NF Residents Sample Clauses

NF Residents. A Participant who was already residing in a NF on the CHC Implementation Date must receive NF services from the same NF until the earliest date any of the following: a. The Participant’s stay in the NF ends. b. The Participant is disenrolled from CHC. c. The NF is no longer enrolled in the MA Program. If a Participant appeals a decision to transfer or discharge the Participant from the NF, the continuity of care period will continue until the Participant’s appeal is adjudicated by BHA. A change in CHC-MCO, a temporary hospitalization, or therapeutic leave does not interfere with or terminate this continuity of care period as long as the Participant remains a resident of the NF. The CHC-MCO in which the Participant is enrolled must enter into an agreement or payment arrangement with the Participant’s NF to make payments for the Participant’s NF services during the continuity of care period, regardless of whether the NF is in the CHC-MCO Network. The Department is requiring the extended continuity of care provision described above to avoid unnecessary disruptions in continuity of care for NF residents and to promote their quality of care and quality of life. To meet this requirement the Department expects CHC-MCOs to pay all NFs at the FFS level unless the parties otherwise agree to another payment arrangement. The CHC-MCO may require Out-of- Network NFs to meet the same requirements as Network NFs, with the exception that a CHC-MCO may not require Out-of-Network Providers to undergo full credentialing. Participants who do not qualify for the continuity of care period in this section, will receive the continuity of care described in Sections C. 3.