Common use of Functional Eligibility Clause in Contracts

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. Residency 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. Choice 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. Enrollment in Partnership Dual Eligible SNP 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

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. Residency 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. Choice 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. Enrollment in Partnership Dual Eligible SNP 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. program.‌ MCO Specific Eligibility Criteria‌ Criteria Each MCO may have geographical criteria limiting eligibility for enrollment established in Article XIX, MCO Specific Contract Terms. Eligibility Determination Process‌.

Functional Eligibility. Functional eligibility for Family Care and Partnership is determined using the LTCFS Long-Term Care Functional Screen (See Section F., Long 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 LTCFSLong-Term Care Functional Screen. The benefit package available to a Partnership member is identified in Addendum VI.A. 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 LTCFSLong-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 VI.A. 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 VI.B. VII.B. Residency 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. Choice 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. Enrollment in Partnership Dual Eligible SNP 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.