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...