Hospital Discharge Appeals. 1. When an Enrollee is being discharged from the hospital, the Contractor must assure that the Enrollee receives a written notice of explanation called the Important Message From Medicare About Your Rights.
Hospital Discharge Appeals. 2.10.4.1. When a Beneficiary is being discharged from the hospital, the ICDS Plan must comply with requirements in 42 C.F.R. §§ 422.620-422.622.
Hospital Discharge Appeals. 2.12.7.1 The Contractor must comply with the hospital discharge Appeal requirements at 42 C.F.R. §§ 422.620-422.622
Hospital Discharge Appeals. 1. When an Enrollee is being discharged from the hospital, the Contractor must comply with the hospital discharge Appeal requirements at 42 C.F.R. §§ 422.620-422.622.
Hospital Discharge Appeals. 2.10.4.1. When a Beneficiary is being discharged from the hospital, the ICDS Plan must assure that the Beneficiary receives a written notice of explanation called an Important Message from Medicare About your Rights regarding the right to appeal the discharge decision from an inpatient hospital admission.
Hospital Discharge Appeals. 2.12.7.1 When an Enrollee is being discharged from the hospital, the Contractor must assure that the Enrollee receives a written notice in compliance with requirements in 42 C.F.R. §§ 422.620-422.622.
Hospital Discharge Appeals. 2.13.6.1. When a Participant is being discharged from the hospital, the FIDA Plan must comply with requirements in 42 C.F.R. §§ 422.620-422.622.
Hospital Discharge Appeals. 1. When a Dual Eligible Senior Enrollee is being discharged from the hospital, the Contractor must assure that the Enrollee receives a written notice of explanation called Important Notice from Medicare About Your Rights (IM).
Hospital Discharge Appeals. When a Dual Eligible Enrollee is being discharged from the hospital, the Contractor shall assure that the Enrollee receives a written notice of explanation required by 42 CFR §§ 422.620-622. The Enrollee has the right to request a review of any hospital discharge notice by a Quality Improvement Organization (QIO). The notice includes information on filing the QIO Appeal. Such a request shall be made by noon of the first workday after the receipt of the notice. If the Enrollee asks for immediate review by the QIO, the Enrollee will be entitled to this process instead of the standard Appeals process described above. Note: an Enrollee may file an oral or written request for an expedited 72-hour Contractor Appeal if the Enrollee has missed the deadline for requesting the QIO review. The QIO will make its decision within one full working day after it receives the Enrollee’s request, medical records, and any other information it needs to make its decision. If the QIO agrees with the Contractor’s decision, the Contractor is not responsible for paying the cost of the hospital stay beginning at noon of the calendar following the day the QIO notifies the Enrollee of its decision. If the QIO overturns the Contractor’s decision, the Contractor shall pay for the remainder of the hospital stay. Other Discharge Appeals The Contractor shall comply with the termination of services Appeal requirements for individuals receiving services from a comprehensive outpatient rehabilitation facility, skilled nursing facilities, or home health agency at 42 C.F.R. §§ 422.624 and 422.626. Quality Management Quality Improvement (QI) Program The Contractor shall deliver quality care that enables Enrollees to stay healthy, get better, manage chronic illnesses and/or disabilities, maintain their independence in the community, and maintain/improve their quality of life. Quality care refers to: Clinical quality of physical health care, including primary and specialty care; Clinical quality of mental health care focused on recovery, resiliency and rehabilitation; Clinical quality of substance use disorder treatment focused on intervention, treatment, recovery, resiliency and rehabilitation; Quality of LTSS; Quality of oral health care; Adequate access and availability to primary, mental health care, substance use disorder treatment, specialty health care, oral health care, pharmacy, and LTSS providers and services; Continuity and coordination of care across all care and service settings, and ...
Hospital Discharge Appeals. 2.11.5.1. The ICO must comply with the hospital discharge Appeal requirements at 42 C.F.R. §§ 422.620-422.622.
