Dual Eligible Enrollee definition

Dual Eligible Enrollee means an Enrollee who is simultaneously eligible for Medicaid and Medicare benefits. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services mean comprehensive and preventive health care services for children who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Special Services means necessary health care, diagnostic services, treatment, and other measures described in Section 1905(a) of the Social Security Act to correct or ameliorate defects and physical and mental illnesses, and conditions identified by EPSDT screening services for children who are enrolled in Medicaid, whether or not such services are covered under the State Medicaid Plan.
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Examples of Dual Eligible Enrollee in a sentence

  • The Contractor will receive two monthly capitation payments for each Dual Eligible Enrollee: one amount from Medicare and a second amount from MassHealth.

  • When a Dual Eligible Enrollee is being discharged from the hospital, the Contractor shall assure that the Enrollee receives a written notice of explanation required by 42 CFR §§ 422.620-622.

  • The MCO may not request disenrollment of Enrollee for any reason, except a Dual Eligible Enrollee, as described in section 3.21.4(B).

Related to Dual Eligible Enrollee

  • Potential Enrollee means a Medical Assistance Recipient who may voluntarily elect to enroll in a given managed care program, but is not yet an Enrollee of an MCO.

  • Enrollee means any person entitled to health care services from a carrier.

  • Adult basic education means education or instruction

  • Eligible veteran means an individual who is certified by the Wisconsin Department of Veterans Affairs as meeting all of the following conditions:

  • Late enrollee means an eligible employee or dependent who

  • Level of service has the meaning set forth in Section 2.02(c).

  • Number of Students Who Began Program means the number of students who began the program who are scheduled to complete the program within the reporting calendar year.

  • Child day care center and "center" means any place in which child day care is provided for thirteen or more children at one time or any place that is not the permanent residence of the licensee or administrator in which child day care is provided for seven to twelve children at one time. In counting children for the purposes of this definition, any children under six years of age who are related to a licensee, administrator or employee and who are on the premises of the center shall be counted.

  • Newborn means a baby less than nine days old.

  • Adult day care center means any facility that is either operated for profit or that desires licensure

  • Qualifying Educational Program means a program at a post-secondary school level of not less than three consecutive weeks duration that requires each student taking the program to spend not less than 10 hours per week on courses or work in that program.

  • Eligible patient means an individual who meets all of the following conditions:

  • Provider network means an affiliated group of varied health care providers that is established to provide a continuum of health care services to individuals;

  • School-age child means a child age five through 12 years old.

  • Cultural Competence means the ability to recognize and respond to health-related beliefs and cultural values, disease incidence and prevalence, and treatment efficacy. Examples of cultural competent care include striving to overcome cultural, language, and communications barriers, providing an environment in which individuals from diverse cultural backgrounds feel comfortable discussing their cultural health beliefs and practices in the context of negotiating treatment options, encouraging individuals to express their spiritual beliefs and cultural practices, and being familiar with and respectful of various traditional healing systems and beliefs and, where appropriate, integrating these approaches into treatment plans.

  • Adult foster care facility means an adult foster care facility licensed under the adult foster care facility licensing act, 1979 PA 218, MCL 400.701 to 400.737.

  • Eligible entity means a political subdivision that has:

  • Medicare eligible expenses means expenses of the kinds covered by Medicare Parts A and B, to the extent recognized as reasonable and medically necessary by Medicare.

  • Denial of Service Attack means an attack intended by the perpetrator to overwhelm the capacity of a "computer system" by sending an excessive volume of electronic data to such "computer system" in order to prevent authorized access to such "computer system".

  • Approved abuse education training program means a training program using a curriculum approved by the abuse education review panel of the department of public health or a training program offered by a hospital, a professional organization for physicians, or the department of human services, the department of education, an area education agency, a school district, the Iowa law enforcement academy, an Iowa college or university, or a similar state agency.

  • Cultural Competency means the ability to recognize, respect, and address the unique needs, worth, thoughts, communications, actions, customs, beliefs and values that reflect an individual’s racial, ethnic, religious, sexual orientation, and/or social group.

  • Terms of Service means those Support Services and Professional Services terms posted at xxxx://xxx.XXXXXXX.xxx/terms-of-service/, which are incorporated herein. Client acknowledges and agrees it has read, understands and agrees to be bound by the Terms of Service.

  • Adult education means all education or instruction,

  • Preschool age child means a child age three through five not yet attending kindergarten. If a child is older than age five and not attending kindergarten or a higher grade, OCCL considers that child in the preschool-age group.

  • Switched Access Service means an offering of facilities for the purpose of the origination or termination of traffic from or to Exchange Service customer in a given area pursuant to a Switched Access tariff. Switched Access Services include: Feature Group A, Feature Group B, Feature Group D, 800 Series, and 900 access. Switched Access does not include traffic exchanged between LECs for purpose of local exchange interconnection.

  • Support Service means an activity, such as information technology, accounting, human resources, legal, and other support functions that are required to support the ongoing delivery of core services.