Medicaid Covered Nursing Facility Stays. The MCOP shall evaluate the member’s need for the level of services provided by a nursing facility. To make this decision, the MCOP shall use the criteria for nursing facility-based level of care pursuant to OAC rules 5160-3-08, 5160-3-09 and 5160-1-01. The MCOP shall evaluate for both intermediate and skilled levels of care concurrently when making a level of care determination. The MCOP shall provide documentation of the member’s level of care determination to the nursing facility. If properly submitted by a provider, the MCOP is required to accept the Ohio Medicaid Managed Care/MyCare Ohio Nursing Facility Request Form to prior authorize nursing facility services and determine level of care. The MCOP shall maintain a written record that the criteria were met, or if not met, the MCOP shall maintain documentation that a Notice of Action was issued in accordance with OAC 5160-58-
Appears in 9 contracts
Samples: The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan, The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan, The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan
