Common use of Post-Stabilization Care Services Clause in Contracts

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: 1. The Contractor does not respond to a request for pre-approval within one hour; 2. The Contractor cannot be contacted; or 3. The Contractor representative and the treating physician cannot reach an agreement concerning the Member’s care and a Contractor physician is not available for consultation. In this situation, the Contractor must give the treating physician the opportunity to consult with a Contractor physician and the treating physician may continue with care of the patient until a Contractor physician is reached or one of the criteria of 42 C.F.R. § 422.113 is met. The Contractor must not charge Members upon the end of Post-Stabilization Care Services that the Contractor has not provided service authorization. Post-Stabilization Care Services not approved by the Contractor end when: 1. A Contractor physician with privileges at the treating hospital assumes responsibility for the Member’s care; 2. A Contractor physician assumes responsibility for the Member’s care through transfer; 3. A Contractor representative and the treating physician reach an agreement concerning the Member’s care; or 4. The Member is discharged.

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(c438.114(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: 1. The Contractor does not respond to a request for pre-approval within one hour; 2. The Contractor cannot be contacted; or 3. The Contractor representative and the treating physician cannot reach an agreement concerning the Member’s care and a Contractor physician is not available for consultation. In this situation, the Contractor must give the treating physician the opportunity to consult with a Contractor physician and the treating physician may continue with care of the patient until a Contractor physician is reached or one of the criteria of 42 C.F.R. § 422.113 438.114 is met. The Contractor must not charge Members upon the end of Post-Stabilization Care Services that the Contractor has not provided service authorization. Post-Stabilization Care Services not approved by the Contractor end when: 1. A Contractor physician with privileges at the treating hospital assumes responsibility for the Member’s care; 2. A Contractor physician assumes responsibility for the Member’s care through transfer; 3. A Contractor representative and the treating physician reach an agreement concerning the Member’s care; or 4. The Member is discharged.

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 Outa Non-of-network Contracted Provider that are not pre- pre-approved by a Network contracted Provider or other Contractor representative, but administered to maintain, improve or resolve the Member’s stabilized condition if: 1. The Contractor does not respond to a request for pre-approval within one hour; 2. The Contractor cannot be contacted; or 3. The Contractor representative and the treating physician cannot reach an agreement concerning the Member’s care and a Contractor physician is not available for consultation. In this situation, the Contractor must give the treating physician the opportunity to consult with a Contractor physician and the treating physician may continue with care of the patient until a Contractor physician is reached or one of the criteria of 42 C.F.R. § 422.113 422.113(c) is met. The Contractor must not charge Members upon the end of Post-Stabilization Care Services that the Contractor has not provided service authorizationpre-approved. Post-Stabilization Care Services not approved by the Contractor end when: 1. A Contractor physician with privileges at the treating hospital assumes responsibility for the Member’s care; 2. A Contractor physician assumes responsibility for the Member’s care through transfer; 3. A Contractor representative and the treating physician reach an agreement concerning the Member’s care; or 4. The Member is discharged.

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(c438.114(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: 1. The Contractor does not respond to a request for pre-approval within one hour; 2. The Contractor cannot be contacted; or 3. The Contractor representative and the treating physician cannot reach an agreement concerning the Member’s care and a Contractor physician is not available for consultation. In this situation, the Contractor must give the treating physician the opportunity to consult with a Contractor physician and the treating physician may continue with care of the patient until a Contractor physician is reached or one of the criteria of 42 C.F.R. § 422.113 438.114 is met. The Contractor must not charge Members upon the end of Post-Stabilization Care Services that the Contractor has not provided service authorization. Post-Stabilization Care Services not approved by the Contractor end when: 1. A Contractor physician with privileges at the treating hospital assumes responsibility for the Member’s care; 2. A Contractor physician assumes responsibility for the Member’s care through transfer; 3. A Contractor representative and the treating physician reach an agreement concerning the Member’s care; or 4. The Member is discharged.

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: 1. The Contractor does not respond to a request for pre-approval within one (1) hour; 2. The Contractor cannot be contacted; or 3. The Contractor representative and the treating physician cannot reach an agreement concerning the Member’s care and a Contractor physician from the Contractor’s Provider Network is not available for consultation. In this situation, the Contractor must give the treating physician the opportunity to consult with a Contractor physician from the Contractor’s Provider Network and the treating physician may continue with care of the patient Member until a Contractor physician is reached or one of the criteria of 42 C.F.R. § 422.113 422.113(c) is met. The Contractor must not charge Members upon the end of Post-Stabilization Care Services that the Contractor has not provided service authorizationpre-approved. Post-Stabilization Care Services not approved by the Contractor end when: 1. A Contractor physician from the Contractor’s Provider Network with privileges at the treating hospital assumes responsibility for the Member’s care; 2. A Contractor physician from the Contractor’s Provider Network assumes responsibility for the Member’s care through transfer; 3. A Contractor representative and the treating physician reach an agreement concerning the Member’s care; or 4. The Member is discharged.

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: 1. The Contractor does not respond to a request for pre-approval within one (1) hour; 2. The Contractor cannot be contacted; or 3. The Contractor representative and the treating physician cannot reach an agreement concerning the Member’s care and a Contractor physician from the Contractor’s Provider Network is not available for consultation. In this situation, the Contractor must give the treating physician the opportunity to consult with a Contractor physician from the Contractor’s Provider Network and the treating physician may continue with care of the patient Member until a Contractor physician is reached or one of the criteria of 42 C.F.R. § 422.113 422.113(c) is met. The Contractor must not charge Members upon the end of Post-Stabilization Care Services that the Contractor has not provided service authorizationpre-approved. Post-Stabilization Care Services not approved by the Contractor end when: 1. A Contractor physician from the Contractor’s Provider Network with privileges at the treating hospital assumes responsibility for the Member’s care; 2. A Contractor physician from the Contractor’s Provider Network assumes responsibility for the Member’s care through transfer; 3. A Contractor representative and the treating physician reach an agreement concerning the Member’s care; or 4. The Member is discharged.

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 Outa Non-of-network Contracted Provider that are not pre- approved by a Network Provider contracted provider or other Contractor representative, but administered to maintain, improve or resolve the Member’s stabilized condition if: 1. The Contractor does not respond to a request for pre-approval within one (1) hour; 2. The Contractor cannot be contacted; or 3. The Contractor representative and the treating physician cannot reach an agreement concerning the Member’s care and a Contractor physician is not available for consultation. In this situation, the Contractor must give the treating physician the opportunity to consult with a Contractor physician and the treating physician may continue with care of the patient Member until a Contractor physician is reached or one of the criteria of 42 C.F.R. § 422.113 422.113(c) is met. The Contractor must not charge Members upon the end of Post-Stabilization Care Services that the Contractor has not provided service authorizationpre-approved. Post-Stabilization Care Services not approved by the Contractor end when: 1. A Contractor physician with privileges at the treating hospital assumes responsibility for the Member’s care; 2. A Contractor physician assumes responsibility for the Member’s care through transfer; 3. A Contractor representative and the treating physician reach an agreement concerning the Member’s care; or 4. The Member is discharged.

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 Outa Non-of-network Contracted Provider that are not pre- approved by a Network Provider contracted provider or other Contractor representative, but administered to maintain, improve or resolve the Member’s stabilized condition if: 1. The Contractor does not respond to a request for pre-approval within one (1) hour; 2. The Contractor cannot be contacted; or 3. The Contractor representative and the treating physician cannot reach an agreement concerning the Member’s care and a Contractor physician from the Contractor’s Provider Network is not available for consultation. In this situation, the Contractor must give the treating physician the opportunity to consult with a Contractor physician from the Contractor’s Provider Network and the treating physician may continue with care of the patient Member until a Contractor physician is reached or one of the criteria of 42 C.F.R. § 422.113 422.113(c) is met. The Contractor must not charge Members upon the end of Post-Stabilization Care Services that the Contractor has not provided service authorizationpre-approved. Post-Stabilization Care Services not approved by the Contractor end when: 1. A Contractor physician from the Contractor’s Provider Network with privileges at the treating hospital assumes responsibility for the Member’s care; 2. A Contractor physician from the Contractor’s Provider Network assumes responsibility for the Member’s care through transfer; 3. A Contractor representative and the treating physician reach an agreement concerning the Member’s care; or 4. The Member is discharged.