Common use of Implementing Contingencies if the Member Lacks Funds for Room and Board Clause in Contracts

Implementing Contingencies if the Member Lacks Funds for Room and Board. If the member lacks sufficient income available to pay room and board in the facility, the MCO either: a. Develops an alternative plan of care to support the member’s needs and outcomes; or b. Supplements the payment to the facility in an amount that the member’s income available to pay for room and board is lacking. Using procedures specified by the Department, document whether supplementation for the particular member in the particular facility is a cost-effective substitution for nursing facility care.

Implementing Contingencies if the Member Lacks Funds for Room and Board. If the member lacks sufficient income available to pay room and board in the facility, the MCO either: a. Develops an alternative plan of care to support the member’s needs and outcomes; or b. Supplements May supplement the member’s payment to the facility in an amount that to make up the member’s income available to pay for shortfall. Any MCO supplementation of member payment of room and board is lacking. Using procedures specified by the Department, document whether supplementation for the particular member from capitation revenue shall not be considered a countable expense in the particular facility is a cost-effective substitution for nursing facility caredeveloping MCO capitation rates.

Implementing Contingencies if the Member Lacks Funds for Room and Board. If the member lacks sufficient income available to pay room and board in the facility, the MCO either: a. Develops Develop an alternative plan of care to support the member’s needs and outcomes; or b. Supplements Contribute to the member’s payment to the facility in an amount that to make up the shortfall. Any MCO contribution to a member’s income available to pay for room and board is lacking. Using procedures specified by the Department, document whether supplementation for the particular member obligation from capitation revenue shall not be considered a countable expense in the particular facility is a cost-effective substitution for nursing facility caredeveloping MCO capitation rates.