Medically frail means that term as described in 42 CFR 440.315(f).
Medically frail means that term as defined in section 35(22).
Medically frail means an Adult Member who would be covered under the Alternative Benefit Plan (ABP) but who has been determined as meeting HSD’s definitions and criteria for the following conditions: (i) disabling mental disorder, including individuals up to age 21 with serious emotional disturbances and adults with serious mental illness; (ii) a chronic substance use disorder; (iii) a serious and complex medical condition as defined by HSD in Section 13 of the Policy Manual; (iv) a physical, intellectual or developmental disability that significantly impairs the Member’s ability to perform one or more activities of daily living; or (v) a disability determination based on Social Security criteria. Medically Necessary means physical, behavioral health, and long-term services and supports, and supplies, that: (i) are essential to prevent, diagnose or treat medical conditions or are essential to enable the Member to attain, maintain or regain the Member's optimal functional capacity; (ii) are delivered in the amount, duration, scope and setting that are both sufficient and effective to reasonably achieve their purposes and clinically appropriate to the specific physical, behavioral health, and long-term care needs of the Member; (iii) are provided within professionally accepted standards of practice and national guidelines; (iv) are required to meet the physical, behavioral health, and long-term care needs of the Member and are not primarily for the convenience of the Member, the provider, or the CONTRACTOR; and (v) are reasonably expected to achieve appropriate growth and development as directed by HSD. Member means a person who has been determined eligible for Centennial Care and who has enrolled in the CONTRACTOR’s MCO. Member Advisory Board shall have the meaning ascribed to such term in Section 4.12.2 of this Agreement. Member Materials shall have the meaning ascribed to such term in Section 4.14 of this Agreement.
Examples of Medically frail in a sentence
Medically frail beneficiaries above the 100 percent of the FPL who do not make monthly POWER account contributions would have cost sharing described in STC 11(c) of this section.
Medically frail beneficiaries above the 100 percent of the FPL who do not make monthly POWER account contributions shall have cost sharing described in STC 10(c) of this section.
Medically frail newly eligible adults will be enrolled in the High Risk Benefit Plan and may choose to receive services through the Low Risk Plan.
Medically Frail 405 IAC 10-6-1 Medically frail screening Authority: IC 12-15-44.2-19Affected: IC 12-15-44.2; IC 27-8-10.1 Sec.
TPUD has quality control processes embedded in its existing general practices.
More Definitions of Medically frail
Medically frail means an individual who, in accordance with the process in 405 IAC 10-6-1, is determined to have any one (1) of the following:
Medically frail means an individual who is a minimal threat to
Medically frail means an Adult Member who would be covered under the ABP but who has been determined as meeting HCA’s definitions and criteria for the following conditions: (i) disabling mental disorder, including individuals up to age twenty-one (21) with serious emotional disturbances (SEDs) and adults with serious mental illness (SMI); (ii) a chronic substance use disorder; (iii) a serious and complex medical condition as defined by HCA in Section 13 of the Managed Care Policy Manual; (iv) a physical, intellectual, or developmental disability that significantly impairs the Member’s ability to perform one (1) or more activities of daily living (ADL); or (v) a disability determination based on Social Security criteria. Medically Necessary means Physical Health, Behavioral Health, and LTSS, and supplies, that:
Medically frail means an individual who has a mental or physical
Medically frail means an individual in the adult expansion population who meets
Medically frail means an Adult Member who would be covered under the ABP but who has been determined as meeting HCA’s definitions and criteria for the following conditions: (i) disabling mental disorder, including individuals up to age twenty-one (21) with serious emotional disturbances (SEDs) and adults with serious mental illness (SMI); (ii) a chronic substance use disorder; (iii) a serious and complex medical condition as defined by HCA in Section 13 of the Managed Care Policy Manual; (iv) a physical, intellectual, or developmental disability that significantly impairs the Member’s ability to perform one (1) or more activities of daily living (ADL); or (v) a disability determination based on Social Security criteria. Medically Necessary means Physical Health, Behavioral Health, and LTSS, and supplies, that: (i) are essential to prevent, diagnose or treat medical conditions or are essential to enable the Member to attain, maintain, or regain the Member's optimal functional capacity; (ii) are delivered in the amount, duration, scope and setting that are both sufficient and effective to reasonably achieve their purposes and clinically appropriate to the specific Physical Health, Behavioral Health, and LTC needs of the Member; (iii) are provided within professionally accepted standards of practice and national guidelines; (iv) are required to meet the Physical Health, Behavioral Health, and LTC needs of the Member and are not primarily for the convenience of the Member, the Provider, or the CONTRACTOR; and (v) are reasonably expected to achieve appropriate growth and development as directed by HCA.
Medically frail means an Adult Member who would be covered under the Alternative Benefit Plan (ABP) but who has been determined as meeting HSD’s definitions and criteria for the following conditions: (i) disabling mental disorder, including individuals up to age 21 with serious emotional disturbances and adults with serious mental illness; (ii) a chronic substance use disorder; (iii) a serious and complex medical condition as defined by HSD in Section 13 of the Medically Necessary means physical, behavioral health, and long-term services and supports, and supplies, that: (i) are essential to prevent, diagnose or treat medical conditions or are essential to enable the Member to attain, maintain or regain the Member's optimal functional capacity; (ii) are delivered in the amount, duration, scope and setting that are both sufficient and effective to reasonably achieve their purposes and clinically appropriate to the specific physical, behavioral health, and long-term care needs of the Member; (iii) are provided within professionally accepted standards of practice and national guidelines; (iv) are required to meet the physical, behavioral health, and long-term care needs of the Member and are not primarily for the convenience of the Member, the provider, or the CONTRACTOR; and (v) are reasonably expected to achieve appropriate growth and development as directed by HSD. Member means a person who has been determined eligible for Centennial Care and who has enrolled in the CONTRACTOR’s MCO. Member Advisory Board shall have the meaning ascribed to such term in Section 4.12.2 of this Agreement. Member Materials shall have the meaning ascribed to such term in Section 4.14 of this Agreement.