Common use of Nursing Facility Services Clause in Contracts

Nursing Facility Services. The PH-MCO is responsible for payment for up to thirty (30) days of nursing home care (including hospital reserve or bed hold days) if a Member is admitted to a Nursing Facility in accordance with Exhibit BB, Rule F.1 of this Agreement.. Members are disenrolled from HealthChoices thirty (30) days following the admission date to the Nursing Facility as long as the Member has not been discharged from the Nursing Facility. A PH-MCO may not deny or otherwise limit Medically Necessary services, such as home health services, on the grounds that the Member needs, but is not receiving, a higher level of care. A PH- MCO may not offer financial or other incentives to obtain or expedite a Member’s admission to a Nursing Facility except as short-term nursing care, not to exceed thirty (30) days. The PH-MCO must abide by the decision of the OPTIONS assessment process determination letter related to the need for Nursing Facility services. Recipients who are placed into a Nursing Facility from a hospital and who were not previously enrolled in the HealthChoices Program or individuals who enter a Nursing Facility from a hospital and are then determined eligible for MA will not be enrolled in HealthChoices. However, should an individual leave the Nursing Facility to reside in the HealthChoices Zone covered by this Agreement and then be determined eligible for Enrollment into HealthChoices, they will then be required to enroll into the HealthChoices Program. Individuals who are residing in Nursing Facilities and are subsequently found eligible for MA will not be enrolled in the HealthChoices Program. Individuals eligible for MA, but not mandated into the HealthChoices Program when they enter Nursing Facilities, or Recipients who are placed in Nursing Facilities inside the HealthChoices Zone covered by this Agreement, who previously resided outside the HealthChoices Zone covered by this agreement, will not be enrolled in the HealthChoices Program.

Nursing Facility Services. ‌ The PH-MCO is responsible for payment for up to thirty (30) days of nursing home care (including hospital reserve or bed hold days) if a Member is admitted to a Nursing Facility in accordance with Exhibit BB, Rule F.1 of this Agreement.. Members are disenrolled from HealthChoices thirty (30) days following the admission date to the Nursing Facility as long as the Member has not been discharged from the Nursing Facility. A PH-MCO may not deny or otherwise limit Medically Necessary services, such as home health services, on the grounds that the Member needs, but is not receiving, a higher level of care. A PH- MCO may not offer financial or other incentives to obtain or expedite a Member’s admission to a Nursing Facility except as short-term nursing care, not to exceed thirty (30) days. The PH-MCO must abide by the decision of the OPTIONS assessment process determination letter related to the need for Nursing Facility services. Recipients who are placed into a Nursing Facility from a hospital and who were not previously enrolled in the HealthChoices Program or individuals who enter a Nursing Facility from a hospital and are then determined eligible for MA will not be enrolled in HealthChoices. However, should an individual leave the Nursing Facility to reside in the HealthChoices Zone covered by this Agreement and then be determined eligible for Enrollment into HealthChoices, they will then be required to enroll into the HealthChoices Program. Individuals who are residing in Nursing Facilities and are subsequently found eligible for MA will not be enrolled in the HealthChoices Program. Individuals eligible for MA, but not mandated into the HealthChoices Program when they enter Nursing Facilities, or Recipients who are placed in Nursing Facilities inside the HealthChoices Zone covered by this Agreement, who previously resided outside the HealthChoices Zone covered by this agreement, will not be enrolled in the HealthChoices Program.

Nursing Facility Services. The PH-MCO is responsible for payment for up to thirty (30) days of nursing home care (including hospital reserve or bed hold days) if a Member is admitted to a Nursing Facility in accordance with Exhibit BB, Rule F.1 of this Agreement.. Facility. Members are disenrolled from HealthChoices thirty (30) days following the admission date to the Nursing Facility nursing facility as long as the Member has not been discharged (from the Nursing Facilitynursing facility). A PH-MCO may not deny or otherwise limit Medically Necessary services, such as home health services, on the grounds that the Member needs, but is not receiving, a higher level of care. A PH- PH-MCO may not offer financial or other incentives to obtain or expedite a Member’s 's admission to a Nursing Facility nursing facility except as short-term nursing care, not to exceed thirty (30) days. The PH-MCO CMO must abide by the decision of the OPTIONS assessment process determination letter related to the need for Nursing Facility nursing facility services. Recipients MA Consumers who are placed into a Nursing Facility nursing facility from a hospital and who were not previously enrolled in the HealthChoices HC-L/C Program or individuals who enter a Nursing Facility nursing facility from a hospital and are then determined eligible for MA will not be enrolled in HealthChoices. HC-L/C. However, should an individual leave the Nursing Facility nursing facility to reside in the HealthChoices HC-L/C Zone covered by this Agreement and then be determined eligible for Enrollment enrollment into HealthChoicesHC-L/C, they will then be required to enroll into the HealthChoices HC-L/C Program. Individuals who are residing in Nursing Facilities nursing facilities and are subsequently found eligible for MA will not be enrolled in the HealthChoices Program. Individuals individuals eligible for MA, but not mandated into the HealthChoices HC-L/C Program when they enter Nursing Facilitiesnursing facilities, or Recipients MA Consumers who are placed in Nursing Facilities nursing facilities inside the HealthChoices Zone covered by this AgreementHC-L/C Zone, who previously resided outside the HealthChoices Zone covered by this agreementHC-L/C Zone, will not be enrolled in the HealthChoices HC-L/C Program.

Nursing Facility Services. The PH-MCO is responsible for payment for up to thirty (30) days of nursing home care (including hospital reserve or bed hold days) if a Member is admitted to a Nursing Facility in accordance with Exhibit BB, Rule F.1 of this Agreement.. Facility. Members are disenrolled from HealthChoices thirty (30) days following the admission date to the Nursing Facility as long as the Member has not been discharged (from the Nursing Facility). A PH-MCO may not deny or otherwise limit Medically Necessary services, such as home health services, on the grounds that the Member needs, but is not receiving, a higher level of care. A PH- PH-MCO may not offer financial or other incentives to obtain or expedite a Member’s 's admission to a Nursing Facility except as short-term nursing care, not to exceed thirty (30) days. The PH-MCO CMO must abide by the decision of the OPTIONS assessment process determination letter related to the need for Nursing Facility services. Recipients MA Consumers who are placed into a Nursing Facility from a hospital and who were not previously enrolled in the HealthChoices Program or individuals who enter a Nursing Facility from a hospital and are then determined eligible for MA will not be enrolled in HealthChoices. However, should an individual leave the Nursing Facility to reside in the HealthChoices Zone covered by this Agreement zone and then be determined eligible for Enrollment enrollment into HealthChoices, they will then be required to enroll into the HealthChoices Program. Individuals who are residing in Nursing Facilities and are subsequently found eligible for MA will not be enrolled in the HealthChoices Program. Individuals eligible for MA, but not mandated into the HealthChoices Program when they enter Nursing Facilities, or Recipients MA Consumers who are placed in Nursing Facilities inside the HealthChoices Zone covered by this Agreementzone, who previously resided outside the HealthChoices Zone covered by this agreementzone, will not be enrolled in the HealthChoices Program.