Waiver Services Sample Clauses
Waiver Services. If the initial review does not support a return to the community, the Service Coordinator will conduct a second assessment 90 days after the initial assessment to determine any changes in the individual’s condition or circumstances that would allow a return to the community. The Service Coordinator will develop and implement the transition plan. The HMO will provide these services as part of the Promoting Independence initiative. The HMO must maintain the documentation of the assessments completed and make them available for state review at any time. It is possible that the STAR+PLUS HMO will be unaware of the Member’s entry into a nursing facility. It is the responsibility of the nursing facility to review the Member’s Medicaid card upon entry into the facility and notify the HMO. The nursing facility is also required to notify HHSC of the entry of a new resident.
Waiver Services. State Plan Amendments
a. HIV/AIDS Targeted Case Management (TCM) Program
Waiver Services. If the initial review does not support a return to the community, the Service Coordinator will conduct a second assessment 90 days after the initial assessment to determine any changes in the individual’s condition or circumstances that would allow a return to the community. The Service Coordinator will develop and implement the transition plan. The MCO will provide these services as part of the PI initiative. The MCO must maintain the documentation of the assessments completed and make them available for state review at any time. It is possible that the STAR+PLUS MCO will be unaware of the Member’s entry into a nursing facility. It is the responsibility of the nursing facility to review the Member’s Medicaid card upon entry into the facility and notify the MCO. The nursing facility is also required to notify HHSC of the entry of a new resident.
Waiver Services. Defendant will provide additional Waiver Services, in conjunction with covered EPSDT services, to support members of the Class, help maintain them in their homes and communities, and avoid higher levels of care and out-of-home placements. These services are defined in Appendix A of this Agreement.
Waiver Services. 113 6.9.16 Drugs covered under the Medicare Prescription Drug Program 113 6.9.17 Nursing Facility Services. 113 6.9.18 Other. 113 6.10 Enrollee Liability. 113 6.10.1 Copayments. 113 6.10.2 Limitation. 113 6.11 Penalty for Illegal Remuneration. 114
Waiver Services. State Plan Amendments
a. HIV/AIDS Waiver Program The Contractor must arrange for and provide services to persons with AIDS or symptomatic HIV the same as those provided under the Department's AIDS Waiver Program. Individuals enrolled in the Department's AIDS Waiver Program who would not otherwise be eligible for MA, are included in HealthChoices. The Contractor shall be responsible for tracking these Members in accordance with federal reporting requirements. A full description of the AIDS Waiver Program can be found in the HealthChoices Proposers' Library.
b. HIV/AIDS Targeted Case Management (TCM) Program The Contractor must ensure the provision of TCM services for persons with AIDS or symptomatic HIV, including access to needed medical and social services using the existing TCM program standards of practice followed by the Department or comparable standards approved by the Department. In addition, individuals within the PH-MCO who provide the TCM services must meet the same qualifications as those under the Department's TCM Program. A full description of the TCM Program including practice standards for case managers, can be found in the HealthChoices Proposers' Library.
c. Michael Dallas Waiver (MDW) Program The Contractor must arrange for and provide enhanced medical benefits to technology-dependent individuals under age twenty-one (21), equal or in addition to that provided under the Department's MDW Program, to minimize hospitalization/institutionalization of the child. MA Consumers currently receiving services through the MDW Program and deemed MA eligible solely through the MDW in the future are exempt from the HC-L/C Program. MA Consumers age 21 years and older currently receiving home and community based services through the MDW, will be enrolled in HealthChoices but all waiver services will be covered under the MA FFS delivery system.
Waiver Services. If the initial review does not support a return to the community, the Service Coordinator will conduct a second assessment 90 days after the initial assessment to determine any changes in the individual’s condition or circumstances that would allow a return to the community. The Service Coordinator will develop and implement the transition plan. Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 8 Version 1.7 The HMO will provide these services as part of the Promoting Independence initiative. The HMO must maintain the documentation of the assessments completed and make them available for state review at any time. It is possible that the STAR+PLUS HMO will be unaware of the Member’s entry into a nursing facility. It is the responsibility of the nursing facility to review the Member’s Medicaid card upon entry into the facility and notify the HMO. The nursing facility is also required to notify HHSC of the entry of a new resident.