Functional Eligibility Re-determination Clause Samples
The Functional Eligibility Re-determination clause establishes the process for periodically reassessing whether an individual or entity continues to meet the necessary criteria for eligibility under a program or agreement. Typically, this involves scheduled reviews or triggered assessments based on changes in circumstances, such as health status, income, or other qualifying factors. By requiring ongoing verification, the clause ensures that only those who remain eligible continue to receive benefits or services, thereby maintaining program integrity and preventing misuse.
Functional Eligibility Re-determination. Once enrolled, the MCO is responsible to assure that all members have a current and accurate level of care as determined by the LTCFS, in accordance with Section F. of this article. This includes at minimum an annual re-determination of level of care. It may also include a post-enrollment re-determination shortly after enrollment or a re-determination necessitated by a change in the member’s condition.
Functional Eligibility Re-determination. Once enrolled, the Contractor is responsible to assure that all members have a current and accurate level of care as determined by the InterRAI, in accordance with Section 2.1.2