Common use of Level of Care Re-Determinations Clause in Contracts

Level of Care Re-Determinations. The MCO shall develop procedures to assure that all members have a current and accurate level of care as determined by the LTC FS. Level of care re- determinations may only be completed by an individual trained and certified to administer the LTC FS. The responsibility to assure that all members have a current and accurate level of care shall include: a. Post-Enrollment Re-Determination The MCO may re-determine level of care for a new member shortly after enrollment if the interdisciplinary team believes that different or additional information has come to light as a result of the initial comprehensive assessment. The MCO shall consult with the ADRC if the MCO re-determines level of care for a newly enrolled member or when a newly enrolled member is found to be functionally ineligible or eligibility changes to a non-nursing home level of care within six (6) months of the submission of the most recent pre-enrollment screen. The MCO shall review and compare the screens, attempt to resolve the differences, and contact the Department or its designee if differences cannot be resolved.

Level of Care Re-Determinations. The MCO shall develop procedures to assure that all members have a current and accurate level of care as determined by the LTC FSLTCFS. Level of care re- determinations may only be completed by an individual trained and certified to administer the LTC FSLTCFS. The responsibility to assure that all members have a current and accurate level of care shall include: a. Post-Enrollment Re-Determination The MCO may re-determine level of care for a new member shortly after enrollment if the interdisciplinary team believes that different or additional information has come to light as a result of the initial comprehensive assessment. The MCO shall consult with the ADRC if the MCO re-determines level of care for a newly enrolled member or when a newly enrolled member is found to be functionally ineligible or eligibility changes to a non-nursing home level of care within six (6) months of the submission of the most recent pre-enrollment screen. The MCO shall review and compare the screens, attempt to resolve the differences, and contact the Department or its designee if differences cannot be resolved.

Level of Care Re-Determinations. The MCO shall develop procedures to assure that all members have a current and accurate level of care as determined by the LTC FS. Level of care re- determinations may only be completed by an individual trained and certified to administer the LTC FS. The responsibility to assure that all members have a current and accurate level of care shall include: a. Post-Enrollment Re-Determination The MCO may re-determine level of care for a new member shortly after enrollment if the interdisciplinary team believes that different or additional information has come to light as a result of the initial comprehensive assessment. The MCO shall consult with the ADRC if the MCO re-determines level of care for a newly enrolled member or when a newly enrolled member is found to be functionally ineligible or eligibility and changes to a non-nursing home level of care within six (6) months of the submission of the most recent pre-enrollment screen. The MCO shall review and compare the screens, attempt to resolve the differences, and contact the Department or its designee if differences cannot be resolved.