LHD Eligibility Determination Clause Samples

LHD Eligibility Determination. LHD is responsible for conducting Members’ financial and residential eligibility determinations. DHCS must determine Members’ medical eligibility, initially and on an annual basis, for CCS-Eligible Condition(s) based on evaluation of documentation provided by MCPs or by a CCS paneled provider. DHCS must notify LHD of Members who meet the medical eligibility criteria and must assist LHD with ensuring such Members are enrolled in its CCS Program. i. LHD must assist its CCS Program with obtaining, and may request from MCPs, any additional information required (e.g., medical reports) to determine CCS Program eligibility. ii. LHD must ensure its CCS Program informs the Member and their family (or designated legal caregiver) of the CCS eligibility determination. iv. DHCS is responsible for creating a NOA for a Member who is denied services or is determined to be medically ineligible, and LHD is responsible for sending such NOA to a Member evaluated for its CCS Program. v. If LHD receives a Member referral through an Inter-County Transfer, the CCS Program must complete applicable activities as set forth in the DHCS CCS Inter-county Transfer NL.