Common use of Post-Stabilization Care Clause in Contracts

Post-Stabilization Care. The MCO must cover and pay for post-stabilization care services in the amount, duration, and scope necessary to comply with 42 CFR 438.114 and 42 CFR 422.113(c). These regulations state that the MCO must make timely and reasonable payment to or on behalf of the plan enrollee for the following services obtained from a provider or supplier whether or not that provider or supplier contracts with the MCO to provide services covered by the MCO. Post-stabilization care services are covered services that: • Were pre-approved by the organization; or • Were not pre-approved by the organization because the organization did not respond to the provider of post-stabilization care services’ request for pre-approval within one hour after being requested to approve such care, or could not be contacted for pre-approval. Post-stabilization services are not “emergency services,” which the MCO is obligated to cover in-or-out of plan according to the “prudent layperson” standard. Rather, they are non-emergency services that the MCO could choose not to cover out-of-plan except in the circumstances described above. The intent of this provision is to promote efficient and timely coordination of appropriate care of a managed care enrollee after the enrollee’s condition has been determined to be stable.

Post-Stabilization Care. The MCO must cover and pay for post-stabilization care services in the amount, duration, and scope necessary to comply with 42 CFR 438.114 and 42 CFR 422.113(c). These regulations state that the MCO must make timely and reasonable payment to or on behalf of the plan enrollee for the following services obtained from a provider or supplier whether or not that provider or supplier contracts with the MCO to provide services covered by the MCO. Post-stabilization care services are covered services that: •  Were pre-approved by the organization; or •  Were not pre-approved by the organization because the organization did not respond to the provider of post-stabilization care services’ request for pre-approval within one hour after being requested to approve such care, or could not be contacted for pre-approval. Post-stabilization services are not “emergency services,” which the MCO is obligated to cover in-or-out of plan according to the “prudent layperson” standard. Rather, they are non-emergency services that the MCO could choose not to cover out-of-plan except in the circumstances described above. The intent of this provision is to promote efficient and timely coordination of appropriate care of a managed care enrollee after the enrollee’s condition has been determined to be stable.

Post-Stabilization Care. The MCO must cover and pay for post-stabilization care services in the amount, duration, and scope necessary to comply with 42 CFR 438.114 and 42 CFR 422.113(c). These regulations state that the MCO must make timely and reasonable payment to or on behalf of the plan enrollee for the following services obtained from a provider or supplier whether or not that provider or supplier contracts with the MCO to provide services covered by the MCO. Post-stabilization care services are covered services that: • Were pre-approved by the organization; or • Were not pre-approved by the organization because the organization did not respond to the provider of post-stabilization care services’ request for pre-approval within one hour after being requested to approve such care, or could not be contacted for pre-approval. Post-stabilization services are not “emergency services,” which the MCO is obligated to cover in-or-out of plan according to the “prudent layperson” standard. Rather, they are non-non- emergency services that the MCO could choose not to cover out-of-plan except in the circumstances described above. The intent of this provision is to promote efficient and timely coordination of appropriate care of a managed care enrollee after the enrollee’s condition has been determined to be stable.

Post-Stabilization Care. The MCO must cover and pay for post-stabilization care services in the amount, duration, and scope necessary to comply with 42 CFR 438.114 and 42 CFR 422.113(c). These regulations state that the MCO must make timely and reasonable payment to or on behalf of the plan enrollee for the following services obtained from a provider or supplier whether or not that provider or supplier contracts with the MCO to provide services covered by the MCO. Post-stabilization care services are covered services that: • Were pre-approved by the organization; or • Were not pre-approved by the organization because the organization did not respond to the provider of post-stabilization care services’ request for pre-pre- approval within one (1) hour after being requested to approve such care, care or could not be contacted for pre-approval. Post-stabilization services are not “emergency services,” which the MCO is obligated to cover in-or-out of plan according to the “prudent layperson” standard. Rather, they are non-emergency services that the MCO could choose not to cover out-of-plan except in the circumstances described above. The intent of this provision is to promote efficient and timely coordination of appropriate care of a managed care enrollee after the enrollee’s condition has been determined to be stable.

Post-Stabilization Care. The MCO must cover and pay for post-stabilization care services in the amount, duration, and scope necessary to comply with 42 CFR 438.114 438.114(b)&(e) and 42 CFR 422.113(c)422.113. These regulations state that the MCO must make timely and reasonable payment to or on behalf of the plan enrollee for the following services obtained from a provider or supplier whether or not that provider or supplier contracts with the MCO to provide services covered by the MCO. Post-stabilization care services are covered services that: •  Were pre-approved by the organization; or •  Were not pre-approved by the organization because the organization did not respond to the provider of post-stabilization care services’ request for pre-approval within one hour after being requested to approve such care, or could not be contacted for pre-approval. Post-stabilization services are not “emergency services,” which the MCO is obligated to cover in-or-out of plan according to the “prudent layperson” standard. Rather, they are non-non- emergency services that the MCO could choose not to cover out-of-plan except in the circumstances described above. The intent of this provision is to promote efficient and timely coordination of appropriate care of a managed care enrollee after the enrollee’s condition has been determined to be stable.

Post-Stabilization Care. The MCO must cover and pay for post-stabilization care services in accordance with the amount, duration, and scope necessary to comply with guidelines for coordinating post-stabilization care established under Medicare Part C at 42 CFR 438.114 and 42 CFR 422.113(c)§422.113. Post-stabilization services are defined in Article II of this contract. These regulations state that the MCO must make timely and reasonable payment to or on behalf of the plan enrollee for the following services obtained from a provider or supplier whether or 4 Qualified medical personnel must be accessible 24 hours each day, seven days a week, to provide direction to patients in need of urgent or emergency care. Such medical personnel include, but are not limited to, physicians, physicians on-call, licensed practical nurses, or registered nurses. not that provider or supplier contracts with the MCO to provide services covered by the MCO. Post-stabilization care services are covered services that: • Were pre-approved by the organization; or • Were not pre-approved by the organization because the organization did not respond to the provider of post-stabilization care services’ request for pre-approval within one hour after being requested to approve such care, or could not be contacted for pre-approval. Post-stabilization services are not “emergency services,” which the MCO is obligated to cover in-or-out of plan according to the “prudent layperson” standard. Rather, they are non-non- emergency services that the MCO could choose not to cover out-of-plan except in the circumstances described above. The intent of this provision is to promote efficient and timely coordination of appropriate care of a managed care enrollee after the enrollee’s condition has been determined to be stable.

Post-Stabilization Care. The MCO must cover and pay for post-stabilization care services in the amount, duration, and scope necessary to comply with 42 CFR 438.114 and 42 CFR 422.113(c)422.113. These regulations state that the MCO must make timely and reasonable payment to or on behalf of the plan enrollee for the following services obtained from a provider or supplier whether or not that provider or supplier contracts with the MCO to provide services covered by the MCO. Post-stabilization care services are covered services that: • Were pre-approved by the organization; or • Were not pre-approved by the organization because the organization did not respond to the provider of post-stabilization care services’ request for pre-approval within one hour after being requested to approve such care, or could not be contacted for pre-approval. Post-stabilization services are not “emergency services,” which the MCO is obligated to cover in-or-out of plan according to the “prudent layperson” standard. Rather, they are non-non- emergency services that the MCO could choose not to cover out-of-plan except in the circumstances described above. The intent of this provision is to promote efficient and timely coordination of appropriate care of a managed care enrollee after the enrollee’s condition has been determined to be stable.

Post-Stabilization Care. The MCO must cover and pay for post-stabilization care services in accordance with the amount, duration, and scope necessary to comply with guidelines for coordinating post-stabilization care established under Medicare Part C at 42 CFR 438.114 and 42 CFR 422.113(c)§422.113. Post-stabilization services are defined in Article II of this contract. These regulations state that the MCO must make timely and reasonable payment to or on behalf of the plan enrollee for the following services obtained from a provider or supplier whether or not that provider or supplier contracts with the MCO to provide services covered by the MCO. Post-stabilization care services are covered services that: •  Were pre-approved by the organization; or •  Were not pre-approved by the organization because the organization did not respond to the provider of post-stabilization care services’ request for pre-approval within one hour after being requested to approve such care, or could not be contacted for pre-approval. Post-stabilization services are not “emergency services,” which the MCO is obligated to cover in-or-out of plan according to the “prudent layperson” standard. Rather, they are non-non- emergency services that the MCO could choose not to cover out-of-plan except in the circumstances described above. The intent of this provision is to promote efficient and timely coordination of appropriate care of a managed care enrollee after the enrollee’s condition has been determined to be stable.