Department Policy for Member Use of Personal Resources Sample Clauses

Department Policy for Member Use of Personal Resources. 1. Prohibited Use of Member Resources
Sample 1Sample 2Sample 3
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Department Policy for Member Use of Personal Resources. The MCO is responsible for items and services in the benefit package that are necessary to support the member’s individual outcomes. The MCO and its providers are strictly prohibited from billing members for such services. Any use of personal resources to enhance services or make a gift to the MCO or one of its providers must be wholly voluntary on the part of the consumer.
Sample 1
Department Policy for Member Use of Personal Resources. 1. Permitted Uses of Member Resources a. The member, member’s family, or significant other wants to voluntarily purchase services, which the PO has denied, provided proper notice of that decision has been given to the member; b. The member, member’s family, or significant other wants to voluntarily purchase a service or item, limited to the services or items in paragraph3.a. below, which has not been authorized by the PO or included in the MCP because it has not been identified as needed to support the member’s long term care outcomes, provided proper notice of the PO’s decision denying the service or item has been given to the member; c. The member, member’s family, or significant other wants to voluntarily purchase a service or item, limited to the services or items in paragraph3.a. below, as a substitute for an item or service authorized in the MCP where the member prefers a more costly alternative because it offers a broader scope or additional features than the service or item authorized by the IDT, or because the member prefers an additional amount or longer duration of the service or item authorized by the IDT; d. The member, member's family, or significant other wants to voluntarily purchase a non-emergency, non-court-ordered service or item that is authorized by the PO from an out-of-network provider, , and the PO has considered but decided not to authorize the out-of network provider because it does not meet the PO’s standards or accept the PO payment rate for the service. e. The member, member’s family, or significant other wants to make a voluntary donation of cash or something else of value to the PO (see Article I. for definition); or f. The member, member’s family, or significant other wants to make a voluntary payment to the State Medicaid Program.
Sample 1

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