Common use of Intake Clause in Contracts

Intake. The intake process begins when you or someone on your behalf contacts CHA PACE. A representative will explain our program and obtain further information about you. • How CHA PACE works • The kinds of services CHA PACE offers • The answers to any questions you may have about CHA PACE • That when you enroll, you must agree to receive all your medical and health care exclusively from CHA PACE or its contracted service providers, with the exception of emergency services • Your monthly payment, if any If you are interested in joining CHA PACE, the CHA PACE enrollment staff will discuss your health and safety status with other members of the enrollment team. CHA PACE will ask that you sign a release allowing us to obtain your past medical records so our team has complete information about your health conditions. Within three weeks, we will have evaluated your health and safety status. We will meet to share our findings and ideas for your care. At this meeting, we will decide whether you meet the criteria for admission into the program, that is, whether your health needs appear to meet the MassHealth criteria for nursing facility level-of-care and whether you are living safely in your home or in the community. This includes assessing whether CHA PACE can meet your medical, nursing, psychological and social needs in conjunction with your family or support network, if any, and whether remaining in your home or in the community jeopardizes your health and safety. You may be denied enrollment if remaining in your home and or the community would jeopardize your health and safety. In such cases, the CHA PACE staff will provide written notification explaining the reason for the denial and refer you to appropriate alternative services. Mailing Address: Executive Office of Health & Human Services Board of Hearings Location: 000 Xxxxxxx Xx. Quincy, MA 02171 Phone: (000) 000-0000 Or 0-000-000-0000 TTY: (000) 000-0000 Fax: (000) 000-0000 If we assess that you are eligible for CHA PACE, you and your care giver/family will be invited to meet with our staff. At that time, we will review and come to an agreement about your participation in CHA PACE before you sign the Enrollment Agreement. At this meeting you and your care giver/family will have an opportunity to: • Discuss the plan of care recommended by enrollment staff and your suggestions and preferences. • Ask questions about your monthly payment, if any. • Ask questions about losing Medicare and MassHealth benefits that you may currently have (except for emergency or urgent care), as you will only be eligible for services provided and/or authorized by CHA PACE after enrollment. • Discuss the partnership between you, and/or your caregiver/family and CHA PACE. • What to do if you are dissatisfied with the care you receive from CHA PACE (see the Grievances and Appeals section of this agreement). • If you decide to join CHA PACE, you will be given the opportunity to agree to and accept the conditions of enrollment by signing the Enrollment Agreement.

Intake. The intake process Intake begins when you or someone calls on your behalf contacts CHA PACEor comes to LIFE. A representative • If it appears from this conversation that you are potentially eligible, a LIFE Enrollment Specialist will schedule a visit to your home, explain our program and obtain further information about youconduct a preliminary screening. • How CHA PACE works • The kinds of services CHA PACE offers • The answers to any questions you may have about CHA PACE • That when you enroll, you must agree to receive all your medical and health care exclusively from CHA PACE or its contracted service providers, with the exception of emergency services • Your monthly payment, if any If you are interested in joining CHA PACE, the CHA PACE enrollment staff will discuss your health and safety status with other members of the enrollment team. CHA PACE We will ask that you sign a release of information allowing us to obtain your past medical records so our team has complete information about Interdisciplinary Team can fully assess your health conditionsstatus. Within three weeks, we • Gathering this information will allow you to attend the LIFE center so that you can get to know us and have evaluated your health needs evaluated by each Interdisciplinary Team Member. A tuberculosis skin test(s) or a chest x-ray, or proof of within the last year is required during the enrollment/ intake process. Testing will be done at intake if needed and safety statusresults will not impact or preclude enrollment. We • LIFE is committed to serving the elderly who need long-term care; therefore, an independent opinion must confirm that your health status qualifies you to join the PACE program administered by LIFE St. Xxxxxx of the Pines. • Our LIFE Staff will meet complete the information on the North Carolina Medicaid Program Long Term Care Services Assessment tool and will submit to share our findings the Division of Medical Assistance. • The Division of Medical Assistance will review this Assessment tool submitted by LIFE and ideas determine if you are eligible for your carenursing home care by state requirements. At this meetingIn the event that the Division of Medical Assistance finds that you are not eligible for nursing home care by state requirements, we you will decide whether you meet the criteria for admission not be able to enroll into the program, that is, whether your health needs appear to meet the MassHealth criteria for nursing facility level-of-care and whether . If we determine you are living not able to live safely in your home or in the community, your enrollment will be denied. LIFE will work with you to make other arrangements for the care you need. You have the right to appeal your eligibility determination or a denial of enrollment. This includes assessing whether CHA PACE can meet your medical, nursing, psychological and social needs in conjunction with your family appeal should be made through the State Fair Hearing Process through the Office of Administrative Hearings: If you are a Medicare Beneficiary or support network, if any, and whether remaining in your home or in the community jeopardizes your health and safety. You may be denied enrollment if remaining in your home and or the community would jeopardize your health and safety. In such cases, the CHA PACE staff will provide written notification explaining the reason Private Pay for the denial and refer LIFE program you to appropriate alternative services. Mailing Addresscan contact: Executive Office • Should the Division of Health & Human Services Board of Hearings Location: 000 Xxxxxxx Xx. Quincy, MA 02171 Phone: (000) 000-0000 Or 0-000-000-0000 TTY: (000) 000-0000 Fax: (000) 000-0000 If we assess Medical Assistance approve that you are eligible for CHA PACEnursing home care by state requirements, assessments will occur in the LIFE Center and in your home. • First, the In-Home Services Coordinator, RN, a member of the Interdisciplinary Team, will coordinate a time to visit you in your home and determine if you can live safely in the community with LIFE services. There may be other members of the Interdisciplinary Team who may also visit you in your care giver/family will be invited home. • Next, the Interdisciplinary Team and an Enrollment Specialist coordinate a time for you to meet with our staff. At that time, we will review and come to an agreement about the LIFE Center. Here, various Interdisciplinary Team members shall evaluate your participation in CHA PACE before you sign needs. • When each Interdisciplinary Team member has evaluated your situation, the Enrollment Agreement. At this meeting you Interdisciplinary Team will meet to share their findings and will develop your care giver/family will have an opportunity to: • Discuss the individual plan of care recommended by enrollment staff and your suggestions and preferences. • Ask questions about your monthly payment, if any. • Ask questions about losing Medicare and MassHealth benefits that you may currently have (except for emergency or urgent care), as you will only be eligible for services provided and/or authorized by CHA PACE after enrollment. • Discuss the partnership between you, and/or your caregiver/family and CHA PACE. • What to do if you are dissatisfied with the care you receive from CHA PACE (see the Grievances and Appeals section of this agreement). • If you decide to join CHA PACE, you will be given the opportunity to agree to and accept the conditions of enrollment by signing the Enrollment Agreement.

Intake. The intake process begins when you or someone on your behalf contacts CHA PACEESP. A representative will explain our program and obtain further information about you. • How CHA PACE ESP works • The kinds of services CHA PACE ESP offers • The answers to any questions you may have about CHA PACE ESP • That when you enroll, you must agree to receive all your medical and health care exclusively from CHA PACE ESP or its contracted service providers, with the exception of emergency services • Your monthly payment, if any If you are interested in joining CHA PACEESP, the CHA PACE ESP’s enrollment staff will discuss your health and safety status with other members of the enrollment team. CHA PACE ESP will ask that you sign a release allowing us to obtain your past medical records so our team has complete information about your health conditions. Within three weeks, we will have evaluated your health and safety status. We will meet to share our findings and ideas for your care. At this meeting, we will decide whether you meet the criteria for admission into the program, that is, whether your health needs appear to meet the MassHealth criteria for nursing facility level-of-care and whether you are living safely in your home or in the community. This includes assessing whether CHA PACE ESP can meet your medical, nursing, psychological and social needs in conjunction with your family or support network, if any, and whether remaining in your home or in the community jeopardizes your health and safety. You may be denied enrollment if remaining in your home and or the community would jeopardize your health and safety. In such cases, the CHA PACE ESP staff will provide written notification explaining the reason for the denial and refer you to appropriate alternative services. Mailing Address: Executive Office of Health & Human Services Board of Hearings Location: 000 Xxxxxxx Xx. Quincy, MA 02171 Phone: (000) 000-0000 Or 0-000-000-0000 TTY: (000) 000-0000 Fax: (000) 000-0000 If we assess that you are eligible for CHA PACEESP, you and your care giver/family will be invited to meet with our staff. At that time, we will review and come to an agreement about your participation in CHA PACE ESP before you sign the Enrollment Agreement. At this meeting you and your care giver/family will have an opportunity to: • Discuss the plan of care recommended by enrollment staff and your suggestions and preferences. • Ask questions about your monthly payment, if any. • Ask questions about losing Medicare and MassHealth benefits that you may currently have (except for emergency or urgent care), as you will only be eligible for services provided and/or authorized by CHA PACE ESP after enrollment. • Discuss the partnership between you, and/or your caregiver/family and CHA PACEESP. • What to do if you are dissatisfied with the care you receive from CHA PACE ESP (see the Grievances and Appeals section of this agreement). • If you decide to join CHA PACEESP, you will be given the opportunity to agree to and accept the conditions of enrollment by signing the Enrollment Agreement. ESP is authorized to serve only those eligible for a nursing facility level of care. Accordingly, an outside screening must confirm that your health situation in fact qualifies you for this care. At the time of enrollment, MassHealth, through its screening agent, authorizes your eligibility for ESP. If the screening agent finds that you are not qualified for a nursing facility level of care, you will not be eligible to enroll, though you would have the right to appeal this finding. On an annual basis, the screening agent of the MassHealth program will determine whether you continue to be eligible for a nursing facility level of care. If, in the opinion of the screening agent, you do not meet the criteria for long term care, you will be deemed ineligible for ESP, and you must disenroll. ESP’s staff will work with you to reinstate you, if you are eligible.