Disenrollment due to Medical Status Change Sample Clauses

Disenrollment due to Medical Status Change. When an NHC client is receiving inpatient acute medical/surgical or rehabilitation hospital services and is disenrolled from NHC due to a medical status change (e.g., the level of care the client requires changes from acute care services to custodial care), the plan is responsible for the hospitalization and all related services in the Basic Benefits Package until an appropriate discharge from the hospital occurs or for sixty (60) days, whichever is earlier. If the client is to be transferred to another level of care (e.g., acute rehabilitation, home health, etc.) when discharged from the hospital, the plan shall inform the provider of service that the client is no longer participating in NHC and shall instruct the provider to contact Department’s contracted Peer Review Organization (PRO) for certification and authorization of services, as appropriate.
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