Common use of Medicaid Covered Nursing Facility Stays Clause in Contracts

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, 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 5160-58-08.4. In accordance with OAC rule 5160-3-14, the preadmission screening and resident review (PASRR) process must be completed before a level of care determination can be issued. The MCOP shall have processes in place to ensure that PASRR requirements are met in accordance with OAC chapter 5160-3 prior to issuing a level of care determination.

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, 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 5160-58-08.4. In accordance with OAC rule 5160-3-14, the preadmission screening and resident review (PASRR) process must be completed before a level of care determination can be issued. The MCOP shall have processes in place to ensure that PASRR requirements are met in accordance with OAC chapter 5160-3 prior to issuing a level of care determination.. At a minimum, the MCOP shall pay nursing facility providers in accordance with ORC section