Medically Frail Annual Review Sample Clauses

Medically Frail Annual Review. The Contractor shall maintain documentation that every medically frail member meets specific medically frail criteria, as set forth by OMPP, for receipt of HIP State Plan benefits. The Contractor shall confirm a member’s status as medically frail at least annually, except for those members mentioned in 3.3.2.1, from the member’s most recent medically frail determination in accordance with a process as determined by OMPP. At minimum, the Contractor shall affirm the medically frail designation by conducting an annual review of the member’s claim history and/ or pharmacy data against the Milliman Guidelines. Following the completion of the annual medically frail confirmation, the Contractor shall notify the State’s fiscal agent of the results no later than fifteen (15) calendar days prior to the one year anniversary of the Contractor’s previous medically frail determination or confirmation, as applicable. If a member is determined no longer to be medically frail, the member will be transferred to either (i) HIP Plus if they are currently making the required POWER account contributions, or are otherwise over 100% FPL, or (ii) HIP Basic if they are currently paying copayments at the time of service and under 100% FPL.
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Medically Frail Annual Review. The Contractor shall maintain documentation that every medically frail member meets specific medically frail criteria, as set forth by OMPP, for receipt of HIP State Plan benefits. The Contractor shall confirm a member’s status as medically frail at least annually, except for those members mentioned in 3.3.2.1, from the member’s most recent medically frail determination in accordance with a process as determined by OMPP. At minimum, the Contractor shall affirm the medically frail designation by conducting an annual review of the member’s claim history and/ or pharmacy data against the Milliman Guidelines. EXHIBIT 2.H HEALTHY INDIANA PLAN SCOPE OF WORK Following the completion of the annual medically frail confirmation, the Contractor shall notify the State’s fiscal agent of the results no later than fifteen (15) calendar days prior to the one year anniversary of the Contractor’s previous medically frail determination or confirmation, as applicable. If a member is determined no longer to be medically frail, the member will be transferred to either (i) HIP Plus if they are currently making the required POWER account contributions, or are otherwise over 100% FPL, or (ii) HIP Basic if they are currently paying copayments at the time of service and under 100% FPL.

Related to Medically Frail Annual Review

  • Evaluation Cycle: Annual Orientation A) At the start of each school year, the superintendent, principal or designee shall conduct a meeting for Educators and Evaluators focused substantially on educator evaluation. The superintendent, principal or designee shall:

  • MEDICALLY FRAGILE STUDENTS 1. If a teacher will be providing instructional or other services to a medically fragile student, the teacher or another adult who will be present when the instruction or other services are being provided will be advised of the steps to be taken in the event an emergency arises relating to the student's medical condition.

  • Medical Review Officer The Medical Review Officer (MRO) shall be a licensed physician who has a knowledge of substance abuse disorders and has appropriate medical training to interpret and evaluate an individual’s positive test result together with the employee’s medical history and any other relevant biomedical information.

  • OPTIONAL TWELVE-MONTH PAY PLAN 1. Where the Previous Collective Agreement does not contain a provision that allows an employee the option of receiving partial payment of annual salary in July and August, the following shall become and remain part of the Collective Agreement.

  • Clinical Management for Behavioral Health Services (CMBHS) System The CMBHS is the official record of documentation by System Agency. Grantee shall:

  • Medically Necessary Services for the State plan services in Addendum VIII. B medically necessary has the meaning in Wis. Admin. Code DHS §101.03(96m): services (as defined under Wis. Stat. § 49.46

  • TESTING OF THE BCDR PLAN The Service Provider shall test the BCDR Plan on a regular basis (and in any event not less than once in every Contract Year). Subject to paragraph 6.2, the Purchaser may require the Service Provider to conduct additional tests of some or all aspects of the BCDR Plan at any time where the Purchaser considers it necessary, including where there has been any change to the Services or any underlying business processes, or on the occurrence of any event which may increase the likelihood of the need to implement the BCDR Plan. If the Purchaser requires an additional test of the BCDR Plan, it shall give the Service Provider written notice and the Service Provider shall conduct the test in accordance with the Purchaser's requirements and the relevant provisions of the BCDR Plan. The Service Provider's costs of the additional test shall be borne by the Purchaser unless the BCDR Plan fails the additional test in which case the Service Provider's costs of that failed test shall be borne by the Service Provider. The Service Provider shall undertake and manage testing of the BCDR Plan in full consultation with the Purchaser and shall liaise with the Purchaser in respect of the planning, performance, and review, of each test, and shall comply with the reasonable requirements of the Purchaser in this regard. Each test shall be carried out under the supervision of the Purchaser or its nominee. The Service Provider shall ensure that any use by it or any Sub-contractor of “live” data in such testing is first approved with the Purchaser. Copies of live test data used in any such testing shall be (if so required by the Purchaser) destroyed or returned to the Purchaser on completion of the test. The Service Provider shall, within twenty (20) Working Days of the conclusion of each test, provide to the Purchaser a report setting out: the outcome of the test; any failures in the BCDR Plan (including the BCDR Plan's procedures) revealed by the test; and the Service Provider's proposals for remedying any such failures. Following each test, the Service Provider shall take all measures requested by the Purchaser, (including requests for the re-testing of the BCDR Plan) to remedy any failures in the BCDR Plan and such remedial activity and re-testing shall be completed by the Service Provider, at no additional cost to the Purchaser, by the date reasonably required by the Purchaser and set out in such notice. For the avoidance of doubt, the carrying out of a test of the BCDR Plan (including a test of the BCDR Plan’s procedures) shall not relieve the Service Provider of any of its obligations under this Contract. The Service Provider shall also perform a test of the BCDR Plan in the event of any major reconfiguration of the Services or as otherwise reasonably requested by the Purchaser.

  • Medically Necessary In general, We will not Cover any dental service, procedure, treatment, test or device that We determine is not Medically Necessary. If an External Appeal Agent certified by the State overturns Our denial, however, We will Cover the service, procedure, treatment, test or device for which coverage has been denied, to the extent that such service, procedure, treatment, test or device, is otherwise Covered under the terms of this Contract.

  • Benefit Level Two Health Care Network Determination Issues regarding the health care networks for the 2017 insurance year shall be negotiated in accordance with the following procedures:

  • Orally Administered Anticancer Medication In accordance with RIGL § 27-20-67, prescription drug coverage for orally administered anticancer medications is provided at a level no less favorable than coverage for intravenously administered or injected cancer medications covered under your medical benefit.

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