and Partnership is determined using the LTCFS (See Section F., Long Term Care Functional Screen of this Article). In order to be functionally eligible for Partnership, an otherwise eligible individual must have a nursing home level of care as determined by the LTCFS. The benefit package available to a Partnership member is identified in Addendum VI.A. and C. In order to be functionally eligible for Family Care, an otherwise eligible individual must have either a nursing home level of care or a non-nursing home level of care as determined by the LTCFS. The benefit package available to a Family Care member who has a nursing home level of care is identified in Addendum VI.A. and B. The benefit package available to a Family Care member who has a non-nursing home level of care is identified in Addendum VI.B. To be eligible for Family Care or Partnership, an otherwise eligible individual must be a resident, as determined by the Department or income maintenance agency, of an area served by an MCO that offers the Family Care or Partnership program in which the individual intends to enroll. An otherwise eligible individual must make the choice to enroll in the MCO that operates the program in which the person intends to enroll. The choice to enroll is verified by the signature of the member or the member’s legal decision maker on an enrollment form approved by the Department. A Partnership applicant who is eligible for Medicare must enroll in the Partnership MCO’s Dual Eligible SNP. The Partnership Dual Eligible SNP may only enroll full-benefit dually beneficiaries who are also enrolled in its Partnership program. MCO Specific Eligibility Criteria‌ Each MCO may have geographical criteria limiting eligibility for enrollment established in Article XIX, MCO Specific Contract Terms. Eligibility Determination Process‌
Sample 1Sample 2
Functional Eligibility. Functional eligibility for Family Care and Partnership is determined using the Long-Term Care Functional Screen (See Section F., Long-Term Care Functional Screen of this Article). In order to be functionally eligible for Partnership, an otherwise eligible individual must have a nursing home level of care as determined by the Long-Term Care Functional Screen. The benefit package available to a Partnership member is identified in Addendum VII.A. and C. In order to be functionally eligible for Family Care, an otherwise eligible individual must have either a nursing home level of care or a non-nursing home level of care as determined by the Long-Term Care Functional Screen. The benefit package available to a Family Care member who has a nursing home level of care is identified in Addendum VII.A. and B. The benefit package available to a Family Care member who has a non-nursing home level of care is identified in Addendum VII.B. To be eligible for Family Care or Partnership, an otherwise eligible individual must be a resident, as determined by the Department or income maintenance agency, of an area served by an MCO that offers the Family Care or Partnership program in which the individual intends to enroll. An otherwise eligible individual must make the choice to enroll in the MCO that operates the program in which the person intends to enroll. The choice to enroll is verified by the signature of the member or the member’s legal decision maker on an enrollment form approved by the Department.
Sample 1

Related to Functional Eligibility

  • Service Eligibility Criteria 5.3.4.1 High capacity EELs must comply with the following service eligibility requirements. <<customer_short_name>> must certify for each high-capacity EEL that all of the following service eligibility criteria are met: 5.3.4.1.1 <<customer_short_name>> has received state certification to provide local voice service in the area being served; 5.3.4.2 For each combined circuit, including each DS1 circuit, each DS1 EEL, and each DS1-equivalent circuit on a DS3 EEL: 5.3.4.2.1 1) Each circuit to be provided to each End User will be assigned a local number prior to the provision of service over that circuit; 5.3.4.2.2 2) Each DS1-equivalent circuit on a DS3 EEL must have its own local number assignment so that each DS3 must have at least twenty-eight (28) local voice numbers assigned to it; 5.3.4.2.3 3) Each circuit to be provided to each End User will have 911 or E911 capability prior to provision of service over that circuit; 5.3.4.2.4 4) Each circuit to be provided to each End User will terminate in a collocation arrangement that meets the requirements of 47 C.F.R. § 51.318(c); 5.3.4.2.4 5) Each circuit to be provided to each End User will be served by an interconnection trunk over which <<customer_short_name>> will transmit the calling party’s number in connection with calls exchanged over the trunk; 5.3.4.2.5 6) For each twenty-four (24) DS1 EELs or other facilities having equivalent capacity, <<customer_short_name>> will have at least one (1) active DS1 local service interconnection trunk over which <<customer_short_name>> will transmit the calling party’s number in connection with calls exchanged over the trunk; and 5.3.4.2.6 7) Each circuit to be provided to each End User will be served by a switch capable of switching local voice traffic. 5.3.4.3 BellSouth may, on an annual basis, audit <<customer_short_name>>’s records in order to verify compliance with the qualifying service eligibility criteria. The audit shall be conducted by a third party independent auditor, and the audit must be performed in accordance with the standards established by the American Institute for Certified Public Accountants (AICPA). To the extent the independent auditor’s report concludes that <<customer_short_name>> failed to comply with the service eligibility criteria, <<customer_short_name>> must true-up any difference in payments, convert all noncompliant circuits to the appropriate service, and make the correct payments on a going-forward basis. In the event the auditor’s report concludes that <<customer_short_name>> did not comply overall in any material respect with the service eligibility criteria, <<customer_short_name>> shall reimburse BellSouth for the cost of the independent auditor. To the extent the auditor’s report concludes that <<customer_short_name>> did comply in all material respects with the service eligibility criteria, BellSouth will reimburse <<customer_short_name>> for its reasonable and demonstrable costs associated with the audit. <<customer_short_name>> will maintain appropriate documentation to support its certifications. 5.3.4.4 In the event <<customer_short_name>> converts special access services to UNEs, <<customer_short_name>> shall be subject to the termination liability provisions in the applicable special access tariffs, if any.

  • Member Eligibility Verify Member eligibility contemporaneous with the rendering of services. BCBS will provide systems and/or methods for verification of eligibility and benefit coverage for Members. This is furnished as a service and not as a guarantee of payment;

  • 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.

  • Student Eligibility The LEA and POSTSECONDARY INSTITUTION shall qualify and advise candidates for dual credit from the pool of eligible high school students. A candidate for dual credit is eligible for consideration for fall, spring, and summer semesters if he or she: a. is enrolled during the fall and spring in a LEA in one-half or more of the minimum course requirements approved by PED for public school students under its jurisdiction or by being in physical attendance at a bureau of Indian education-funded high school at least three documented contact hours per day pursuant to 25 CFR 39.211(c); b. obtains permission from the LEA representative (in consultation with the student’s individualized education program team, as needed), the student’s parent or guardian if the student is under 18 years old, and POSTSECONDARY INSTITUTION representative prior to enrolling in a dual credit course; and c. meets POSTSECONDARY INSTITUTION requirements to enroll as a dual credit student.

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