Post-Stabilization Care Services. The Contractor shall cover and pay for Post-Stabilization Care Services in accordance with the provisions of 42 C.F.R. § 422.113(c). The Contractor is financially responsible for Post-Stabilization Care Services obtained within the Contractor’s Provider Network or from an Out-of-network Provider that are not pre- approved by a Network Provider or other Contractor representative, but administered to maintain, improve or resolve the Member’s stabilized condition if:
Post-Stabilization Care Services. Services related to an emergency medical condition that are provided after an Enrollee is stabilized in order to maintain the stabilized condition, or are provided, to improve or resolve the condition.
Post-Stabilization Care Services. Covered Services related to an Emergency Medical Condition that are provided after an Enrollee is stabilized in order to maintain the condition, or to improve or resolve the Enrollee's condition pursuant to 42 CFR 422.113. Potential Enrollee — Pursuant to 42 CFR 438.10(a), an eligible Medicaid Recipient who is subject to Mandatory Assignment or may voluntarily elect to enroll in a given Health Plan, but is not yet an Enrollee of a specific Health Plan. Pre-Enrollment — The provision of Marketing and educational materials to a Medicaid Recipient and assistance in completing the Request for Benefit Information (RBI).
Post-Stabilization Care Services. 2.10.10.1. The Contractor must cover and pay for Post-Stabilization Care Services.
Post-Stabilization Care Services. Covered services related to an emergency medical condition that are provided after an enrollee is stabilized in order to maintain, improve or resolve the enrollee's condition pursuant to 42 CFR 422.113. Potential Enrollee — Pursuant to 42 CFR 438.10(a), an eligible Medicaid recipient who is subject to mandatory assignment or one who may voluntarily elect to enroll in a given Managed Care Plan, but is not yet actually enrolled in a managed care plan. Preadmission Screening and Resident Review (PASRR) — Pursuant to 42 CFR Part 483, the process of screening and determining if nursing facility services and specialized mental health services or mental retardation services are needed by nursing facility applicants and residents. A DCF Office of Mental Health contractor completes the Level II reviews for those residents identified as having a mental illness. Agency for Persons with Disabilities staff complete reviews for those residents identified with a diagnosis of mental retardation. Pre-Enrollment — The provision of marketing materials to a Medicaid recipient.
Post-Stabilization Care Services. “Post-stabilization care services” means covered services, related to an emergency medical condition, that are provided after an enrollee is stabilized in order to maintain the stabilized condition, or, under the circumstances described in 42 CFR 438.114(e) to improve or resolve the enrollee’s condition. Post-stabilization care services provided on an inpatient hospital basis are paid for by the OVHA for all enrollees in the public insurance programs under the Global Commitment to Health Waiver. The OVHA may conduct concurrent review for post-stabilization services as soon as medically appropriate. However, the OVHA must pay for all inpatient post-stabilization care services that are pre-approved by the OVHA, all post- stabilization services that are not pre-approved but are administered to maintain the enrollee’s stabilized condition within one hour of a request to the OVHA for pre- approval, and all services that are not pre-approved but are administered to maintain, improve or resolve an enrollee’s stabilized condition if the: • OVHA does not respond to a request for pre-approval within one hour; • OVHA cannot be contacted; or • XXXX’s representative and the treating physician cannot agree concerning the enrollee’s treatment and the OVHA does not have a physician available for consultation. In this situation, the OVHA must allow the treating physician to continue with care of the enrollee until the OVHA physician is reached or the enrollee is discharged. The OVHA’s financial responsibility for post-stabilization services for services it has not pre-approved ends when any of the following conditions is met the: • XXXX-contracted physician who has privileges at the treating hospital assumes responsibility for the enrollee’s care; • XXXX-contracted physician assumes responsibility for the enrollee’s care through transfer; • OVHA and the treating physician reach an agreement concerning the enrollee’s care; or • Enrollee is discharged.
Post-Stabilization Care Services. Non-emergency services subsequent to an emergency that a treating physician views as medically necessary to maintain the stabilized condition after an emergency medical condition has been stabilized or to improve or resolve the enrollee’s condition. An MCOs financial responsibility for post stabilization care services shall end when one of the following are met:
Post-Stabilization Care Services. Medicaid covered services related to an emergency medical condition that are provided after an enrollee is stabilized in order to maintain, improve or resolve the enrollee’s condition pursuant to 42 C.F.R. §438.114.
Post-Stabilization Care Services. Covered services related to the Enrollee's underlying condition that are provided after an Enrollee’s Emergency Medical Condition has been Stabilized and/or under the circumstances described in 42 CFR 438.114(e).
Post-Stabilization Care Services. 1. Notwithstanding Title 9, CCR, Section 1830.220 regarding out-of-plan services, the Contractor is financially responsible for post-stabilizationcare services obtained within or outside the Contractor's provider network that:
