Skilled Nursing Care. All Skilled Nursing Care services, except home infusion and related services, require Prior Authorization by the Company in order to be eligible for benefits. If prior approval is not obtained, the Company has the right to request medical records to review to determine whether services are eligible under this Contract.
Skilled Nursing Care. Skilled supervision and management of a complicated or extensive plan of care for a CDCR/CCHCS patient and/or DJJ youth initiated and monitored by a physician in which there is a significantly high probability that complications would arise without the skilled supervision or implementation of the treatment program by a licensed nurse or therapist.
Skilled Nursing Care. Skilled Nursing Care is defined as care within the limitations to the equipment and staff of a Skilled Nursing Facility and includes services and items such as nursing care; room and board (including semi-private rooms); medical social services; medical supplies; and durable medical equipment ordinarily furnished by a Skilled Nursing Facility; and external prosthetic devices and braces ordinarily furnished by a Skilled Nursing Facility. Medicare guidelines are used to determine when care in a Skilled Nursing Facility is covered, except that a prior three day stay in an acute care hospital is not required. Up to 120 days of prescribed Skilled Nursing Care per Accumulation Period are provided or arranged at approved facilities (including Hospitals or Skilled Nursing Facilities) without charge. kpgroup_snf_0d_120accum_16.doc 01/2016 EMERGENCY DEPARTMENT SERVICES RIDER $75 IN AND OUT OF THE SERVICE AREA The Group Medical and Hospital Service Agreement is amended by deleting sections S-1(a) and S-1(b) (Emergency Department Services) of the benefit schedule and substituting a new sections S-1(a) and S-1(b) as follows:
Skilled Nursing Care. Riverview shall provide ten (10) days of skilled nursing care, hereafter referred to as “Skilled Nursing Care,” per year for you in Riverview Care Center when such care is prescribed by your physician and if the Care Center can meet your needs. If space is not immediately available at Riverview Care Center, you shall be admitted to Riverview Care Center as soon as possible in accordance with the admission policies of Riverview Care Center. If space at the Care Center is not available, Riverview will provide the benefits described in this Section 3.2 at a comparable facility in the Spokane area at a daily rate which is not more than the median care rate charged by Riverview Care Center. Riverview will assist you in locating an alternate health care facility. You shall be responsible for payment of all transportation costs to and from Riverview and the alternate health care facility. Prior to utilizing the ten (10) days of Skilled Nursing Care offered by Riverview, you shall first use your U.S. Government or State medical benefits, if applicable. The Skilled Nursing Care in Riverview Care Center provided in this Agreement is secondary to such coverage. You are responsible for the payment of all doctor, special nursing care, dental, drugs, ancillary services, hospital care, and other care you may require during the term of this Agreement. The ten (10) days of Skilled Nursing Care are limited to each twelve (12) month period, commencing upon the Occupancy Date. The Skilled Nursing Care is not cumulative from one twelve (12) month period to the next. Any fraction of a day of such Skilled Nursing Care shall be considered one (1) day. The right to Skilled Nursing Care is not transferable or assignable by you. The Skilled Nursing Care has no cash value, and you are not entitled to any payment for Skilled Nursing Care not used during any twelve
Skilled Nursing Care. When determined appropriate pursuant to the Medical Care Contract, you may receive 24-hour nursing care at Villa Marin's Nursing Facility on a priority access basis over nonresidents. As part of the admissions process, you agree to sign a separate Skilled Nursing Facility Admission Agreement in its then current form. The current version of this document is attached as Appendix D. The services you receive and certain additional rights and obligations will be set forth in the Skilled Nursing Facility Admission Agreement. The terms of this Agreement shall continue to apply, and in the event of a conflict between the terms of the two agreements, this Agreement shall govern.
