Common use of Presumptive Eligibility- HIP Clause in Contracts

Presumptive Eligibility- HIP. Individuals determined presumptively eligible for HIP before 1/1/2019 in accordance with 42 CFR §435.1110 will be enrolled with an MCE for a presumptively eligible period, which begins on the day a qualified hospital, qualified provider or other authorized entity makes a determination that the individual is presumptively eligible. Individuals determined presumptively eligible on 1/1/2019 and after, will be in the Fee for Service program During the member’s presumptively eligible period, the Contractor shall provide health benefits equivalent to the HIP Basic plan benefits, as described in Exhibit 6 of this Contract. The member will not be provided a POWER Account during the presumptively eligible period; however, the member will be subject to copayments for services as set forth in Section 4.1.2. The Contractor shall reduce reimbursement to providers for services rendered to a presumptively eligible member by the amount of the individual’s required copayment. The presumptive eligibility period will continue in accordance with the requirements in the HIP MCE Policies and Procedures Manual but should not be longer than (1) the last day of the month following the start of the presumptive eligibility period for individuals who do not file an application;

Presumptive Eligibility- HIP. Individuals determined presumptively eligible for HIP before 1/1/2019 in accordance with 42 CFR §435.1110 will be enrolled with an MCE for a presumptively eligible period, which begins on the day a qualified hospital, qualified provider or other authorized entity makes a determination that the individual is presumptively eligible. Individuals determined presumptively eligible on 1/1/2019 and after, will be in the Fee for Service program During the member’s presumptively eligible period, the Contractor shall provide health benefits equivalent to the HIP Basic plan benefits, as described in Exhibit 6 of this Contract. The member will not be provided a POWER Account during the presumptively eligible period; however, the member will be subject to copayments for services as set forth in Section 4.1.24.1. 2. The Contractor shall reduce reimbursement to providers for services rendered to a presumptively eligible member by the amount of the individual’s required copayment. The presumptive eligibility period will continue in accordance with the requirements in the HIP MCE Policies and Procedures Manual but should not be longer than (1) the last day of the month following the start of the presumptive eligibility period for individuals who do not file an application;