Medicaid SSI Sample Clauses

Medicaid SSI. If a member is in a nursing home 90 days or longer, the member shall be disenrolled. In the event the member transfers from the nursing home to a hospital and back to the nursing home, the applicable 90 day period shall run continuously from the first admission to the nursing home and shall include any days in the hospital.
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Medicaid SSI. All mandatory Medicaid SSI or SSI related Medicaid members shall have the right to disenroll from the HMO pursuant to 42 CFR 438.56 unless otherwise limited by a State Plan Amendment. A voluntary disenrollment shall be effective no later than the first day of the second month following the month in which the member requests termination. Wisconsin currently has a State Plan Amendment which allows the Department to “lock-in” members to the HMO for a period of 12 months in mandatory HMO service areas, unless disenrollment is allowed for just cause. Voluntary exemptions and disenrollments from the HMO are allowed for a variety of reasons. All voluntary Medicaid SSI members shall have the right to disenroll from the HMO within the first 90 days of enrollment. Such voluntary Medicaid SSI disenrollment shall be effective no earlier than the first day of the month following the request to disenroll. If the member, legal guardian or authorized representative does not elect disenrollment during the first three months of enrollment, the member will be locked-in to the HMO for the remainder of the 12-month enrollment period.
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Medicaid SSI. The current State Plan Amendment requires an all-in opt-out enrollment in the HMO for enrollment areas where there are two or more HMOs with sufficient slots for the eligible populations. See Article I for definition of “all-in opt-out”. If at any time during the Contract period the Department obtains a State Plan Amendment, a waiver or revised authority under the Social Security Act (as amended), the conditions of enrollment described, including but not limited to voluntary enrollment and the right to voluntary disenrollment will be amended by the terms of said waiver and a State Plan Amendment.
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Medicaid SSI. The current State Plan Amendment requires mandatory enrollment into an HMO for those service areas in which there are two or more HMOs with sufficient slots for the HMO eligible population and in rural areas, as defined in 42 CFR 438.52, where there is only one HMO with an adequate provider network as determined by the Department. Medicaid SSI members who are dual eligible for Medicaid and Medicare and members who are enrolled in a Medicaid Purchase Plan (XXXX) are not subject to mandatory enrollment.
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Medicaid SSI. The PIHP may request an exemption after an SSI member has been in a nursing home 90 days and is expected to remain in the facility. In the event the member transfers from the nursing home to a hospital and back to the nursing home, the applicable 90 day period shall run continuously from the first admission to the nursing home and shall include any days in the hospital. The PIHP must wait until after 90 days before requesting an exemption, which will occur the first of the next month.
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Medicaid SSI. The current State Plan Amendment requires mandatory enrollment into an HMO for those service areas in which there are two or more HMOs. Enrollment for an HMO is voluntary for Medicaid members who are enrolled in Medicare and members who are enrolled in Medicaid Purchase Plan (XXXX). Enrollment Determination The Department will identify BadgerCare Plus, Medicaid SSI and SSI-Related Medicaid members who are eligible for enrollment in the HMO as the result of eligibility under the medical eligibility status codes listed in the chart at the following link: xxxxx://xxx.xxxxxxxxxxxxx.xx.xxx/WIPortal/content/Managed%20Care%20Orga nization/Enrollment_Information/word/MedStats.docx.spage Medical Status Codes Eligible for BadgerCare Plus and Medicaid SSI HMO Enrollment. Enrollment Section a. Members may generally choose an HMO upon eligibility. b. If the member does not choose an HMO and is required to enroll in an HMO, the Department will enroll the member in an HMO. The HMO will be selected based on a round xxxxx selection, except for the following: Newborn Enrollment: If the mother is enrolled in a BadgerCare Plus HMO at the time of birth, and the child is reported to the certifying agency within 100 days of birth, the newborn will be enrolled in the same HMO as the mother back to the infant’s date of birth. If the newborn is not reported to the certifying agency within 100 days, then the newborn will be enrolled in the same HMO as the mother the next available enrollment month. If the mother is not enrolled in a BadgerCare Plus HMO on the date of birth, the newborn will be auto assigned to an HMO unless otherwise exempt. Infants weighing less than 1200 grams will be exempt from enrollment for one year if the data submitted to the fiscal agent by the HMO or the provider supports the infant’s low birth weight. If an infant weighs less than 1200 grams, the HMO or provider should check the box on the BadgerCare Plus Newborn Report.
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Medicaid SSI. The HMO may request an exemption after an SSI member has been in a nursing home 90 days and is expected to remain in the facility. In the event the member transfers from the nursing home to a hospital and back to the nursing home, the applicable 90 day period shall run continuously from the first admission to the nursing home and shall include any days in the hospital. The HMO must wait until after 90 days before requesting an exemption, which will occur the first of the next month.
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Related to Medicaid SSI

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • Medicaid If and when the Resident’s assets/funds have fallen below the Medicaid eligibility levels, and the Resident otherwise satisfies the Medicaid eligibility requirements and is not entitled to any other third party coverage, the Resident may be eligible for Medicaid (often referred to as the “payor of last resort”). THE RESIDENT, RESIDENT REPRESENTATIVE AND SPONSOR AGREE TO NOTIFY THE FACILITY AT LEAST THREE (3) MONTHS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S FUNDS (APPROXIMATELY $50,000) AND/OR INSURANCE COVERAGE TO CONFIRM THAT A MEDICAID APPLICATION HAS OR WILL BE SUBMITTED TIMELY AND ENSURE THAT ALL ELIGIBILITY REQUIREMENTS HAVE BEEN MET. THE RESIDENT, RESIDENT REPRESENTATIVE AND/OR SPONSOR AGREE TO PREPARE AND FILE AN APPLICATION FOR MEDICAID BENEFITS PRIOR TO THE

  • Medicaid Program Parties (applicable to any Party providing services and supports paid for under Vermont’s Medicaid program and Vermont’s Global Commitment to Health Waiver):

  • Medicare Parts A and B of the health care program for the aged and disabled provided by Title XVIII of the United States Social Security Act, as amended from time to time. [MEMBER]. An eligible person who is covered under this Contract (includes Covered Employee[ and covered Dependents, if any)].

  • Contractor Standards Contractor shall comply with Contractor Standards provisions codified in the SDMC. Contractor understands and agrees that violation of Contractor Standards may be considered a material breach of the Contract and may result in Contract termination, debarment, and other sanctions.

  • Health Care Compliance Neither the Company nor any Affiliate has, prior to the Effective Time and in any material respect, violated any of the health care continuation requirements of COBRA, the requirements of FMLA, the requirements of the Health Insurance Portability and Accountability Act of 1996, the requirements of the Women's Health and Cancer Rights Act of 1998, the requirements of the Newborns' and Mothers' Health Protection Act of 1996, or any amendment to each such act, or any similar provisions of state law applicable to its Employees.

  • Compassionate Care Leave 1. For the purposes of this article “family member” means:

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

  • Child Care Leave The Employer shall, upon her request, grant an employee: (i) Who is the natural parent of a newborn or unborn child, or (ii) Who is adopting or has adopted a child, a leave of absence without pay of thirty-seven (37) consecutive weeks or such a shorter period as the employee requests so as to enable the employee to care for the child An employee who is or will be a natural parent intending to take this childcare leave shall (iii) Provide the Employer with a medical doctor’s certificate specifying the probable date of delivery or the date upon which the birth has occurred and, (iv) In absence of an emergency, give four (4) weeks written notice to the Employer of the commencement date and duration of the leave. An employee who is a parent of the newborn, other than the birth mother, shall be granted three (3) days leave without loss of pay within a reasonable period of time surrounding the occasion of the birth of the child. While on child care leave, an employee shall retain her full employment status and continue to accumulate seniority. An employee who is an adoptive parent intending to take this leave shall: (v) Provide the Employer with the proof that a child has been or will be placed with the employee for the purpose of adoption, (vi) Notify the Employer of the commencement date and duration of the leave on being made aware of the date of placement with the employee for adoption, and (vii) In the absence of an emergency, give four (4) months notice to the Employer before the anticipated day on which a child will come into the employees care and custody in the case of private adoption or upon approval in accordance with the Family Services Act as a prospective adopting parent. Where a natural mother intends to take a child care leave in addition to a maternity leave, except if the newborn is hospitalized when an employee’s maternity leave expires, the employee is required to commence the child care leave immediately on expiration of the maternity leave unless the Employer and the employee otherwise agree. The child care leave may be taken by either natural or adoptive parents. Where both parents are employees it may be shared by the child’s parent’s but the leave is only thirty-seven (37) weeks in TOTAL, regardless of how it is divided, and it must be taken in a consecutive manner. The combined maternity leave of seventeen (17) weeks and child care leave thirty-seven (37) weeks taken by one or both parents cannot total more than fifty-two (52) weeks after that date. Child care leave shall begin not earlier than the date on which the newborn or adopted child came into the care and custody of the employee and end not later than fifty-two (52) weeks after that date.

  • Subcontracting for Medicaid Services Notwithstanding any permitted subcontracting of services to be performed under this Agreement, Party shall remain responsible for ensuring that this Agreement is fully performed according to its terms, that subcontractor remains in compliance with the terms hereof, and that subcontractor complies with all state and federal laws and regulations relating to the Medicaid program in Vermont. Subcontracts, and any service provider agreements entered into by Party in connection with the performance of this Agreement, must clearly specify in writing the responsibilities of the subcontractor or other service provider and Party must retain the authority to revoke its subcontract or service provider agreement or to impose other sanctions if the performance of the subcontractor or service provider is inadequate or if its performance deviates from any requirement of this Agreement. Party shall make available on request all contracts, subcontracts and service provider agreements between the Party, subcontractors and other service providers to the Agency of Human Services and any of its departments as well as to the Center for Medicare and Medicaid Services.

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