Common use of Nursing Facility Services Clause in Contracts

Nursing Facility Services. For Medicaid covered nursing facility stays, the MCP shall evaluate the member’s need for the level of services provided by a nursing facility. To make this decision, the MCP 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 MCP shall provide documentation of the member’s level of care determination to the nursing facility. The MCP shall maintain a written record that the criteria were met, or if not met, the MCP shall maintain documentation that a Notice of Action was issued in accordance with OAC 5160-26-08.4. 1. The MCP is prohibited from paying for nursing facility services during restricted Medicaid coverage periods (RMCP). The MCP shall utilize HIPPA compliant enrollment files for patient liability obligations and RMCPs.

Nursing Facility Services. For Medicaid covered nursing facility stays, the MCP shall must evaluate the member’s need for the level of services provided by a nursing facility. To make this decision, the MCP shall must use the criteria for nursing facility-based intermediate or skilled level of care pursuant to OAC rules 5160-3- 08, 5160-3-09 and 5160-1-01. The MCP shall must provide documentation of the member’s level of care determination to the nursing facility. The MCP shall must maintain a written record that the criteria were met, or if not met, the MCP shall must maintain documentation that a Notice of Action was issued in accordance with OAC 5160-26-08.4. 1. The MCP is prohibited from paying for nursing facility services during restricted Medicaid coverage periods (RMCP). The MCP shall utilize HIPPA compliant enrollment files must accept provider documentation of determinations made by County Department of Job and Family Services (CDJFS) for patient liability obligations obligations, lump sum amounts, and RMCPs.

Nursing Facility Services. For Medicaid covered nursing facility stays, the MCP shall must evaluate the member’s need for the level of services provided by a nursing facility. To make this decision, the MCP shall must 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 MCP shall must provide documentation of the member’s level of care determination to the nursing facility. The MCP shall must maintain a written record that the criteria were met, or if not met, the MCP shall must maintain documentation that a Notice of Action was issued in accordance with OAC 5160-26-08.4. 1. The MCP is prohibited from paying for nursing facility services during restricted Medicaid coverage periods (RMCP). The MCP shall must utilize HIPPA compliant enrollment files for patient liability obligations and RMCPs.

Nursing Facility Services. For Medicaid covered nursing facility stays, the MCP shall evaluate the member’s need for the level of services provided by a nursing facility. To make this decision, the MCP shall use the criteria for nursing facility-based level of care pursuant to OAC rules 5160-3- 3-08, 5160-3-09 and 5160-1-01. The MCP shall provide documentation of the member’s level of care determination to the nursing facility. The MCP shall maintain a written record that the criteria were met, or if not met, the MCP shall maintain documentation that a Notice of Action was issued in accordance with OAC rule 5160-26-08.4. 1. The MCP is prohibited from paying for nursing facility services during restricted Medicaid coverage periods (RMCP). The MCP shall utilize HIPPA compliant enrollment files for patient liability obligations and RMCPs.