Nursing Facilities Clause Samples
Nursing Facilities. Nursing facility care, although a part of the care continuum, presents a challenge for managed care. Because of the process for becoming eligible for Medicaid assistance in a nursing facility, there is frequently a significant time gap between entry into the nursing home and determination of Medicaid eligibility. During this gap from entry to Medicaid eligibility, the resident has “nested” in the facility and many of the community supports are no longer available. To require participation of all nursing facility residents would result in the HMO maintaining a Member in the nursing facility without many options for managing their health. For this reason, persons who qualify for Medicaid as a result of nursing facility residency are not enrolled in STAR+PLUS. The STAR+PLUS HMO must participate in the Promoting Independence initiative for such individuals. Promoting Independence (PI) is a philosophy that aged and disabled individuals remain in the most integrated setting to receive long-term care services. PI is Texas' response to the U.S. Supreme Court ruling in ▇▇▇▇▇▇▇▇ v. ▇.▇. that requires states to provide community-based services for persons with disabilities who would otherwise be entitled to institutional services, when: • the state's treatment professionals determine that such placement is appropriate; • the affected persons do not oppose such treatment; and • the placement can be reasonably accommodated, taking into account the resources available to the state and the needs of others who are receiving state supported disability services. In accordance with legislative direction, the HMO must designate a point of contact to receive referrals for nursing facility residents who may potentially be able to return to the community through the use of 1915(c) Nursing Facility Waiver services. To be eligible for this option, an individual must reside in a nursing facility until a written plan of care for safely moving the resident back into a community setting has been developed and approved. A STAR+PLUS Member who enters a nursing facility will remain a STAR+PLUS Member for a total of four months. The nursing facility will ▇▇▇▇ the state directly for covered nursing facility services delivered while the Member is in the nursing facility. See Section 8.3.2.7 for further information.
Nursing Facilities. The MCOP shall contract with at least the minimum number of facilities identified in Table 2. If a contracted nursing facility experiences a CHOP, the plan shall not require the new nursing facility to request a new authorization for members who had a previous authorization that is still current.
Nursing Facilities. 2.6.3.1. Contractor shall contract with SNFs, as defined in California Code of Regulations Title 22 section 51121(a), in its Service Area that are licensed by California Department of Public Health (CDPH) and certified by DHCS for participation as a SNF in the Medi-Cal Program and additional Contractor credentialing standards, if any. See Section 2.10.2.3.
2.6.3.2. If SNFs beds are not available in the Contractor’s Service Area, Contractor shall contract with qualified SNFs in areas outside of the Contractor’s Service Area, in correspondence to the Contractor’s projected need for SNF beds of its Enrollees.
Nursing Facilities. Nursing facility care, although a part of the care continuum, presents a challenge for managed care. Because of the process for becoming eligible for Medicaid assistance in a nursing facility, there is frequently a significant time gap between entry into the nursing home and determination of Medicaid eligibility. During this gap, it is likely that the resident will have "nested" in the facility and many of the community supports are no longer available. To require participation of all nursing facility residents would result in the MCO maintaining a Member in the nursing facility without many options for managing their health. For this reason, persons who qualify for Medicaid as a result of nursing facility residency are not enrolled in STAR+PLUS. The STAR+PLUS MCO must participate in the Promoting Independence (PI) initiative for such individuals. PI is a philosophy that aged and disabled individuals remain in the most integrated setting to receive Long-term Services and Supports. PI is Texas' response to the U.S. Supreme Court ruling in ▇▇▇▇▇▇▇▇ v. ▇.▇., which requires states to provide community-based services for persons with disabilities who would otherwise be entitled to institutional services, when:
Nursing Facilities. The Employer shall provide a dedicated space for unit members to express breast milk as frequently as needed. This space shall not be a bathroom, must be shielded from view and free from intrusion by coworkers or the public, shall have a lock, and shall not be accessible to students. The employer shall provide access to a clean sink with running water and a refrigerator suitable for storing milk in close proximity to the employee’s workspace.
Nursing Facilities. This section is deleted effective August 31, 2014. Nursing facility care, although a part of the care continuum, presents a challenge for managed care. Because of the process for becoming eligible for Medicaid assistance in a nursing facility, there is frequently a significant time gap between entry into the nursing home and determination of Medicaid eligibility. During this gap, it is likely that the resident will have "nested" in the facility and many of the community supports are no longer available. To require participation of all nursing facility residents would result in the MCO maintaining a Member in the nursing facility without many options for managing their health. For this reason, persons who qualify for Medicaid as a result of nursing facility residency are not enrolled in STAR+PLUS. The STAR+PLUS MCO must participate in the Promoting Independence (PI) initiative for such individuals. PI is a philosophy that aged and disabled individuals remain in the most integrated setting to receive Long-term Services and Supports. PI is Texas' response to the U.S. Supreme Court ruling in ▇▇▇▇▇▇▇▇ v. ▇.▇., which requires states to provide community-based services for persons with disabilities who would otherwise be entitled to institutional services, when:
Nursing Facilities. If Provider is a Nursing Facility, in addition to the other requirements set forth in the Agreement and this Appendix, Provider shall:
(a) Promptly notify Subcontractor and/or Health Plan, and/or other entities as directed by the State, of a Covered Person’s admission or request for admission to the nursing facility regardless of payor source for the nursing facility stay, or when there is a change in a Covered Person’s known circumstances and to notify Subcontractor and/or Health Plan, and/or entity as directed by the State, prior to a Covered Person’s discharge;
(b) Provide written notice to the State, Health Plan and Subcontractor in accordance with State and Federal requirements before voluntarily terminating the Agreement and to comply with all applicable State and Federal requirements regarding voluntary termination;
(c) Notify Subcontractor and/or Health Plan immediately when considering discharging a Covered Person and to consult with the Covered Person’s case manager to intervene in resolving issues if possible and, if not, to prepare and implement a discharge and/or transition plan as appropriate;
(d) Not request that a Covered Person leave after his/her Medicare benefit days have been exhausted;
(e) Notify the Covered Person and/or the Covered Person representative (if applicable) in writing 30 calendar days prior to discharge in accordance with State and Federal requirements (see, e.g., 42 CFR 483.12) (Subcontractor and/or Health Plan shall notify the nursing facility in writing 30 calendar days prior to a Covered Person leaving the facility);
(f) Accept payment or appropriate denial made by Subcontractor and/or Health Plan (or, if applicable, payment by Subcontractor and/or Health Plan that is supplementary to the Covered Person’s Third Party payor) plus the amount of any applicable patient liability, as payment in full for services provided and shall not solicit or accept any payment from the Covered Person in excess of the amount of applicable patient liability responsibilities;
(g) Collect the applicable patient liability amounts from Covered Persons, notifying the Covered Person’s case manager if there is an issue with collecting a Covered Person’s patient liability, and making good faith efforts to collect payment;
(h) Notify Subcontractor and/or Health Plan of any change in a Covered Person’s medical or functional condition that could impact the Covered Person’s level of care for the currently authorized level of nursing facility service...
Nursing Facilities. Civicorps shall provide a dedicated space for unit members to express breast milk as frequently as needed by the employee. This space shall not be a bathroom, must be shielded from view and free from intrusion by coworkers or the public, shall have a lock, shall not be accessible to students, and shall be clean. The unit member shall have access to fresh water, a power source, and refrigeration. Break time provided for this purpose shall, if possible, run concurrently with any break time already provided to the unit member and shall not seriously disrupt the operations of Civicorps.
Nursing Facilities. The MCOP must contract with at least the minimum number of facilities that are identified in the attached Appendix H chart.