Medically frail means that term as described in 42 CFR 440.315(f).
Medically frail means that term as defined in section 35(22).
Medically frail means an Adult Member who would be covered under the Alternative Benefit Plan (ABP) but who has been determined as meeting HSD’s definitions and criteria for the following conditions: (i) disabling mental disorder, including individuals up to age 21 with serious emotional disturbances and adults with serious mental illness; (ii) a chronic substance use disorder; (iii) a serious and complex medical condition as defined by HSD in Section 13 of the Policy Manual; (iv) a physical, intellectual or developmental disability that significantly impairs the Member’s ability to perform one or more activities of daily living; or (v) a disability determination based on Social Security criteria. Medically Necessary means physical, behavioral health, and long-term services and supports, and supplies, that: (i) are essential to prevent, diagnose or treat medical conditions or are essential to enable the Member to attain, maintain or regain the Member's optimal functional capacity; (ii) are delivered in the amount, duration, scope and setting that are both sufficient and effective to reasonably achieve their purposes and clinically appropriate to the specific physical, behavioral health, and long-term care needs of the Member; (iii) are provided within professionally accepted standards of practice and national guidelines; (iv) are required to meet the physical, behavioral health, and long-term care needs of the Member and are not primarily for the convenience of the Member, the provider, or the CONTRACTOR; and (v) are reasonably expected to achieve appropriate growth and development as directed by HSD. Member means a person who has been determined eligible for Centennial Care and who has enrolled in the CONTRACTOR’s MCO. Member Advisory Board shall have the meaning ascribed to such term in Section 4.12.2 of this Agreement. Member Materials shall have the meaning ascribed to such term in Section 4.14 of this Agreement.
Examples of Medically frail in a sentence
The following individuals are ABP Exempt and may voluntarily opt-out of the ABP: Individuals who qualify for medical assistance on the basis of being blind or disabled (or being treated as being blind or disabled) without regard to whether the individuals are eligible for Supplemental Security Income benefits; Individuals who are terminally ill and are receiving benefits for hospice care; Pregnant women; or Individuals who are Medically Frail.
More Definitions of Medically frail
Medically frail means an individual who, in accordance with the process in 405 IAC 10-6-1, is determined to have any one (1) of the following:
Medically frail means an individual who is a minimal threat to
Medically frail means an individual who has a mental or physical
Medically frail means an individual in the adult expansion population who meets
Medically frail means an Adult Member who would be covered under the ABP but who has been determined as meeting HCA’s definitions and criteria for the following conditions: (i) disabling mental disorder, including individuals up to age twenty-one (21) with serious emotional disturbances (SEDs) and adults with serious mental illness (SMI); (ii) a chronic substance use disorder; (iii) a serious and complex medical condition as defined by HCA in Section 13 of the Managed Care Policy Manual; (iv) a physical, intellectual, or developmental disability that significantly impairs the Member’s ability to perform one (1) or more activities of daily living (ADL); or (v) a disability determination based on Social Security criteria. Medically Necessary means Physical Health, Behavioral Health, and LTSS, and supplies, that: (i) are essential to prevent, diagnose or treat medical conditions or are essential to enable the Member to attain, maintain, or regain the Member's optimal functional capacity; (ii) are delivered in the amount, duration, scope and setting that are both sufficient and effective to reasonably achieve their purposes and clinically appropriate to the specific Physical Health, Behavioral Health, and LTC needs of the Member; (iii) are provided within professionally accepted standards of practice and national guidelines; (iv) are required to meet the Physical Health, Behavioral Health, and LTC needs of the Member and are not primarily for the convenience of the Member, the Provider, or the CONTRACTOR; and (v) are reasonably expected to achieve appropriate growth and development as directed by HCA.
Medically frail means an Adult Member who would be covered under the ABP but who has been determined as meeting HCA’s definitions and criteria for the following conditions: (i) disabling mental disorder, including individuals up to age twenty-one (21) with serious emotional disturbances (SEDs) and adults with serious mental illness (SMI); (ii) a chronic substance use disorder; (iii) a serious and complex medical condition as defined by HCA in Section 13 of the Managed Care Policy Manual; (iv) a physical, intellectual, or developmental disability that significantly impairs the Member’s ability to perform one (1) or more activities of daily living (ADL); or (v) a disability determination based on Social Security criteria. Medically Necessary means Physical Health, Behavioral Health, and LTSS, and supplies, that:
Medically frail means an individual who meets the criteria of 42 C.F.R. 440.315 as determined by the department based on methodology administered by the department or another entity selected by the department.