SPAN OF ELIGIBILITY. 47 6.4 CONTINUITY OF CARE AND OUT-OF-NETWORK PROVIDERS ........................................................ 48 6.5
SPAN OF ELIGIBILITY. 3 and its subparts are replaced with the following language"
SPAN OF ELIGIBILITY. The following outlines HMO's responsibilities for payment of hospital and free-standing psychiatric facility (facility) admissions:
6.3.1 Inpatient Admission Prior to Enrollment in HMO. HMO is responsible for payment of physician and non-hospital/facility charges for the period for which HMO is paid a capitation payment for that Member. HMO is not responsible for hospital/facility charges for Members admitted prior to the date of enrollment in HMO.
6.3.2 Inpatient Admission After Enrollment in HMO. HMO is responsible for all charges until the Member is discharged from the hospital/facility or until the Member loses Medicaid eligibility.
6.3.2.1 If a Member regains Medicaid eligibility and the Member was enrolled in HMO at the time the Member was admitted to the hospital, HMO is responsible for charges as follows:
SPAN OF ELIGIBILITY. The following outlines HMO's responsibilities for payment of hospital and freestanding psychiatric facility (facility) admissions:
6.3.1 Inpatient Admission Prior to Enrollment in HMO. HMO is responsible for payment of physician and non-hospital/facility charges for the period for which HMO is paid a capitation payment for that Member. HMO is not responsible for hospital/facility charges for Members admitted prior to the date of enrollment in HMO.
6.3.2 Inpatient Admission After Enrollment in HMO. HMO is responsible for all hospital/facility charges until the Member is discharged from the hospital/facility or until the Member loses Medicaid eligibility.
6.3.2.1 If a Member regains Medicaid eligibility and the Member was enrolled in HMO at the time the Member was admitted to the hospital, HMO is responsible for hospital/facility charges as follows:
6.3.2.1.1 Member Re-enrolls into HMO After Regaining Medicaid Eligibility. HMO is responsible for charges for the period for which HMO receives capitation payment for the Member or until the Member is discharged or loses Medicaid eligibility.
6.3.2.1.2 Member Re-enrolls in Another Health Plan After Regaining Medicaid Eligibility. HMO is responsible for hospital/facility charges until the Member is discharged or 1999 Renewal Contract Bexar Service Area August 9, 1999 loses Medicaid eligibility.
SPAN OF ELIGIBILITY. The following outlines HMO's responsibilities for payment of hospital and freestanding psychiatric facility (facility) admissions:
SPAN OF ELIGIBILITY. 37 6.4 CONTINUITY OF CARE AND OUT-OF-NET WORK PROVIDERS................. 38 6.5
SPAN OF ELIGIBILITY. 30 6.4 CONTINUITY OF CARE AND OUT-OF-NETWORK PROVIDERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 6.5
SPAN OF ELIGIBILITY. HMO must provide all services to Members assigned to HMO under this contract for all periods for which HMO has received payment, except as follows:
6.3.1 Inpatient admission prior to enrollment in HMO. HMO is responsible for payment of physician and non-hospital services from the date of enrollment in HMO. HMO is not responsible for hospital charges for Members admitted prior to enrollment.
6.3.2 Inpatient admission after enrollment in HMO. HMO is responsible for all services until the Member is discharged from the hospital, unless the Member loses Medicaid or STAR eligibility. In such cases, HMO is liable for all services during the period HMO is paid capitation for the Member.
6.3.3 Discharge after voluntary disenrollment from HMO and re-enrollment into a new HMO. HMO remains responsible for payment of hospital charges until the Member is discharged. HMO to whom Member transfers is responsible for payment of all physician and non-hospital charges beginning on the effective date of enrollment into the new HMO.
SPAN OF ELIGIBILITY. HMO must provide all covered services to Members assigned to HMO for all periods for which HMO has received payment, except as follows:
6.3.1 Inpatient admission to hospital or free-standing psychiatric facility (facility) prior to enrollment in HMO. HMO is responsible for payment of physician and non-hospital/non-facility services from the date of enrollment in HMO. HMO is not responsible for hospital/facility charges for Members admitted prior to enrollment.
6.3.2 Inpatient admission after enrollment in HMO. HMO is responsible for all hospital/facility charges until the Member is discharged from the hospital/facility or until the Member loses Medicaid eligibility.
6.3.3 Discharge after voluntary disenrollment from HMO and re-enrollment into a new HMO. HMO remains responsible for payment of hospital/facility charges until the Member is discharged. HMO to whom Member transfers is responsible for payment El Paso Service Area HMO Contract of all physician and non-hospital/non-facility charges beginning on the effective date of enrollment into the new HMO.
SPAN OF ELIGIBILITY. The following outlines HMO's responsibilities for payment of hospital and free-standing psychiatric facility (facility) admissions:
6.3.1 Inpatient Admission Prior to Enrollment in HMO. HMO is responsible for payment of physician and non-hospital/facility charges for the period for which HMO is paid a capitation payment for that Member. HMO is not responsible for hospital/facility charges for Members admitted prior to the date of enrollment in HMO.
6.3.2 Inpatient Admission After Enrollment in HMO. HMO is responsible for all charges until the Member is discharged from the hospital/facility or until the 1999 Renewal Contract Harrxx Xxxvice Area 43 August 9, 1999 Member loses Medicaid eligibility.
6.3.2.1 If a Member regains Medicaid eligibility and the Member was enrolled in HMO at the time the Member was admitted to the hospital, HMO is responsible for charges as follows:
