Community Home Care Nursing Facility Certifiable (Category E) Sample Clauses

Community Home Care Nursing Facility Certifiable (Category E). (A) The Community Home Care NHC Rate Cell category will be assigned to those Recipients who, at the time of enrollment in the MCO, are: (1) In need of NHC level home care; and (2) Coded in a community living arrangement in MMIS; and (3) Indicated in MMIS to have an open home care services agreement and receiving Medicaid home care services the cost of which are reimbursed under the approved Medicaid State plan. (B) The Home Care Rate Cell (E) is assigned when a person has been assessed as meeting a Nursing Facility level of care and when PCA or PDN services are delivered at least monthly based on a demonstrated need. Home health aide, skilled nurse visits and home care therapies are included under the risk adjusted acute care base rate and must not be counted under the long term care home care rate cell. Medicare home care services are also paid separately and are not counted under this rate cell. (C) For changes in MnDHO Community Home Care Nursing Facility Certifiable Rate Cell Categories after initial enrollment, the Community NHC Home Care Rate Cell category will be assigned after the MCO: (1) Notifies the STATE that an Enrollee is living in a community setting; (2) Notifies the STATE that an Enrollee has received a Long Term Care Consultation and has been identified to be in need of Home and Community-Based Services; (3) Provides the STATE with a copy of or enters in MMIS the Screening Document (DHS-3427) completed for that Enrollee. (4) Provides information documenting that the person has been assessed as meeting a Nursing Facility level of care and that PCA or PDN services are required at least monthly based on a demonstrated need. Home health aide, skilled RN visits and home care therapies are included under the risk adjusted acute care base rate and must not be counted under the long term care home care rate cell. Medicare home care services are also paid separately and are not counted under this rate cell.
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