Potential Enrollee Sample Clauses
The 'Potential Enrollee' clause defines who qualifies as an individual or entity eligible to participate in a program, plan, or service. In practice, this clause typically outlines the criteria or conditions that must be met for someone to be considered for enrollment, such as age, residency, or other eligibility requirements. Its core function is to clearly establish the boundaries of eligibility, ensuring that only appropriate candidates are considered and reducing ambiguity or disputes over who may apply.
Potential Enrollee. Member who is subject to mandatory enrollment in managed care or may voluntarily elect to enroll in a given managed care program, but is not yet an enrollee of the Contractor’s Plan.
Potential Enrollee. An individual who is eligible to enroll in the Demonstration but has not yet done so. This includes individuals who are enrolled in Medicare Part A and B and are receiving full Medicaid benefits, have no other comprehensive private or public health coverage, and who meet all other Demonstration eligibility criteria.
Potential Enrollee. A Medicaid beneficiary who is subject to mandatory enrollment or may voluntarily elect to enroll in a given Contractor but is not yet Member of a specific Contractor.
Potential Enrollee a MassHealth Member who may voluntarily elect to enroll in the Senior Care Options Program, but is not yet an Enrollee.
Potential Enrollee. In accordance with 42 C.F.R. § 438.2, a Medicaid eligible RIte Care, Rhody Health Partners, or an ACA Adult Expansion population individual who has not yet been enrolled by the Contractor.
Potential Enrollee. A Medicaid beneficiary who is subject to mandatory enrollment or may voluntarily elect to enroll in a given CCO but is not yet Member of a specific CCO.
Potential Enrollee. A person who is a Medicaid-eligible beneficiary but has not yet enrolled with the Contractor.
Potential Enrollee. A Medicaid beneficiary who is subject to mandatory enrollment or may voluntarily elect to enroll in an MCO, but is not yet an enrollee of a specific MCO. Pre-Admission Screening and Resident Review (PASRR) – Pre-Admission Screening and Resident Review (PASRR) is a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long-term care. PASRR requires that all applicants to a Medicaid-certified nursing facility (1) be evaluated for mental illness and/or intellectual disability; (2) be offered the most appropriate setting for their needs (in the community, a nursing facility, or acute care settings); and (3) receive the services they need in those settings.