Conditions for Coverage. Hospice care services must be certified by CareFirst BlueChoice, provided by a Qualified Hospice Care Program, and meet the following conditions for coverage: A. The Member must have a life expectancy of six (6) months or less; B. The Member’s attending Primary Care Physician or other Contracting Physician must submit a written hospice care services plan of treatment to CareFirst BlueChoice; C. The Member must meet the criteria of the Qualified Hospice Care Program; D. The need and continued appropriateness of hospice care services must be certified by CareFirst BlueChoice as meeting the criteria for coverage in accordance with CareFirst BlueChoice utilization management requirements; and E Prior authorization has been obtained from CareFirst BlueChoice.
Appears in 13 contracts
Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement, Individual Enrollment Agreement for a Qualified Health Plan
Conditions for Coverage. Hospice care services must be certified by CareFirst BlueChoice, provided by a Qualified Hospice Care Program, and meet the following conditions for coverage:
A. The Member must have a life expectancy of six (6) months or less;
B. The Member’s attending Primary Care Physician or other Contracting Physician must submit a written hospice care services plan of treatment to CareFirst BlueChoice;
C. The Member must meet the criteria of the Qualified Hospice Care Program;
D. The need and continued appropriateness of hospice care services must be certified by CareFirst BlueChoice as meeting the criteria for coverage in accordance with CareFirst BlueChoice utilization management requirements; and E Prior authorization has been obtained from CareFirst BlueChoice.
Appears in 2 contracts
Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement
