Eligibility Review Clause Samples

Eligibility Review. Borrowers re- ceiving interest assistance will be re- viewed annually within 30 to 60 days prior to the anniversary date of the loan. All existing agreements must be reviewed and processed for the upcom- ing 12 months during the review period. Interest assistance will not be renewed if the amount that the borrower quali- fies for is less than $20 per month. (1) The Lender will obtain written verification of the income of each bor- rower and all adult members of the borrower’s household and conduct the review.

Eligibility Review. The IRO shall perform the Verification Review annually to cover each of the five Reporting Periods. The IRO shall perform all components of each Verification Review.

Eligibility Review. The IRO shall select a Beneficiary Sample. For each Medicare beneficiary in the Beneficiary Sample, the IRO shall randomly select a Claim Period to be reviewed (Selected Claim Period). The IRO shall review the medical records of each Medicare beneficiary in the Beneficiary Sample based on the supporting documentation available at VITAS's offices or under VITAS's control and applicable billing and coding regulations and guidance to determine whether the beneficiary was eligible for hospice services for the Selected Claim Period. For any beneficiary in the Beneficiary Sample that results in a determination by the IRO that the beneficiary was not eligible for the hospice benefit during the Selected Claim Period, the IRO shall review all claims for hospice services billed by VITAS for that beneficiary to determine whether the beneficiary was eligible for hospice services. The IRO shall submit a supplemental report no later than 90 days after the IRO completes its report. VITAS shall refund any Overpayments identified as a result of this additional review and documentation of the refund of any identified Overpayments shall be made available to OIG upon request. Additionally, the IRO shall perform a review of the system(s) and process(es) that resulted in VITAS's erroneous determination that the beneficiary was eligible for the hospice benefit, to identify any problems or weaknesses that may have resulted in the identified error(s). The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) for determining eligibility for the hospice benefit.

Eligibility Review. The IRO shall select a Beneficiary Sample. The IRO shall review the medical records of the Medicare and Medicaid beneficiaries in the Beneficiary Sample to determine whether the beneficiaries were eligible for hospice services for each Claim Period for which a claim was submitted since the date of admission. The IRO shall review medical records for the Medicare beneficiaries selected based on the supporting documentation available at HOK’s offices or under HOK’s control and applicable billing and coding regulations and guidance to determine whether the Medicare or Medicaid beneficiary was eligible for the hospice‌ benefit during each Claim Period.‌ For any beneficiary in the Beneficiary Sample that results in a determination by the IRO that the beneficiary was not eligible for the hospice benefit during the Claim Period, the IRO shall perform a review of the system(s) and process(es) that resulted in ▇▇▇’s erroneous determination that the beneficiary was eligible for the hospice benefit, to identify any problems or weaknesses that may have resulted in the identified error(s). The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) for determining eligibility for the hospice benefit.

Eligibility Review. Vendor shall initiate the eligibility determination workflow and ensure the appropriate step (e.g., Florida KidCare Application received, under review, pending information, eligibility approved, enrollment pending payment, enrolled) is reflected in the CRM System. Vendor shall notify the Customer if any additional information is required to complete the eligibility determination. Vendor shall apply any new information received to the Family Account. Vendor shall follow business rules codified in a business rules engine to screen for potential Medicaid eligibility and determine eligibility for the Program. Customers may submit documents affecting their eligibility status at any time during their 12- month continuous eligibility period. Vendor shall conduct an eligibility review at that time.

Eligibility Review. Verify that discounted college month and/or semester passes are only sold to students who meet the eligibility requirement for enrollment, as set forth by MTS Fare Ordinance No. 4. This includes students with a current enrollment for seven (7) units or more, or the equivalent non-unit hours, at an accredited post-secondary school.

Eligibility Review. The Eligibility Review Team shall perform the Eligibility Review annually to cover each of the five Reporting Periods. Subject to the IRO Verification Review and Section III.D.4 of the CIA, as applicable, the Eligibility Review Team shall perform all components of each Eligibility Review.

Eligibility Review. (a) The Co-op will review the eligibility of each household that applies for special needs housing. (b) Each year the Co-op will review the eligibility of each household on the special needs waiting list and each household occupying a special needs unit. (c) Eligibility criteria will be determined under Government Requirements. If these are not complete enough, the Board will make any other required decisions regarding eligibility criteria. The Board can consult others as stated in clause (g). (d) The Board will adopt all necessary additional detailed procedures. (e) Members and applicants must co-operate and provide any information requested by the Co-op in connection with the review. (f) Members must give the Co-op written notice within 30 calender days of: · any change in any information relating to a household’s eligibility for a modified unit or special needs housing · any change in a document previously given to the Co-op, the Service Manager or a support services agency relating to a household’s eligibility for special needs housing. (g) The Board will not make determinations of eligibility itself (except on an internal review). Determination of eligibility will be made, in whole or in part by: · a staff person, · a committee (not including directors) or · a support services agency. Who makes the decision may be different depending on the type of special needs housing. The Board will decide who will make the decision. The Board will ask the decision-maker to sign a confidentiality agreement, if the confidentiality provisions of the Co-op’s by-laws do not apply to them, unless they are bound by professional or other adequate confidentiality obligations. S O C I A L H O U S I N G R E F O R M A C T B Y - L A W 23 (h) Article 6 (Procedures for Decisions, Internal Reviews and Notices) will apply with respect to decisions relating to eligibility. (i) Households could cease to be eligible because of a change in the medical condition of a member of the household or the death of a member of a household or for other reasons. (j) If a household on the waiting list is not eligible, or is no longer eligible, for a unit, then it will be removed from the waiting list. (k) If a household occupying a unit at the Co-op ceases to be eligible, Article 3 (Internal transfers) will apply.

Eligibility Review. Odyssey Hospice’s Eligibility Review Team, composed of individuals listed in Appendix B, shall review the eligibility of Odyssey Hospice’s Medicare beneficiaries for the hospice services those Medicare beneficiaries received and shall prepare an Eligibility Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference. Odyssey Corporate Integrity Agreement