Responsibility for Payment of Medical Assistance NF Days Sample Clauses

Responsibility for Payment of Medical Assistance NF Days. ‌ After the 180-day benefit period is expended for MSC+, the STATE shall assume responsibility for Medical Assistance Nursing Facility Days.
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Responsibility for Payment of Medical Assistance NF Days. After the one hundred eighty (180) day Benefit Period for MSHO is expended, the STATE shall assume responsibility for Medical Assistance Nursing Facility days 180 Day Separation Period for MSHO. (A) If the MCO has not previously had liability for NF services for an Enrollee, the one hundred and eighty (180) Day Separation Period is defined as one hundred and eighty (180) consecutive Institutional or community days that an Enrollee resides in the community after the MCO has already paid for 180 days of SNF/NF services as required under the 180-day SNF/NF benefit policy. If the MCO has already been liable for 180 days of SNF/NF services, then the one hundred and eighty (180) day Separation Period is defined as one hundred and eighty (180) consecutive Institutional or community days after the MCO has already been liable for 180 days of SNF/NF services. In either case, after this separation period has expired, the MCO shall be liable for a new, distinct 180-day SNF/NF Benefit Period for any Enrollee who is still community-based (i.e., an Enrollee is in MSHO Rate Cell Category A or B, on the last day of the separation period. If an Enrollee becomes Institutionalized (i.e., has been assigned to Rate Cell Category “D” for MSHO) prior to the end of the separation period, no new SNF/NF Benefit Period is applied. (B) If an MSHO Enrollee is hospitalized and/or placed in a Nursing Facility during the one hundred and eighty (180) day Separation Period for thirty (30) days or less, the MSHO Enrollee shall still be considered to be residing in the community and these days shall be counted toward the one hundred and eighty (180) day Separation Period. If the Enrollee spends more than thirty (30) days in a hospital and/or Nursing Facility, the counting of the one hundred and eighty (180) day Separation Period shall begin over again if and when the Enrollee returns to the community. (C) The STATE shall have the responsibility for tracking the one hundred and eighty (180) day Separation Period. The MCO shall cooperate with the STATE in verifying the one hundred and eighty (180) day Separation Period. On a monthly basis, the STATE shall identify community MSHO Enrollees for whom the 180 day NF benefit is not in effect. Of these, if the Enrollee is not within a 180 day separation period, the STATE shall begin a new 180 day NF Benefit Period on the first day of the next available month. (D) The STATE enrollment data will contain information indicating the MCO’s Nursing Facility...
Sample 1

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