Initial Eligibility Determination Activities Clause Samples
The Initial Eligibility Determination Activities clause outlines the procedures and criteria for assessing whether an individual or entity meets the necessary requirements to participate in a program or receive certain benefits. Typically, this involves collecting relevant information, verifying documentation, and evaluating the applicant against established standards or guidelines. By clearly defining the steps and responsibilities involved in the eligibility review process, this clause ensures that only qualified applicants are approved, thereby maintaining program integrity and reducing the risk of errors or fraud.
Initial Eligibility Determination Activities. 1.2.1 LIDDA must complete all assessment activities required by the Health and Human Services Commission (“HHSC”) to determine whether the individual meets an intermediate care for individuals with an intellectual disability or related conditions (“ICF/IID”) level-of-care (“LOC”) for individuals referred to the LIDDA for assessments for eligibility for CFC services based on an intellectual or developmental disability (“IDD”).
1.2.2 LIDDA must conduct initial service planning activities and assign a service coordinator no later than 30 days after HHSC authorizes the individual’s ICF/IID LOC for individuals 21 years of age or older with an ICF/IID LOC.
1.2.3 LIDDA must conduct reassessment activities for individuals who are receiving CFC services and communicate with the MCOs as directed by HHSC no later than 60 days prior to the expiration of the ICF/IID LOC for an individual.
1.2.4 LIDDA must ensure an assigned service coordinator provides service coordination to an individual 21 years of age or older while the individual is receiving Community First Choice (“CFC”) services through an MCO in the LIDDA’s local service area (“LSA”).
1.2.5 LIDDA must participate in the fair hearing to explain why no services were recommended if an MCO denies an individual’s request for services because there were no services on the individual’s recommended service plan and the individual requests a fair hearing to appeal the denial.
Initial Eligibility Determination Activities. 1.2.1 The LIDDA must complete all assessment activities required by HHSC to determine whether the individual meets an ICF/IID level-of-care (LOC) for individuals referred to the LIDDA for assessments for eligibility for CFC services based on IDD.