Nursing Facility Services. For Medicaid covered nursing facility stays, the MCP must evaluate the member’s need for the level of services provided by a nursing facility. To make this decision, the MCP must use the criteria for nursing facility-based level of care pursuant to OAC rules 5160- 3-08 and 5160-1-01. The MCP must maintain a written record that the criteria were met, or if not met, the MCP must maintain documentation that a Notice of Action was issued in accordance with OAC 5160-26-08.4. 1. The MCP is prohibited from paying for NF services during restricted Medicaid coverage periods (RMCP). The MCP must accept provider documentation of determinations made by County Department of Job and Family Services (CDJFS) for patient liability obligations, lump sum amounts, and RMCPs.
Appears in 3 contracts
Sources: Provider Agreement, Provider Agreement, Provider Agreement