1915(c) Habilitation Supports Waiver Payments Sample Clauses

1915(c) Habilitation Supports Waiver Payments. The 1915(c) Habilitation Supports Waiver (HSW) capitation payment will be made to the PIHPs based on HSW beneficiaries who have enrolled through the MDCH enrollment process and have met the following requirements: Has a developmental disability (as defined by Michigan law) Is Medicaid-eligible (as defined in the CMS approved waiver) Is residing in a community setting If not for HSW services would require ICF/MR level of care services Chooses to participate in the HSW in lieu of ICF/MR services Receives at least one HSW approved service to each month enrolled Beneficiaries enrolled in the HSW may not be enrolled simultaneously in any other 1915(c) waiver, such as the Children’s Waiver Program (CWP) and Children with Serious Emotional Disturbance Waiver (SEDW). The PIHP will not receive payments for HSW enrolled beneficiaries who reside in an ICF/MR, Nursing Home or are incarcerated for an entire month. The PIHP will not receive payments for HSW enrolled beneficiaries enrolled with a Program All Inclusive Care (PACE) organization.
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1915(c) Habilitation Supports Waiver Payments. The 1915(c) Habilitation Supports Waiver capitation payment will be made to PIHPs based on all Medicaid eligibles within the PIHP region, excluding Children’s Waiver enrollees, persons residing in a ICF/MR-DD (MPC/CARO) individuals enrolled in a Program for All Inclusive Care (PACE) organization. SED Waiver enrollees, and individuals incarcerated who are also enrolled in the 1915(c) HSW, The HSW payment will include payment for months associated with periods of retro-eligibility including persons who met the spend-down requirements for a prior month. Additionally, the capitation payment will be adjusted each month for 1) recovery of payments for Medicaid eligibles who DCH has subsequently been notified of their date of death and 2) recovery of payments previously made on behalf of Medicaid eligibles enrolled in the HSW who, upon a retrospective review did not meet all the HSW enrollment criteria e. g. did not receive a 1915 (c) service within the payment month. This HSW payment will be scheduled the third Wednesday of the month. For those PIHPs opting to receive an EFT, the payment will be available on the Thursday following the third Wednesday of the month. When applicable, additional payments may be scheduled (i.e. retro-rate implementation). . HIPAA compliant 834 and 820 transactions will provide eligibility and remittance information. Encounters submitted on a HIPAA compliant 837 will be used to verify receipt of service. Continued HSW enrollment and monthly 1915(c) capitation payment will be made only for individuals who meet all of the following criteria:

Related to 1915(c) Habilitation Supports Waiver Payments

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  • Retiree Benefits – Process for Payment Any bargaining unit nurse who retires and wishes to participate in the benefit plans as outlined in article 17.01(h) will provide advance payment of the benefits either through post-dated cheques provided on a yearly basis or through a preauthorized withdrawal process. It is understood that any transaction would be dated the first of each and every month. The Employer will notify the Union of the benefit costs to retired nurses in January of each year, and each time the benefit costs are renegotiated by the Employer.

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  • Arrangements for Payment of GAG and EAG 57) The Secretary of State shall notify the Company at a date preceding the start of each Academy Financial Year of the GAG and EAG figures in respect of each Academy which, subject to Parliamentary approval, the Secretary of State plans for that Academy Financial Year and of the assumptions and figures on which these are based.

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  • CERTIFICATION PROHIBITING DISCRIMINATION AGAINST FIREARM AND AMMUNITION INDUSTRIES (Texas law as of September 1, 2021) By submitting a proposal to this Solicitation, you certify that you agree, when it is applicable, to the following required by Texas law as of September 1, 2021: If (a) company is not a sole proprietorship; (b) company has at least ten (10) full-time employees; (c) this contract has a value of at least $100,000 that is paid wholly or partly from public funds; (d) the contract is not excepted under Tex. Gov’t Code § 2274.003 of SB 19 (87th leg.); and (e) governmental entity has determined that company is not a sole-source provider or governmental entity has not received any bids from a company that is able to provide this written verification, the following certification shall apply; otherwise, this certification is not required. Pursuant to Tex. Gov’t Code Ch. 2274 of SB 19 (87th session), the company hereby certifies and verifies that the company, or association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned subsidiary, majority-owned subsidiary parent company, or affiliate of these entities or associations, that exists to make a profit, does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association and will not discriminate during the term of this contract against a firearm entity or firearm trade association. For purposes of this contract, “discriminate against a firearm entity or firearm trade association” shall mean, with respect to the entity or association, to: “(1) refuse to engage in the trade of any goods or services with the entity or association based solely on its status as a firearm entity or firearm trade association; (2) refrain from continuing an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; or (3) terminate an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association. See Tex. Gov’t Code § 2274.001(3) of SB 19. “Discrimination against a firearm entity or firearm trade association” does not include: “(1) the established policies of a merchant, retail seller, or platform that restrict or prohibit the listing or selling of ammunition, firearms, or firearm accessories; and (2) a company’s refusal to engage in the trade of any goods or services, decision to refrain from continuing an existing business relationship, or decision to terminate an existing business relationship to comply with federal, state, or local law, policy, or regulations or a directive by a regulatory agency, or for any traditional business reason that is specific to the customer or potential customer and not based solely on an entity’s or association’s status as a firearm entity or firearm trade association.” See Tex. Gov’t Code § 2274.001(3) of SB 19.

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