Common use of 180-Day Separation Period for MSHO Clause in Contracts

180-Day Separation Period for MSHO. ‌ Continuous Separation Period. (1) If the MCO has already been liable for 180 days of SNF/NF services, then the 180-day Separation Period is defined as one hundred and eighty (180) consecutive Institutional or community days after the MCO has already been liable for 180 days of SNF/NF services. After this separation period has expired, the MCO shall be liable for a new, distinct 180-day SNF/NF benefit period for any Enrollee who is still community-based (i.e., an Enrollee is in MSHO Rate Cell Category A or B, on the last day of the separation period). If an Enrollee becomes Institutionalized (i.e., has been assigned to Rate Cell Category “D” for MSHO) prior to the end of the separation period, no new SNF/NF benefit period is applied. (2) If the MCO has not previously had liability for SNF/NF services for an enrollee and the enrollee leaves the NF, there is no Separation Period and the MCO will be assigned NF liability for the Enrollee upon return to the community. (3) If an MSHO Enrollee is hospitalized and/or placed in a Nursing Facility during the 180- day Separation Period for thirty (30) days or less, the MSHO Enrollee shall still be considered to be residing in the community and these days shall be counted toward the 180-day Separation Period. If the Enrollee spends more than thirty (30) days in a hospital and/or Nursing Facility, the counting of the 180-day Separation Period shall begin over again if and when the Enrollee returns to the community. (4) The STATE shall have the responsibility for tracking the 180-day Separation Period. The MCO shall cooperate with the STATE in verifying the 180-day Separation Period. On a monthly basis, the STATE shall identify community MSHO Enrollees for whom the 180-day NF benefit is not in effect. Of these, if the Enrollee is not within a 180-day Separation Period, the STATE shall begin a new 180-day NF benefit period on the first day of the next available month. (5) The STATE enrollment data will contain information indicating the MCO’s Nursing Facility benefit period.

180-Day Separation Period for MSHO. ‌ Continuous Separation Period. (1) If the MCO has already been liable for 180 days of SNF/NF services, then the 180-day Separation Period is defined as one hundred and eighty (180) consecutive Institutional or community days after the MCO has already been liable for 180 days of SNF/NF services. After this separation period has expired, the MCO shall be liable for a new, distinct 180-day SNF/NF benefit period for any Enrollee who is still community-based (i.e., an Enrollee is in MSHO Rate Cell Category A or B, on the last day of the separation period). If an Enrollee Enrollee‌ becomes Institutionalized (i.e., has been assigned to Rate Cell Category “D” for MSHO) prior to the end of the separation period, no new SNF/NF benefit period is applied. (2) If the MCO has not previously had liability for SNF/NF services for an enrollee and the enrollee leaves the NF, there is no Separation Period and the MCO will be assigned NF liability for the Enrollee upon return to the community. (3) If an MSHO Enrollee is hospitalized and/or placed in a Nursing Facility during the 180- day Separation Period for thirty (30) days or less, the MSHO Enrollee shall still be considered to be residing in the community and these days shall be counted toward the 180-day Separation Period. If the Enrollee spends more than thirty (30) days in a hospital and/or Nursing Facility, the counting of the 180-day Separation Period shall begin over again if and when the Enrollee returns to the community. (4) The STATE shall have the responsibility for tracking the 180-day Separation Period. The MCO shall cooperate with the STATE in verifying the 180-day Separation Period. On a monthly basis, the STATE shall identify community MSHO Enrollees for whom the 180-day NF benefit is not in effect. Of these, if the Enrollee is not within a 180-day Separation Period, the STATE shall begin a new 180-day NF benefit period on the first day of the next available month. (5) The STATE enrollment data will contain information indicating the MCO’s Nursing Facility benefit period.

180-Day Separation Period for MSHO. ‌ (A) Continuous Separation Period. (1) If the MCO has already been liable for 180 days of SNF/NF services, then the 180-day Separation Period is defined as one hundred and eighty (180) consecutive Institutional or community days after the MCO has already been liable for 180 days of SNF/NF services. After this separation period has expired, the MCO shall be liable for a new, distinct 180-day SNF/NF benefit period Benefit Period for any Enrollee who is still community-based (i.e., an Enrollee is in MSHO Rate Cell Category A or B, on the last day of the separation period). If an Enrollee becomes Institutionalized (i.e., has been assigned to Rate Cell Category “D” for MSHO) prior to the end of the separation period, no new SNF/NF benefit period Benefit Period is applied. (2) If the MCO has not previously had liability for SNF/NF services for an enrollee and the enrollee leaves the NF, there is no Separation Period separation period and the MCO will be assigned NF liability for the Enrollee enrollee upon return to the community. (3B) If an MSHO Enrollee is hospitalized and/or placed in a Nursing Facility during the 180- 180-day Separation Period for thirty (30) days or less, the MSHO Enrollee shall still be considered to be residing in the community and these days shall be counted toward the 180-day Separation Period. If the Enrollee spends more than thirty (30) days in a hospital and/or Nursing Facility, the counting of the 180-day Separation Period shall begin over again if and when the Enrollee returns to the community. (4C) The STATE shall have the responsibility for tracking the 180-day Separation Period. The MCO shall cooperate with the STATE in verifying the one hundred and eighty (180-) day Separation Period. On a monthly basis, the STATE shall identify community MSHO Enrollees for whom the 180-day NF benefit is not in effect. Of these, if the Enrollee is not within a 180-day Separation Periodseparation period, the STATE shall begin a new 180-180 day NF benefit period Benefit Period on the first day of the next available month. (5D) The STATE enrollment data will contain information indicating the MCO’s Nursing Facility benefit periodBenefit Period.