Nursing Facility Clause Samples
Nursing Facility. If Provider is a nursing facility, in addition to the other requirements set forth in the Agreement or this Appendix, Provider shall:
i) Promptly notify United, and/or the State as directed by the Division of TennCare, 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. Provider shall also notify United, and/or the State as directed by ▇▇▇▇▇▇▇▇, prior to a Covered Person’s discharge from the nursing facility;
ii) Provide written notice to the Division of TennCare and United in accordance with State and federal requirements before voluntarily terminating the Agreement. Provider shall comply with all applicable State and federal requirements regarding voluntary termination;
iii) Notify United immediately if Provider is considering discharging a Covered Person. Provider shall consult with the Covered Person’s Care Coordinator to intervene in resolving issues if possible. If Provider is not able to resolve such issues, Provider shall prepare and implement a discharge and/or transition plan as appropriate;
iv) Notify a Covered Person and/or a Covered Person’s representative (if applicable) in writing prior to discharge in accordance with State and federal requirements;
v) Provider shall accept payment or appropriate denial made by United (or, if applicable, payment by United that is supplementary to the Covered Person’s third party payer) plus the amount of any applicable Patient Liability, as payment in full for services provided and shall not solicit or accept any surety or guarantee of payment from a Covered Person in excess of the amount of applicable Patient Liability. For purposes of this Section 4.7(v), Covered Person shall include the patient, parent(s), guardian, spouse or any other legally responsible person of the Covered Person being served;
vi) Provider’s responsibilities regarding a Covered Person’s Patient Liability as specified in sections A.2.6.7 and A.2.21.5 of the CRA, which shall include but not be limited to collecting the applicable Covered Person Patient Liability amounts from CHOICES Group 1 members, notifying the Covered Person’s Care Coordinator if there is an issue with collecting a Covered Person’s Patient Liability, and making good faith efforts to collect payment;
vii) Provider shall timely seek certification and recertification (as applicable) of a Covered Person’s level of car...
Nursing Facility. An entity or institution that provides organized and structured nursing care and services, and is subject to licensure under Texas Health and Safety Code, Chapter 242, as defined in 40 T.A.C. § 19.101 and 1 T.A.C. § 358.103. (Also called nursing home or skilled nursing facility).
Nursing Facility. A. The Contractor shall perform NF LOC reviews for Medicaid recipients exempt from Centennial Care enrollment and are seeking hospice care in a nursing facility.
B. The Contractor shall perform NF LOC reviews for Medicaid recipients exempt from Centennial Care enrollment who are receiving short term (30 days or less) rehabilitation or skilled nursing services in a nursing facility.
Nursing Facility. Any facility licensed by the State of Michigan, in accordance with the Public Health Code, 1978 PA 368, as amended, MCL 333.1101 – 333.25211, and certified by Medicare in accordance with section 42 CFR 483 et seq. to provide skilled and non-skilled nursing care.
Nursing Facility. 2.14.1.12.1 If a member is enrolled in CHOICES Group 1, the CONTRACTOR shall authorize and initiate nursing facility services for that member in accordance with Section 2.9.6. However, if, prior to nursing facility admission, the member chooses to receive HCBS instead of nursing facility services and is enrolled in Group 2 pursuant to Section 2.9.6, the CONTRACTOR shall authorize and initiate HCBS in accordance with Section 2.9.
Nursing Facility. A licensed Medicare/Medicaid facility certified in accordance with 42 C.F.R. Part 483 to provide inpatient room, board and nursing services to Members who require these services on a continuous basis, but who do not require hospital care or direct daily care from a physician.