Examples of Pool of Funds in a sentence
The Center has approved the application and issued approvals to the family, the vendor of the service, and the child’s primary and specialty physicians.2. Once deemed eligible, the financial and insurance status of the child shall be checked each time the family seeks access to the Pool of Funds to verify that there have been no changes in income or insurance benefits.
When a center desires input from other CCC centers on a client request not covered by the CSHCN Pool of Funds Guidelines, it can canvas all centers.
Underinsured children with gross family income up to 300% of FPL may request use of the Pool of Funds if (1) the family has exhausted its insurance appeal process or (2) a major life event (loss of employment, legal marital separation, death of a spouse, etc.) has affected the family’s ability to pay out-of-pocket medical expenses.
Pool of Funds can only be accessed for services not reimbursable by Medicaid.
Dependency on one of the following to compensate for or minimize limitation of function, activities, or social role: medications, special diet, medical technology, assistive devices or personal assistance.Persons with the following diagnoses do not meet criteria for CCC case management or Pool of Funds.
Before the Pool of Funds can be accessed, written proof that the insurance does not cover the service must be received.
See additional information at http://uscis.gov/graphics/services/visas.htm Financial Requirements The Pool of Funds program is designed for families with gross family income at or below 300% of the Federal Poverty Level (FPL) based on the Virginia Department of Health’s Regulations Governing Financial Eligibility for Services (12 VAC 5-200).
Underinsured Underinsured children with private (non-Medicaid) insurance can access the Pool of Funds if their insurance does not cover medically necessary services, i.e., hearing aids, medication, equipment, etc.
Appeal Process If a request for assistance from the Pool of Funds is denied and the Center appeal process is exhausted, the family may appeal the decision in writing to the Director of the Children with Special Health Care Needs Program at the Virginia Department of Health.
Covered Services Covered services under Pool of Funds (POF) distribution are services that are medically necessary for the treatment and monitoring of a covered condition.