Waiver Programs Sample Clauses

Waiver Programs. (All Plans) The member is or will be participating in CLTS, FamilyCare, IRIS, Pace, or Partnership, other home and community waiver programs. The HMO must inform the Enrollment Specialist of the effective dates that the member is/was participating in the waiver program to accommodate a timely disenrollment. Disenrollment shall be effective the first month in which the member entered the other program. Disenrollments are not backdated more than four months from the date the request is received. Any capitation payments made for months subsequent to disenrollment will be recouped.
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Waiver Programs. The Contractor will maintain systems for identifying and referring Members to the appropriate waiver program. If the agency administering the waiver program concurs with the Contractor's assessment of the Member and there is available placement in the waiver program, the Contractor will initiate Disenrollment for the Member. The Contractor will provide documentation to ensure the Member's orderly transfer to the Medi-Cal Fee-For-Service program. If the Member does not meet the criteria for the waiver program, or if placement is not available, the Contractor will continue to case manage and provide all Medically Necessary services to the Member. ▇▇▇▇▇▇ Medical Centers 95-23637 Article VI
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Waiver Programs. Contractor shall maintain systems for identifying and referring Members to the appropriate waiver program, including the In-Home Medical Care Waiver Program, the Skilled Nursing Facility Waiver Program, the Model Waiver Program, the Acquired Immune Deficiency (AIDS) and AIDS Related Conditions Waiver Program, and the Multipurpose Senior Services Waiver Program. If the agency administering the waiver program concurs with Contractor's assessment of the Member and there is available placement in the waiver program, Contractor shall initiate Disenrollment for the Member. Contractor shall provide documentation to ensure the Member's orderly transfer to the Medi-Cal Fee-For-Service program. If the Member does not meet the criteria for the waiver program, or if placement is not available, Contractor shall continue to case manage and provide all Medically Necessary Covered Sservices to the Member. 116. Article VI, SCOPE OF WORK, Section 6.7.3.1, Miscellaneous Service Carve Outs, is amended to read:
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Waiver Programs. Contractor shall initiate disenrollment for the Member if the Member elects to join any of the following waiver programs identified in Section 2.21 b), In-Home Medi-Cal Waiver Program, Skilled Nursing Facility Waiver Program; the Model Waiver Program; the agency administering the waiver program concurs with Contractor’s assessment of the Member; and there is available placement in the waiver program. Contractor shall follow this procedure: a) Identify and refer Members to the appropriate waiver program; b) Seek concurrence from the waiver program; and c) Upon the Member’s acceptance into waiver program provide documentation to ensure the Member’s orderly transfer to the Medi-Cal FFS program. If the Member does not meet the criteria for the waiver program, or if the placement is not available, the Member will not be disenrolled and Contractor shall continue Medical Case Management and provide all Medically Necessary Covered Services to the Member.
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Waiver Programs. DHCS administers a number of Medi-Cal Home and Community Based Services (HCBS) Waiver programs authorized under Section 1915(c) of the Social Security Act. Contractor shall have procedures in place to identify Members who may benefit from the HCBS Waiver programs, and refer Members to the agency administrating the waiver program. These waiver programs include, but are not limited to, the nursing facility/acute hospital waiver. If the agency administering the waiver program concurs with Contractor’s assessment of the Member and there is available placement in the waiver program, the Member will receive HCBS waiver services while remaining enrolled with Contractor. Contractor shall continue comprehensive case management and shall continue to cover all Medically Necessary Covered Services to the Member. If the Member does not meet the criteria for the HCBS Waiver Program, or if placement is not available, Contractor shall continue to case manage and provide all Medically Necessary covered Services to the Member.
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Waiver Programs. DHCS administers a number of Medi-Cal Home and Community Based Services (HCBS) Waiver programs authorized under Section 1915(c) of the Social Security Act. Contractor shall have procedures in place to identify Members who may benefit from the HCBS Waiver programs, and refer Members to the agency administrating the waiver program. These waiver programs include, but are not limited to, the nursing facility/acute hospital waiver. If the agency administering the waiver program concurs with Contractor’s assessment of the Member and there is available placement in the waiver program, the Member will receive HCBS waiver services while remaining enrolled with Contractor. Contractor shall continue comprehensive case management and shall continue to cover all Medically Necessary Covered Services to the Member. If the Member does not meet the criteria for the HCBS Waiver Program, or if placement is not available, Contractor shall continue to case manage and provide all Medically Necessary covered Services to the Member. 1. Subcontracts‌‌‌‌‌‌‌‌‌‌‌ Contractor shall negotiate in good faith and execute a Subcontract for public health services listed in Paragraph A through Paragraph D below with the Local Health Department (LHD) in each county that is covered by this Contract. The Subcontract shall specify: the scope and responsibilities of both parties in the provision of services to Members; billing and reimbursements; reporting responsibilities; and how services are to be coordinated between the LHD and the Contractor, including exchange of medical information as necessary. The Subcontract shall meet the requirements contained in Exhibit A, Attachment 6, Provision 13, regarding Subcontracts. A. Family Planning Services: as specified in Exhibit A, Attachment 8, Provision 9. B. STD services for the disease episode, as specified in Exhibit A, Attachment 8, Provision 10, by DHCS, for each STD, including diagnosis and treatment of the following STDs: syphilis, gonorrhea, chlamydia, herpes simplex, chancroid, trichomoniasis, human papilloma virus, non- gonococcal urethritis, lymphogranuloma venereum and granuloma inguinale. C. HIV Testing and Counseling as specified in Exhibit A, Attachment 8, Provision 11. D. Immunizations as specified in Exhibit A, Attachment 8, Provision 12. To the extent that Contractor does not meet this requirement on or before four (4) months after the effective date of this Contract, Contractor shall submit documentation substantiating reasonable efforts to ent...
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Waiver Programs. CDHS administers a number of Medi-Cal Home and Community Based Services (HCBS) Waiver Programs authorized under section 1915(c) of the Social Security Act. Contractor shall have procedures in place to identify Members who may benefit from the HCBS Waiver programs, and refer them to the Medical Care Coordination and Case Management Section of CDHS. These waiver programs include the In-Home Medical Care Waiver, the Nursing Facility Subacute Waiver, and the Nursing Facility A/B Waiver. If the agency administering the waiver program concurs with Contractor’s assessment of the Member and there is available placement in the waiver program, Contractor shall initiate disenrollment for the Member. Contractor shall provide documentation to ensure the Member’s orderly transfer to the Medi-Cal Fee-For-Service program. If the Member does not meet the criteria for the waiver program, or if placement is not available, Contractor shall continue comprehensive case management and shall continue to cover all Medically Necessary Covered Services to the Member.
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Related to Waiver Programs

  • Other Programs Nothing contained in this performance stock unit agreement shall affect the right of the Award Holder to participate in and receive benefits under and in accordance with the then current provisions of any pension, insurance, profit-sharing or other employee benefit plan or program of the Corporation or of any Subsidiary of the Corporation.

  • Mentor Program a. Each new Bargaining Unit Member (first year employee) shall be assigned a mentor. An exception may be made, as determined by the Superintendent, for new part-time Bargaining unit Members of whom have prior service in the same program operated by the Board. The mentor shall assist the new Bargaining Unit Member in general teaching procedures, techniques, classroom planning and organization, school functions and regulations and other areas of professional growth and development. The Association President in collaboration with the Lead Mentor/Resident Educator Coordinator and appropriate Directors shall submit nominations of three (3) qualified staff members to the Superintendent, after obtaining the candidates’ permission. The Superintendent may elect to nominate one of the candidates to the Board of Education for assignment, or ask the Association President and Lead Mentor/Resident Educator Coordinator for additional nominations. b. No mentor shall be assigned more than one new Bargaining Unit Member per year. The mentor shall not be involved in any way in the formal evaluation of the new Bargaining Unit Member, but shall confer with the assigned Supervisor on the strengths and weaknesses of the new unit member and his or her overall performance and progress. In order to be assigned, mentors must possess the following qualifications: i. At least two (2) years of successful teaching experience at Tolles. ii. A variety of teaching experience. iii. An ability and willingness to help improve another teacher. c. Mentors shall attend one or two (2) training seminars held outside the regular workday. The Association President in collaboration with the Lead Mentor/Resident Educator Coordinator and appropriate Directors will draft a list of tasks which mentors are to perform. d. Mentor teachers shall certify that they have spent a minimum of 15 hours during the school year in mentor training and working with their assigned new Bargaining Unit Member. The new Bargaining Unit Member may make written application to the Superintendent for up to 15 hours additional mentor service. The mentor teacher, the new Bargaining Unit Member, and the Superintendent or Superintendent’s designee, will meet to discuss a plan of action for additional hours requested. Mentor teachers shall be paid for the documented work hours at the hourly rate of $30. The payment shall be in a one-time lump sum at the end of the school year. e. If there are teachers who are new to the District, the Lead Mentor will receive two (2) days extended time to work with new teachers and the administration before the regular instructional year for the purpose of training new staff members in the successful use of the teacher handbook, school regulations, and operational procedures.

  • Programs An expression of a combination of instructions that causes a computer to function so that it is capable of obtaining a certain result.

  • Special Programs In consideration of the sale of the Eligible Loans under these Master Sale Terms and each Sale Agreement, Purchaser agrees to cause the Servicer to offer borrowers of Trust Student Loans all special programs whether or not in existence as of the date of any Sale Agreement generally offered to the obligors of comparable loans owned by ▇▇▇▇▇▇ Mae subject to the terms and conditions of Section 3.12 of the Servicing Agreement.

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