BadgerCare Plus Criteria Sample Clauses

BadgerCare Plus Criteria. The BC+ enrolled member must be inpatient and have total respiratory support for at least 30 days. Total respiratory support must be required for a total of six or more hours per 24 hour period. The total respiratory support does not need to be continuous during that period. Day one is the day that the member is place on the ventilator. If the member is on the ventilator for less than six hours on the first day, the use must continue into the next day and be more than six total hours. Each day that the member is on the ventilator for part of any day, as long as it is part of the six total hours per 24 hours, it counts as a day for enhanced funding. If a member is removed from the ventilator to be transferred to home or a hospice/skilled nursing facility prior to the 30 day ventilator requirement and he/she dies within 48 hours of the transfer, the Department will pay all Medicaid covered services to the end of the month or the member’s date of death, whichever comes first. This applies to a member being removed from the ventilator in 2016 or after. The need for total respiratory support must be supported by either: 1) appropriate medical documentation that include: • A copy of the member’s admission history and physical exam, • Discharge summary, • Physician and nurse’s notes that pertain to the member’s ventilator use 2) a signed statement from the physician that includes: • Member’s name, date of birth, Medicaid ID# and the primary diagnosis, • The name of the hospital with the admit/discharge dates, • Dates the member was on a ventilator or CPAP • Statement must specify whether the member was on a ventilator or CPAP. If the member is transferred to home or a hospice/skilled nursing facility the Department will need medical documentation that includes the member’s date of death and the date of transfer. Documentation must be submitted at the same time as the quarterly reports as specified in Article XI, J.