Facility-based LTSS. Every six (6) months, the Contractor shall identify Enrollees who are nursing facility residents who may have the desire and/or opportunity to return to the community, based on methods including but not limited to self- or provider referral, MDS results, and predictive modeling. The Contractor shall ensure the development of a Discharge Opportunity Assessment for those individuals. The Discharge Opportunity Assessment shall be conducted within thirty (30) Days of Enrollee identification or referral.
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