Medically Frail Clause Samples
The 'Medically Frail' clause defines the criteria or conditions under which an individual is considered medically frail for the purposes of a contract or policy. Typically, this clause outlines specific health conditions, disabilities, or limitations that qualify a person as medically frail, such as chronic illnesses, severe physical or mental impairments, or the need for institutional care. By clearly establishing who is deemed medically frail, the clause ensures that individuals with significant health vulnerabilities receive appropriate accommodations, protections, or benefits, and it helps prevent disputes over eligibility or coverage.
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Medically Frail. The Contractor shall provide HIP State Plan services to members who meet the definition of medically frail. Consistent with 42 CFR §440.315(f), an individual will be considered medically frail if he or she has one or more of the following: ▪ Disabling mental disorder; ▪ A chronic substance abuse disorder; ▪ Serious and complex medical conditions; ▪ Physical, intellectual, or developmental disability that significantly impair the individuals’ ability to perform one or more activities of daily living; or ▪ A disability determination based on Social Security Administration criteria.