Common use of Post-Stabilization Care Services Clause in Contracts

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 of care is covered on both an inpatient and outpatient basis. Post-stabilization care services provided on an inpatient hospital basis are paid for by DVHA for all enrollees in the public insurance programs under the Global Commitment to Health Demonstration. DVHA may conduct concurrent review for post-stabilization services as soon as medically appropriate. However, DVHA must pay for all inpatient post-stabilization care services that are pre-approved by DVHA, 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 DVHA 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: DVHA does not respond to a request for pre-approval within one hour; DVHA cannot be contacted; or • DVHA’s representative and the treating physician cannot agree concerning the enrollee’s treatment and DVHA does not have a physician available for consultation. In this situation, DVHA must allow the treating physician to continue with care of the enrollee until DVHA physician is reached or the enrollee is discharged. DVHA’s financial responsibility for post-stabilization services for services it has not pre-approved ends when any of the following conditions is met the: • DVHA-contracted physician who has privileges at the treating hospital assumes responsibility for the enrollee’s care; • DVHA-contracted physician assumes responsibility for the enrollee’s care through transfer; • DVHA and the treating physician reach an agreement concerning the enrollee’s care; or Enrollee is discharged. DVHA shall limit charges to enrollees for post-stabilization care services to an amount no greater than what DVHA would charge the enrollee if the enrollee had obtained the services through DVHA.

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 of care is covered on both an inpatient and outpatient basis. Post-stabilization care services provided on an inpatient hospital basis are paid for by DVHA for all enrollees in the public insurance programs under the Global Commitment to Health Demonstration. DVHA may conduct concurrent review for post-stabilization services as soon as medically appropriate. However, DVHA must pay for all inpatient post-stabilization care services that are pre-approved by DVHA, all post-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 DVHA 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 theif: • DVHA does not respond to a request for pre-approval within one hour; • DVHA cannot be contacted; or • DVHA’s representative and the treating physician cannot agree concerning the enrollee’s treatment and DVHA does not have a physician available for consultation. In this situation, DVHA must allow the treating physician to continue with care of the enrollee until DVHA physician is reached or the enrollee is discharged. DVHA’s financial responsibility for post-stabilization services for services it has not pre-approved ends when any of the following conditions is met theare met: • DVHA-contracted physician who has privileges at the treating hospital assumes responsibility for the enrollee’s care; • DVHA-contracted physician assumes responsibility for the enrollee’s care through transfer; • DVHA and the treating physician reach an agreement concerning the enrollee’s care; or • Enrollee is discharged. DVHA shall limit charges to enrollees for post-stabilization care services to an amount no greater than what DVHA would charge the enrollee if the enrollee had obtained the services through DVHA.

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 of care is covered on both an inpatient and outpatient basis. Post-stabilization care services provided on an inpatient hospital basis are paid for by DVHA the OVHA for all enrollees in the public insurance programs under the Global Commitment to Health DemonstrationWaiver. DVHA The OVHA may conduct concurrent review for post-stabilization services as soon as medically appropriate. However, DVHA the OVHA must pay for all inpatient post-stabilization care services that are pre-approved by DVHAthe OVHA, all post-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 DVHA the OVHA for pre-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: DVHA • OVHA does not respond to a request for pre-approval within one hour; DVHA • OVHA cannot be contacted; or • DVHAXXXX’s representative and the treating physician cannot agree concerning the enrollee’s treatment and DVHA the OVHA does not have a physician available for consultation. In this situation, DVHA the OVHA must allow the treating physician to continue with care of the enrollee until DVHA the OVHA physician is reached or the enrollee is discharged. DVHAThe 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: • DVHAXXXX-contracted physician who has privileges at the treating hospital assumes responsibility for the enrollee’s care; • DVHAXXXX-contracted physician assumes responsibility for the enrollee’s care through transfer; • DVHA OVHA and the treating physician reach an agreement concerning the enrollee’s care; or • Enrollee is discharged. DVHA shall limit charges to enrollees for post-stabilization care services to an amount no greater than what DVHA would charge the enrollee if the enrollee had obtained the services through DVHA.

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 of care is covered on both an inpatient and outpatient basis. Post-stabilization care services provided on an inpatient hospital basis are paid for by DVHA for all enrollees in the public insurance programs under the Global Commitment to Health Demonstration. DVHA may conduct concurrent review for post-stabilization services as soon as medically appropriate. However, DVHA must pay for all inpatient post-stabilization care services that are pre-approved by DVHA, all post-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 DVHA 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: • DVHA does not respond to a request for pre-approval within one hour; • DVHA cannot be contacted; or • DVHA’s representative and the treating physician cannot agree concerning the enrollee’s treatment and DVHA does not have a physician available for consultation. In this situation, DVHA must allow the treating physician to continue with care of the enrollee until DVHA physician is reached or the enrollee is discharged. DVHA’s financial responsibility for post-stabilization services for services it has not pre-approved ends when any of the following conditions is met the: • DVHA-contracted physician who has privileges at the treating hospital assumes responsibility for the enrollee’s care; • DVHA-contracted physician assumes responsibility for the enrollee’s care through transferthroughtransfer; • DVHA and the treating physician reach an agreement concerning the enrollee’s care; or • Enrollee is discharged. DVHA shall limit charges to enrollees for post-stabilization care services to an amount no greater than what DVHA would charge the enrollee if the enrollee had obtained the services through DVHA.

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 of care is covered on both an inpatient and outpatient basis. Post-stabilization care services provided on an inpatient hospital basis are paid for by DVHA for all enrollees in the public insurance programs under the Global Commitment to Health DemonstrationWaiver. DVHA may conduct concurrent review for post-stabilization services as soon as medically appropriate. However, DVHA must pay for all inpatient post-stabilization care services that are pre-approved by DVHA, 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 DVHA 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: • DVHA does not respond to a request for pre-approval within one hour; • DVHA cannot be contacted; or • DVHA’s representative and the treating physician cannot agree concerning the enrollee’s treatment and DVHA does not have a physician available for consultation. In this situation, DVHA must allow the treating physician to continue with care of the enrollee until DVHA physician is reached or the enrollee is discharged. DVHA’s financial responsibility for post-stabilization services for services it has not pre-approved ends when any of the following conditions is met the: • DVHA-contracted physician who has privileges at the treating hospital assumes responsibility for the enrollee’s care; • DVHA-contracted physician assumes responsibility for the enrollee’s care through transfer; • DVHA and the treating physician reach an agreement concerning the enrollee’s care; or • Enrollee is discharged. DVHA shall limit charges to enrollees for post-stabilization care services to an amount no greater than what DVHA would charge the enrollee if the enrollee had obtained the services through DVHA.