Common use of Hospice, Generally Clause in Contracts

Hospice, Generally. (A) If an Enrollee is receiving hospice services at the time of enrollment in the Health Plan or if the Enrollee is already enrolled in the Health Plan and has less than six months to live, the Contractor shall provide the Enrollee hospice services or the continuation of hospice services if he or she is already receiving such services prior to enrollment in the Health Plan. (B) If the Enrollee is admitted to a nursing facility, ICF/ID or a freestanding hospice facility, the Contractor must reimburse the hospice Provider for both the hospice care and the room and board until the Enrollee is disenrolled from the Health Plan by the Department. When the Contractor determines that an Enrollee will require care in the hospice facility for more than 30 days, the Contractor shall notify the Enrollee, hospice agency, and hospice facility that the Enrollee will no longer be eligible for coverage of hospice services from the Contractor. The Contractor shall also notify the BMHC of this determination. The BMHC shall change the status of the Enrollee to Fee-For-Service. (C) The Contractor shall pay for room and board expenses of a hospice Enrollee receiving Medicare hospice care while the Enrollee is a resident of a Medicare-certified nursing facility, ICF/ID, or freestanding hospice facility until the Enrollee is disenrolled from the Health Plan by BMHC.

Hospice, Generally. (A) If an Enrollee is receiving hospice services at the time of enrollment in the Health Plan or if the Enrollee is already enrolled in the Health Plan and has less than six months to live, the Contractor shall provide the Enrollee hospice services or the continuation of hospice services if he or she is already receiving such services prior to enrollment in the Health Plan. (B) If the Enrollee is admitted to a nursing facility, ICF/ID or a freestanding hospice facility, the Contractor must reimburse the hospice Provider for both the hospice care and the room and board until the Enrollee is disenrolled from the Contractor’s Health Plan by the Department. When the Contractor determines that an Enrollee will require care in the hospice facility for more than 30 calendar days, the Contractor shall notify the Enrollee, hospice agency, and hospice facility that the Enrollee will no longer be eligible for coverage of hospice services from the Contractor. The Contractor shall also notify the BMHC of this determination. The BMHC shall change the status of the Enrollee to Fee-For-Fee For Service. (C) The Contractor shall pay for room and board expenses of a hospice Enrollee receiving Medicare hospice care while the Enrollee is a resident of a Medicare-certified nursing facility, ICF/ID, or freestanding hospice facility until the Enrollee is disenrolled from the Health Plan by BMHC.

Hospice, Generally. (A) If an Enrollee is receiving hospice services at the time of enrollment in the Contractor's Health Plan or if the Enrollee is already enrolled in the Contractor's Health Plan and has less than six months to live, the Contractor shall provide the Enrollee hospice services or the continuation of hospice services if he or she is already receiving such services prior to enrollment in the Health Plan. (B) If the Enrollee is admitted to a nursing facility, ICF/ID or a freestanding hospice facility, the Contractor must reimburse the hospice Provider for both the hospice care and the room and board until the Enrollee is disenrolled from the Contractor’s Health Plan by the Department. When the Contractor determines that an Enrollee will require care in the hospice facility for more than 30 calendar days, the Contractor shall notify the Enrollee, hospice agency, and hospice facility that the Enrollee will no longer be eligible for coverage of hospice services from the Contractor. The Contractor shall also notify the BMHC OMH of this determination. The BMHC OMH shall change the status of disenroll the Enrollee to Fee-For-Servicefrom the Contractor's Health Plan. (C) The Contractor shall pay for room and board expenses of a hospice Enrollee receiving Medicare hospice care while the Enrollee is a resident of a Medicare-Medicare- certified nursing facility, ICF/ID, or freestanding hospice facility until the Enrollee is disenrolled from the Health Plan by BMHCOMH.