Provision of Services While Financial Eligibility is Pending Sample Clauses

The 'Provision of Services While Financial Eligibility is Pending' clause allows services to be provided to an individual even before their financial eligibility for those services has been fully determined. In practice, this means that an organization or provider may begin delivering necessary support or care while the eligibility review process is still ongoing, ensuring there is no interruption or delay in critical services. This clause is designed to prevent gaps in service delivery that could negatively impact individuals in need, addressing the problem of administrative delays by prioritizing immediate access to services.
Provision of Services While Financial Eligibility is Pending. The MCO will cooperate fully in executing a memorandum of understanding or other written agreement with each ADRC within its service area that describes the circumstances in which the MCO will provide services to an individual who is functionally eligible but whose financial eligibility is pending. This agreement can be to serve individuals whose financial eligibility is pending at the time of initial enrollment or during a period of disenrollment due to loss of financial eligibility. The MOU shall include a process for the resource center to inform the individual, or their legal decision maker, that if he/she is determined not to be eligible, he/she will be liable for the cost of services provided by the MCO. The MCO will not receive a capitation payment for an individual during the time financial eligibility is pending. If and when eligibility is established, the MCO will receive a capitation payment retroactively to the date indicated as the “effective date of enrollment” on the Enrollment Request form, up to a maximum of ninety (90) calendar days of serving the person while financial eligibility was pending. The effective date of enrollment entered on the Enrollment Request Form shall also be no earlier than the date on which an individual or their legal decision maker signs an explicit agreement (not just the enrollee’s signature on the enrollment form) to accept services during the period of pending financial eligibility. If the individual is determined not to be eligible, the MCO may bill that individual for the services the MCO has provided. The MCO shall pay providers for services which were provided and prior authorized by the MCO. MCO providers may not directly collect payment from the individual. The timelines for completion of the comprehensive assessment and member- centered plan shall be the same as those indicated in Article V, Care Management.
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Related to Provision of Services While Financial Eligibility is Pending

  • Provision of Services (a) The HSP will provide the Services in accordance with, and otherwise comply with: (1) the terms of this Agreement; (2) Applicable Law; and

  • Location of Services The Purchaser’s data shall remain within the continental United States at all times and on computing and data storage devices residing therein. Contractor’s services shall be subject to the United States legal jurisdiction.

  • Continuation of Services The Contractor shall work with the current Subcontractor prior to cancellation date to ensure all consumer needs are identified and appropriate placements and transportation needs, as applicable, have been arranged. The Subcontractor shall maintain communication with the Contractor on the process of transferring consumers until all consumers are placed.

  • Modification of Services Credit Union reserves the right to modify the Service from time to time without making prior notice to Member, provided, however, that Credit Union will give you at least thirty (30) days notice prior to making any modifications to the Service that would materially alter their functionality.

  • Termination of Services The Account Owner may act for all Clients to terminate enrollment in the DNA Guardian Program by executing ViaCord’s required documentation. However, once the Child reaches the age of majority, ▇▇▇▇▇▇▇ will follow the request of the Child.