Pregnancy termination. Charges for the termination of Pregnancy is covered only when Medically Necessary.
Pregnancy termination. Charges for the termination of Pregnancy is covered only when Medically 3.2.7 Skilled Nursing Facility care. Coverage for Skilled Nursing Facility Services is limited to sixty (60) days maximum per Plan Year.
Pregnancy termination. The CONTRACTOR shall pay Claims for State and federally approved pregnancy termination and pregnancy termination related services rendered to eligible Members. The CONTRACTOR shall be reimbursed by HCA for Medical Pregnancy Termination services as directed by HCA in the New Mexico Medicaid Billing Manual. The CONTRACTOR shall be reimbursed for paid Claims at either the established Medicaid fee schedule or the contracted rate in the provider agreement, whichever is greater, as of the date of service, plus GRT as applicable. HCA shall reimburse the CONTRACTOR with State funds for State-funded services and State funds and federal match for federally-funded services via invoicing methodology. Non-Contract Providers for Women in the Third Trimester of Pregnancy If a pregnant woman in the third trimester of pregnancy has an established relationship with an obstetrical provider and desires to continue that relationship, and the Provider is not a Contract Provider, the CONTRACTOR shall reimburse the Non-Contract Provider in accordance with the applicable Medicaid fee schedule appropriate to the provider type. Reimbursement for Members Who Disenroll or Whose Enrollment is Suspended While Hospitalized If a Member is hospitalized at the time of enrollment or disenrollment, the payor at the date of admission shall be responsible for payment of all covered inpatient facility and professional services provided within a licensed acute care facility, non-psychiatric specialty unit, or hospitals as designated by the DOH until the date of discharge. Upon discharge, the Member becomes the financial responsibility of HCA or the MCO receiving Capitation Payments during the month in which the Member is enrolled. Discharge, for the purposes of this Agreement, shall mean: (i) when a Member is moved from or to a PPS exempt unit (such as a rehabilitation or psychiatric unit) within an acute care hospital; (ii) when a Member is moved from or to a specialty hospital as designated by DOH or HCA; (iii) when a Member is moved from or to a PPS exempt hospital (such as a psychiatric or rehabilitation hospital); (iv) when a Member leaves the acute care hospital setting to a community setting; and (v) when a Member leaves the acute care hospital setting to an institutional setting. For (v), the “discharge” date is based upon approval of the abstract and/or approval by HCA. It is not a “discharge” when a Member is moved from one (1) acute care facility to another acute care facility, includi...
