Dual Eligibles means Medicaid recipients who are also eligible for Medicare. ECI means Early Childhood Intervention, a federally mandated program for infants and children under the age of three with or at risk for developmental delays and/or disabilities. The federal ECI regulations are found at 34 §C.F.R. 303.1 et seq. The State ECI rules are found at 25 TAC §621.21 et seq. EDI means electronic data interchange.
Dual Eligibles means individuals, who, by reason of age, income and/or disability qualify for Medicare and full-Medicaid benefits under section 1902(a)(10)(A) or 1902(a)(10)(C), by reason of section 1902(f), or under any other category of eligibility for medical assistance for full benefits.
Dual Eligibles means persons who are eligible for both Medicare and Medicaid.
Examples of Dual Eligibles in a sentence
Indicate if any of the following populations are excluded from participating in the waiver: Dual Eligibles Poverty Level Pregnant Women Individuals with other insurance Individuals residing in a nursing facility or ICF/MR Individuals enrolled in a managed care program Individuals participating in a HCBS Waiver program American Indians/Alaskan Natives Special Needs Children (State Defined).
A STAR+PLUS MCO must demonstrate that there are sufficient levels of qualified and competent personnel devoted to Service Coordination to meet the everyday needs of STAR+PLUS Members, including Dual Eligibles.
Dual Eligibles are Medicare beneficiaries who are also eligible for some level of Medicaid assistance.
Full-Benefit Dual Eligibles enrolled in Part C – Medicare Advantage Plans that are fully liable for all Medicaid services covered under this Contract.
Dual Eligibles — An individual who is eligible to receive services through both Medicare and the MA Program (Medicaid).
More Definitions of Dual Eligibles
Dual Eligibles means Medicaid recipients who are also eligible for Medicare.
Dual Eligibles means individuals who – by reason of age, income and/or disability – qualify for Medicare and full Medicaid benefits under section 1902(a)(10)(A) or 1902(a)(10)(C) of the Social Security Act, under section 1902(f) of the Social Security Act, or under any other category of eligibility for medical assistance for full benefits. Durable Medical Equipment (DME) means equipment and supplies that are primarily used to serve a medical purpose, that are medically necessary to individuals with an illness, physical disability, or injury, and that are commonly used at home. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) means the federally required Early and Periodic Screening, Diagnosis and Treatment program. as defined in section 1905(r) of the Social Security Act and 42 CFR Part 441, Subpart B for Members under the age of twenty-one (21). It includes comprehensive periodic and inter-periodic screening and diagnostic services to determine physical and Behavioral Health needs as well as the provision of all Medically Necessary Services listed in section 1902(a) of the Social Security Act even if the service is not available under the State’s Medicaid State plan. Electronic Health Record (EHR) means a record in digital format that is a systematic collection of electronic health information. Electronic health records may contain a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, xxxxx xxxxx, personal statistics such as age and weight, and billing information. Emergency Medical Condition means a p h y s i c a l h e a l t h or Behavioral Health condition manifesting itself through acute symptoms of sufficient severity (including severe pain) such that a prudent layperson with average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in: (i) placing the Members’ health (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; (ii) serious impairment to bodily functions; (iii) serious dysfunction of any bodily organ or part; or (iv) serious disfigurement to the Member. Emergency Services means Covered Services that are inpatient or outpatient and are (i) furnished by a provider that is qualified to furnish these services and (ii) needed to evaluate or stabilize an Emergency Medical Condition. Encounter means a record of any M e m b e r claim adjudicated by ...
Dual Eligibles means persons who are eligible for both Medicare and Medicaid. CONFIDENTIAL MATERIALS OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ASTERISKS DENOTE SUCH OMISSION.
Dual Eligibles not described under Medicare Savings Program - Beneficiaries who are enrolled in both Medicare and Medicaid for whom Medicaid coverage is not limited to the coverage of Medicare premiums and cost sharing
Dual Eligibles means Members who are also eligible for Medicare. Early and Periodic Screening, Diagnostic, and Treatment Program (EPSDT) means the federally-mandated Early and Periodic Screening, Diagnostic, and Treatment Program contained at 42 U.S.C. § 1396d(r). Texas Health Steps is the name used for EPSDT in the State of Texas.
Dual Eligibles. An individual who is eligible to receive services through both Medicare and Medicaid. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT): The pediatric component of the Medicaid program created and implemented by federal statute and regulations. This program establishes standards of care for children and adolescents under age 21, calling for regular screening and for the services needed to prevent, diagnose, correct or ameliorate a physical or mental illness, including alcohol and drug abuse, or condition identified through screening. Medicaid services for children are required as a matter of law to meet these standards, which may require that services outside traditional Medicaid benefits be provided when needed to treat such conditions.
Dual Eligibles. MEDI-CAL AND MEDICARE (Part D) For the period 01/01/06 – 09/30/06 San Bernardino Groups Aid Codes Rate Disabled Duals 20, 24, 26, 28, 36, 60, 64, 66, 68, 6A, 6C, 6E, 6H, 6J, 6N, 6P, 6R, 6V, 2E $ 81.53 Aged Duals 10, 14, 16, 18, 1E, 1H $ 96.21 AIDS Beneficiary Duals $ 307.58