Common use of Post-Stabilization Services Clause in Contracts

Post-Stabilization Services. The PH-MCO must cover Post-Stabilization Services, pursuant to 42 CFR 438.114(b). The PH-MCO must limit charges to Members for Post-Stabilization Services to an amount no greater than what the PH-MCO would charge the Member if he or she had obtained the services through the PH-MCO. The PH-MCO must cover Post-Stabilization Services without requiring authorization, and regardless of whether the Member obtains the services within or outside the PH-MCO Provider Network if any of the following situations exist: a. The Post-Stabilization Services were pre-approved by the PH-MCO. b. The Post-Stabilization Services were administered to maintain the Member’s stabilized condition within one hour of Provider’s request to the PH-MCO for pre-approval of further Post-Stabilization Services. c. The Post-Stabilization Services were not pre-approved by the PH-MCO because the PH-MCO did not respond to the Provider’s request for pre-approval of these Post- Stabilization Services within one (1) hour of the request.

Post-Stabilization Services. ‌ The PH-MCO must cover Post-Stabilization Services, pursuant to 42 CFR 438.114(b). The PH-MCO must limit charges to Members for Post-Stabilization Services to an amount no greater than what the PH-MCO would charge the Member if he or she had obtained the services through the PH-MCO. The PH-MCO must cover Post-Stabilization Services without requiring authorization, and regardless of whether the Member obtains the services within or outside the PH-MCO Provider Network if any of the following situations exist: a. The Post-Stabilization Services were pre-approved by the PH-MCO. b. The Post-Stabilization Services were administered to maintain the Member’s stabilized condition within one hour of Provider’s request to the PH-MCO for pre-approval of further Post-Stabilization Services. c. The Post-Stabilization Services were not pre-approved by the PH-MCO because the PH-MCO did not respond to the Provider’s request for pre-approval of these Post- Stabilization Services within one (1) hour of the request.