Common use of Intake Clause in Contracts

Intake. Intake begins when you or someone calls on your behalf or comes to LIFE. • If it appears from this conversation that you are potentially eligible, a LIFE Enrollment Specialist will schedule a visit to your home, explain our program and conduct a preliminary screening. • We will ask that you sign a release of information allowing us to obtain your past medical records so our Interdisciplinary Team can fully assess your health status. • Gathering this information will allow you to attend the LIFE center so that you can get to know us and have your health needs evaluated by each Interdisciplinary Team Member. A tuberculosis skin test(s) or a chest x-ray, or proof of within the last year is required during the enrollment/ intake process. Testing will be done at intake if needed and results will not impact or preclude enrollment. • LIFE is committed to serving the elderly who need long-term care; therefore, an independent opinion must confirm that your health status qualifies you to join the PACE program administered by LIFE St. ▇▇▇▇▇▇ of the Pines. • Our LIFE Staff will complete the information on the North Carolina Medicaid Program Long Term Care Services Assessment tool and will submit to the Division of Medical Assistance. • The Division of Medical Assistance will review this Assessment tool submitted by LIFE and determine if you are eligible for nursing home care by state requirements. In the event that the Division of Medical Assistance finds that you are not eligible for nursing home care by state requirements, you will not be able to enroll into the program. If we determine you are not able to live safely in the community, your enrollment will be denied. LIFE will work with you to make other arrangements for the care you need. You have the right to appeal your eligibility determination or a denial of enrollment. This appeal should be made through the State Fair Hearing Process through the Office of Administrative Hearings: If you are a Medicare Beneficiary or Private Pay for the LIFE program you can contact: • Should the Division of Medical Assistance approve that you are eligible for nursing home care by state requirements, assessments will occur in the LIFE Center and in your home. • First, the In-Home Services Coordinator, RN, a member of the Interdisciplinary Team, will coordinate a time to visit you in your home and determine if you can live safely in the community with LIFE services. There may be other members of the Interdisciplinary Team who may also visit you in your home. • Next, the Interdisciplinary Team and an Enrollment Specialist coordinate a time for you to come to the LIFE Center. Here, various Interdisciplinary Team members shall evaluate your needs. • When each Interdisciplinary Team member has evaluated your situation, the Interdisciplinary Team will meet to share their findings and will develop your individual plan of care.

Intake. Intake The intake process begins when you or someone calls on your behalf or comes to LIFEcontacts CHA PACE. • If it appears from this conversation that you are potentially eligible, a LIFE Enrollment Specialist A representative will schedule a visit to your home, explain our program and conduct a preliminary screeningobtain further information about you. • We How CHA PACE works • The kinds of services CHA PACE offers • The answers to any questions you may have about CHA PACE • That when you enroll, you must agree to receive all your medical and health care exclusively from CHA PACE or its contracted service providers, with the exception of emergency services • Your monthly payment, if any If you are interested in joining CHA PACE, the CHA PACE enrollment staff will discuss your health and safety status with other members of the enrollment team. CHA PACE will ask that you sign a release of information allowing us to obtain your past medical records so our Interdisciplinary Team can fully assess team has complete information about your health conditions. Within three weeks, we will have evaluated your health and safety status. • Gathering We will meet to share our findings and ideas for your care. At this information meeting, we will allow decide whether you to attend meet the LIFE center so criteria for admission into the program, that you can get to know us and have is, whether your health needs evaluated by each Interdisciplinary Team Memberappear to meet the MassHealth criteria for nursing facility level-of-care and whether you are living safely in your home or in the community. A tuberculosis skin test(s) This includes assessing whether CHA PACE can meet your medical, nursing, psychological and social needs in conjunction with your family or a chest x-raysupport network, if any, and whether remaining in your home or proof of within in the last year is required during the enrollment/ intake process. Testing will be done at intake if needed and results will not impact or preclude enrollment. • LIFE is committed to serving the elderly who need long-term care; therefore, an independent opinion must confirm that community jeopardizes your health status qualifies and safety. You may be denied enrollment if remaining in your home and or the community would jeopardize your health and safety. In such cases, the CHA PACE staff will provide written notification explaining the reason for the denial and refer you to join the PACE program administered by LIFE St. appropriate alternative services. Mailing Address: Executive Office of Health & Human Services Board of Hearings Location: ▇▇▇ ▇▇▇▇▇▇▇ of the Pines▇▇. • Our LIFE Staff will complete the information on the North Carolina Medicaid Program Long Term Care Services Assessment tool and will submit to the Division of Medical Assistance. • The Division of Medical Assistance will review this Assessment tool submitted by LIFE and determine if you are eligible for nursing home care by state requirements. In the event that the Division of Medical Assistance finds that you are not eligible for nursing home care by state requirementsQuincy, you will not be able to enroll into the program. MA 02171 Phone: (▇▇▇) ▇▇▇-▇▇▇▇ Or ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY: (▇▇▇) ▇▇▇-▇▇▇▇ Fax: (▇▇▇) ▇▇▇-▇▇▇▇ If we determine you are not able to live safely in the community, your enrollment will be denied. LIFE will work with you to make other arrangements for the care you need. You have the right to appeal your eligibility determination or a denial of enrollment. This appeal should be made through the State Fair Hearing Process through the Office of Administrative Hearings: If you are a Medicare Beneficiary or Private Pay for the LIFE program you can contact: • Should the Division of Medical Assistance approve assess that you are eligible for nursing home CHA PACE, you and your care giver/family will be invited to meet with our staff. At that time, we will review and come to an agreement about your participation in CHA PACE before you sign the Enrollment Agreement. At this meeting you and your care giver/family will have an opportunity to: • Discuss the plan of care recommended by state requirements, assessments will occur in the LIFE Center enrollment staff and in your homesuggestions and preferences. • FirstAsk questions about your monthly payment, if any. • Ask questions about losing Medicare and MassHealth benefits that you may currently have (except for emergency or urgent care), as you will only be eligible for services provided and/or authorized by CHA PACE after enrollment. • Discuss the In-Home Services Coordinatorpartnership between you, RN, a member of the Interdisciplinary Team, will coordinate a time and/or your caregiver/family and CHA PACE. • What to visit you in your home and determine do if you can live safely in are dissatisfied with the community with LIFE services. There may be other members care you receive from CHA PACE (see the Grievances and Appeals section of the Interdisciplinary Team who may also visit you in your homethis agreement). • NextIf you decide to join CHA PACE, you will be given the Interdisciplinary Team opportunity to agree to and an accept the conditions of enrollment by signing the Enrollment Specialist coordinate a time for you to come to the LIFE Center. Here, various Interdisciplinary Team members shall evaluate your needs. • When each Interdisciplinary Team member has evaluated your situation, the Interdisciplinary Team will meet to share their findings and will develop your individual plan of careAgreement.

Intake. Intake The intake process begins when you or someone calls on your behalf or comes to LIFEcontacts ESP. • If it appears from this conversation that you are potentially eligible, a LIFE Enrollment Specialist A representative will schedule a visit to your home, explain our program and conduct a preliminary screeningobtain further information about you. • We How ESP works • The kinds of services ESP offers • The answers to any questions you may have about ESP • That when you enroll, you must agree to receive all your medical and health care exclusively from ESP or its contracted service providers, with the exception of emergency services • Your monthly payment, if any If you are interested in joining ESP, ESP’s enrollment staff will discuss your health and safety status with other members of the enrollment team. ESP will ask that you sign a release of information allowing us to obtain your past medical records so our Interdisciplinary Team can fully assess team has complete information about your health conditions. Within three weeks, we will have evaluated your health and safety status. • Gathering We will meet to share our findings and ideas for your care. At this information meeting, we will allow decide whether you to attend meet the LIFE center so criteria for admission into the program, that you can get to know us and have is, whether your health needs evaluated by each Interdisciplinary Team Memberappear to meet the MassHealth criteria for nursing facility level-of-care and whether you are living safely in your home or in the community. A tuberculosis skin test(s) This includes assessing whether ESP can meet your medical, nursing, psychological and social needs in conjunction with your family or a chest x-raysupport network, if any, and whether remaining in your home or proof of within in the last year is required during the enrollment/ intake process. Testing will be done at intake if needed and results will not impact or preclude enrollment. • LIFE is committed to serving the elderly who need long-term care; therefore, an independent opinion must confirm that community jeopardizes your health status qualifies and safety. You may be denied enrollment if remaining in your home and or the community would jeopardize your health and safety. In such cases, ESP staff will provide written notification explaining the reason for the denial and refer you to join the PACE program administered by LIFE St. appropriate alternative services. Mailing Address: Executive Office of Health & Human Services Board of Hearings Location: ▇▇▇ ▇▇▇▇▇▇▇ of the Pines▇▇. • Our LIFE Staff will complete the information on the North Carolina Medicaid Program Long Term Care Services Assessment tool and will submit to the Division of Medical Assistance. • The Division of Medical Assistance will review this Assessment tool submitted by LIFE and determine if Quincy, MA 02171 Phone: (▇▇▇) ▇▇▇-▇▇▇▇ Or ▇-▇▇▇-▇▇▇-▇▇▇▇ TTY: (▇▇▇) ▇▇▇-▇▇▇▇ Fax: (▇▇▇) ▇▇▇-▇▇▇▇ If we assess that you are eligible for ESP, you and your care giver/family will be invited to meet with our staff. At that time, we will review and come to an agreement about your participation in ESP before you sign the Enrollment Agreement. At this meeting you and your care giver/family will have an opportunity to: • Discuss the plan of care recommended by enrollment staff and your suggestions and preferences. • Ask questions about your monthly payment, if any. • Ask questions about losing Medicare and MassHealth benefits that you may currently have (except for emergency or urgent care), as you will only be eligible for services provided and/or authorized by ESP after enrollment. • Discuss the partnership between you, and/or your caregiver/family and ESP. • What to do if you are dissatisfied with the care you receive from ESP (see the Grievances and Appeals section of this agreement). • If you decide to join ESP, you will be given the opportunity to agree to and accept the conditions of enrollment by signing the Enrollment Agreement. ESP is authorized to serve only those eligible for a nursing home care by state requirementsfacility level of care. In Accordingly, an outside screening must confirm that your health situation in fact qualifies you for this care. At the event that time of enrollment, MassHealth, through its screening agent, authorizes your eligibility for ESP. If the Division of Medical Assistance screening agent finds that you are not eligible qualified for a nursing home care by state requirementsfacility level of care, you will not be able eligible to enroll into enroll, though you would have the programright to appeal this finding. If we On an annual basis, the screening agent of the MassHealth program will determine whether you are not able continue to live safely be eligible for a nursing facility level of care. If, in the communityopinion of the screening agent, your enrollment you do not meet the criteria for long term care, you will be denieddeemed ineligible for ESP, and you must disenroll. LIFE ESP’s staff will work with you to make other arrangements for the care you need. You have the right to appeal your eligibility determination or a denial of enrollment. This appeal should be made through the State Fair Hearing Process through the Office of Administrative Hearings: If reinstate you, if you are a Medicare Beneficiary or Private Pay for the LIFE program you can contact: • Should the Division of Medical Assistance approve that you are eligible for nursing home care by state requirements, assessments will occur in the LIFE Center and in your home. • First, the In-Home Services Coordinator, RN, a member of the Interdisciplinary Team, will coordinate a time to visit you in your home and determine if you can live safely in the community with LIFE services. There may be other members of the Interdisciplinary Team who may also visit you in your home. • Next, the Interdisciplinary Team and an Enrollment Specialist coordinate a time for you to come to the LIFE Center. Here, various Interdisciplinary Team members shall evaluate your needs. • When each Interdisciplinary Team member has evaluated your situation, the Interdisciplinary Team will meet to share their findings and will develop your individual plan of careeligible.

Intake. Intake The intake process begins when you or someone calls on your behalf or comes to LIFEcontacts Harbor PACE. • If it appears from this conversation that you are potentially eligible, a LIFE Enrollment Specialist A representative will schedule a visit to your home, explain our program and conduct a preliminary screeningobtain further information about you. You will learn: • We How Harbor PACE works • The kind of services Harbor PACE offers • The answers to any questions you may have about Harbor PACE • That upon enrollment, you must agree to receive all your medical and health care exclusively from Harbor PACE or its contracted service providers, with the exception of emergency services or services prior authorized by Harbor PACE • Your anticipated monthly payment if one applies If you are interested in joining Harbor PACE, we will assess your health and safety status to determine your eligibility. Harbor PACE will ask that you sign a medical release of information form allowing us to obtain your past medical records records, so our Interdisciplinary Team can fully assess team has complete information about your health conditions. If you and your care-partner(s) would like, we will schedule a tour of the Harbor PACE Center or visits with other Harbor PACE staff. Shortly after your decision to explore the option of enrolling in Harbor PACE we will arrange for an evaluation of your health and safety status. • Gathering We will assess our findings and plans for your care. During this information time, we will allow decide whether you to attend meet the LIFE center so criteria for admission into the program, that you can get to know us and have is, whether your health needs evaluated by each Interdisciplinary Team Memberappear to meet the MassHealth criteria for nursing facility level-of- care and whether you are living safely in your home or in the community. A tuberculosis skin test(sThis includes assessing whether Harbor PACE can comprehensively meet your care needs in conjunction with your care-partner(s) or support network, and whether remaining in your home or in the community jeopardizes your health and safety. The assessment criteria includes: • Level of care required to meet on-going medical, health, and social needs in the community • Safety of the home environment • Cognitive capacity of the applicant regarding ability to be left unsupervised without jeopardizing health and/or safety • Willingness of the applicant and their care-partner(s) to comply with the plan of care and safety recommendations. Harbor PACE is authorized to serve only those eligible for a chest x-ray, or proof nursing facility level of within the last year is required during the enrollment/ intake processcare. Testing will be done at intake if needed and results will not impact or preclude enrollment. • LIFE is committed to serving the elderly who need long-term care; thereforeAccordingly, an independent opinion outside screening must confirm that your health status situation qualifies you to join for this care. At the PACE program administered by LIFE St. ▇▇▇▇▇▇ time of enrollment, MassHealth, through its screening agent, authorizes your eligibility for Harbor PACE. If the Pines. • Our LIFE Staff will complete the information on the North Carolina Medicaid Program Long Term Care Services Assessment tool and will submit to the Division of Medical Assistance. • The Division of Medical Assistance will review this Assessment tool submitted by LIFE and determine if you are eligible for nursing home care by state requirements. In the event that the Division of Medical Assistance screening agent finds that you are not eligible qualified for a nursing home care by state requirementsfacility level of care, you will not be able eligible to enroll into enroll, though you would have the programright to appeal this finding using the appeal. You may also be denied enrollment if we find that you do not meet the assessment criteria. In such cases, the Harbor PACE staff will provide written notification explaining the reason for the denial and refer you to appropriate alternative services. If we determine you are not able denied enrollment, you have the right to live safely appeal this decision with the Executive Office of Health & Human Services Board of Hearings. You can do so by sending in a Fair Hearing Request Form (see the communityFair Hearing Request Form in this agreement on page 33) or calling. The information for this is below: If we assess that you are eligible for Harbor PACE, you will be invited to meet with Harbor PACE staff. At that time, we will review the program with you again and come to an agreement about your participation in Harbor PACE before you sign the Enrollment Agreement. At this meeting you and your care-partner(s) will have an opportunity to: • Discuss the plan of care recommended by Harbor PACE, noting your suggestions and preferences • Ask questions about your monthly payment if any • Ask questions about losing Medicare and MassHealth benefits that you may currently have (except for emergency or urgent care), as you will only be eligible for services provided and/or authorized by Harbor PACE after enrollment • Discuss the partnership between you, your enrollment will be denied. LIFE will work care-partner(s) and Harbor PACE • Learn what to do if you are dissatisfied with you to make other arrangements for the care you needreceive from Harbor PACE (see the Grievances and Appeals section of this agreement on page 16) • Review current services to ensure continuity of care, including the plan to continue or discontinue services after enrollment If you decide to join Harbor PACE, we will then ask you to agree to and accept the conditions of enrollment by signing the Enrollment Agreement. Upon signing, you will receive an Enrollment Packet including: • A copy of the Harbor PACE enrollment agreement • Instructions on managing emergency/urgent care needs • HIPAA Information • A copy of your initial Service Plan • Listing of Harbor PACE IDT members • Copies of all signed enrollment documents • A membership card that will be mailed to your residence Enrollment in Harbor PACE will result in your disenrollment from any other Medicare plan, such as a Medicare Advantage Plan, or Medicaid prepayment plan or optional benefit. On an annual basis, the screening agent of the MassHealth program will determine whether you are still qualified for nursing facility level of care. If the screening agent determines that you no longer meet the criteria for nursing facility level of care, you will not be eligible to continue your enrollment with Harbor PACE and we must disenroll you from our program. You have the right to appeal your eligibility determination or a denial of enrollment. This appeal should be made through the State Fair Hearing Process through the Office of Administrative Hearings: If you are a Medicare Beneficiary or Private Pay for the LIFE program involuntary disenrollment from Harbor PACE, you can contact: • Should do this by following the Division of Medical Assistance approve that you are eligible for nursing home care by state requirements, assessments will occur in the LIFE Center and in your home. • First, the In-Home Services Coordinator, RN, a member of the Interdisciplinary Team, will coordinate a time to visit you in your home and determine if you can live safely in the community with LIFE servicesprocess described above on page 11. There may be other members of is one exception to this rule. If the Interdisciplinary Team who may also visit MassHealth screening agent determines through your reassessment that although you in your home. • Next, the Interdisciplinary Team and an Enrollment Specialist coordinate a time for you to come to the LIFE Center. Here, various Interdisciplinary Team members shall evaluate your needs. • When each Interdisciplinary Team member has evaluated your situation, the Interdisciplinary Team will do not currently meet to share their findings and will develop your individual plan nursing facility level of care, absent of Harbor PACE care and services you would be likely to require nursing facility level of care within 6 months, you will be deemed eligible to continue your enrollment with Harbor PACE.