Common use of Medically Frail Annual Review Clause in Contracts

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.