Member Continuation of Home Care and Private Duty Nursing (PDN Sample Clauses

Member Continuation of Home Care and Private Duty Nursing (PDN. Services - The MCP must allow its new members that are transitioning from FFS to continue receiving home care services (i.e., nursing, aide, and skilled therapy services) and PDN services. These services must be covered at the current service level, and with the current provider, regardless of whether the current provider is a panel or out-of-panel provider, until the MCP conducts a medical necessity review and renders an authorization decision pursuant to OAC rule OAC rule 5160-26-03. 1. As soon as the MCP becomes aware of the member’s current home care or PDN services, the MCP must initiate contact with the current provider and member as applicable to ensure continuity of care and coordinate a transfer of services to a panel provider, if appropriate. For ABD members under 21 years of age and for members under 21 with an SSI indicator, the MCP must allow continuation of home care services provided pursuant to OAC rule 5160-12-01 at the existing service level with the current home health agency provider for a period of 90 days after initial MCP enrollment. After 90 days of enrollment, prior to requiring transition to a participating provider or proposing a change in the service amount, the MCP must make a home visit, and observe the home care service being provided, to assess the need for continued home care services. For ABD members under 21 years of age and for members under 21 with an SSI indicator, the MCP must allow continuation of PDN services provided pursuant to OAC rule 5160-12-02 at the existing service level with the current provider for a period of 90 days after initial MCP enrollment. After 90 days of enrollment, prior to requiring transition to a participating provider, or proposing a change in the service amount or termination or reduction of the FFS authorized service amount, the MCP must make a home visit, and observe the PDN services being provided, to assess the need for continued PDN services.
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