Common use of Partnership and PACE Eligibility Criteria Clause in Contracts

Partnership and PACE Eligibility Criteria. a. Individuals who at the time of application have a diagnosis of Traumatic Brain Injury (TBI): i. In areas where the Family Care benefit is available and offered to an individual with a diagnosis of TBI, the individual is eligible to enroll. ii. In areas where the Family Care benefit is not available enrollment of individuals with a diagnosis of TBI is limited to those individuals who also meet the LTC FS functional eligibility and target group for Frail Elder or Physical Disability. iii. In areas where the Family Care benefit is not available all individuals with a diagnosis of TBI are eligible to enroll if the MCO has received a waiver from the Department. b. Individuals who at the time of application are living in substitute care (substitute care includes but is not limited to Nursing Home, Adult Family Home, Residential Care Apartment Complex or Community-Based Residential Facility): i. In areas where the Family Care benefit is available individuals living in substitute care are eligible to enroll. ii. In areas where the Family Care benefit is not available enrollment is limited to individuals who express a desired outcome of relocating from substitute care into the community. A member who is already enrolled and moves into substitute care may remain enrolled. A member who lives in substitute care may be re-enrolled without expressing a desired outcome of relocating from substitute care into the community following a disenrollment of sixty (60) calendar days or less due to a temporary loss of Medicaid eligibility. iii. In areas where the Family Care benefit is not available all individuals who at the time of application are living in substitute care are eligible to enroll if the MCO has received a waiver from the Department. c. Individuals who at the time of application have a diagnosis of developmental disability: i. In areas where the Family Care benefit is available individuals with a diagnosis of developmental disability are eligible to enroll. ii. In areas where the Family Care benefit is not available enrollment is limited to individuals with a diagnosis of developmental disability who also meet the LTC FS functional eligibility and target group for Frail Elder or Physical Disability. iii. In areas where the Family Care benefit is not available all individuals with a diagnosis of developmental disability are eligible to enroll if the MCO has received a waiver from the Department.

Partnership and PACE Eligibility Criteria. a. Individuals who at the time of application have a diagnosis of Traumatic Brain Injury (TBI): i. In areas where the Family Care benefit is available and offered to an individual with a diagnosis of TBI, the individual is eligible to enroll. ii. In areas where the Family Care benefit is not available enrollment of individuals with a diagnosis of TBI is limited to those individuals who also meet the LTC FS functional eligibility and target group for Frail Elder or Physical Disability. iii. In areas where the Family Care benefit is not available all individuals with a diagnosis of TBI are eligible to enroll if the MCO has received a waiver from the Department. b. Individuals who at the time of application are living in substitute care (substitute care includes but is not limited to Nursing Home, Adult Family Home, Residential Care Apartment Complex or Community-Based Residential Facility): i. In areas where the Family Care benefit is available individuals living in substitute care are eligible to enroll. ii. In areas where the Family Care benefit is not available enrollment is limited to individuals who express a desired outcome of relocating from substitute care into the community. A member who is already enrolled and moves into substitute care may remain enrolled. A member who lives in substitute care may be re-re- enrolled without expressing a desired outcome of relocating from substitute care into the community following a disenrollment of sixty (60) calendar days or less due to a temporary loss of Medicaid eligibility. iii. In areas where the Family Care benefit is not available all individuals who at the time of application are living in substitute care are eligible to enroll if the MCO has received a waiver from the Department. c. Individuals who at the time of application have a diagnosis of developmental disability: i. In areas where the Family Care benefit is available individuals with a diagnosis of developmental disability are eligible to enroll. ii. In areas where the Family Care benefit is not available enrollment is limited to individuals with a diagnosis of developmental disability who also meet the LTC FS functional eligibility and target group for Frail Elder or Physical Disability. iii. In areas where the Family Care benefit is not available all individuals with a diagnosis of developmental disability are eligible to enroll if the MCO has received a waiver from the Department.

Partnership and PACE Eligibility Criteria. a. Individuals who at the time of application have a diagnosis of Traumatic Brain Injury (TBI): i. In areas where the Family Care benefit is available and offered to an individual with a diagnosis of TBI, the individual is eligible to enroll. ii. In areas where the Family Care benefit is not available enrollment of individuals with a diagnosis of TBI is limited to those individuals who also meet the LTC FS functional eligibility and target group for Frail Elder or Physical Disability. iii. In areas where the Family Care benefit is not available all individuals with a diagnosis of TBI are eligible to enroll if the MCO has received a waiver from the Department. b. Individuals who at the time of application are living in substitute care (substitute care includes but is not limited to Nursing Home, Adult Family Home, Residential Care Apartment Complex or Community-Based Residential Facility): i. In areas where the Family Care benefit is available individuals living in substitute care are eligible to enroll. ii. In areas where the Family Care benefit is not available enrollment is limited to individuals who express a desired outcome of relocating from substitute care into the community. A member who is already enrolled and moves into substitute care may remain enrolled. A member who lives in substitute care may be re-enrolled without expressing a desired outcome of relocating from substitute care into the community following a disenrollment of sixty (60) calendar days or less due to a temporary loss of Medicaid eligibility. iii. In areas where the Family Care benefit is not available all individuals who at the time of application are living in substitute care are eligible to enroll if the MCO has received a waiver from the Department. c. Individuals who at the time of application have a diagnosis of developmental disability: i. In areas where the Family Care benefit is available individuals with a diagnosis of developmental disability are eligible to enroll. ii. In areas where the Family Care benefit is not available enrollment is limited to individuals with a diagnosis of developmental disability who also meet the LTC FS functional eligibility and target group for Frail Elder or Physical Disability. iii. In areas where the Family Care benefit is not available all individuals with a diagnosis of developmental disability are eligible to enroll if the MCO has received a waiver from the Department.