Common use of Change in Living Arrangement Prior to Effective Date of Enrollment Capitation Cut-Off Clause in Contracts

Change in Living Arrangement Prior to Effective Date of Enrollment Capitation Cut-Off. If the MCO discovers and promptly notifies the STATE that an Enrollee was Institutionalized prior to the first effective date of MSC+ enrollment, and was assigned the Nursing Facility Benefit based on the information in MMIS at the time capitation ran, the STATE will retroactively close the “P” span so that the MCO will not have liability for Medicaid Nursing Facility days for this Enrollee, unless the conditions for a new Nursing Facility benefit period are met.

Change in Living Arrangement Prior to Effective Date of Enrollment Capitation Cut-Off. If the MCO discovers and promptly notifies the STATE that an Enrollee was Institutionalized prior to the first effective date of MSC+ enrollment, and was assigned the Nursing Facility Benefit based on the information in MMIS at the time capitation ran, the STATE will will: retroactively close the “P” span so that the MCO will not have liability for Medicaid Nursing Facility days for this Enrollee, unless the conditions for a new Nursing Facility benefit period Benefit Period are met.