Common use of Level of Care Re-Determinations Clause in Contracts

Level of Care Re-Determinations. The MCO shall develop procedures to assure that all members have a current and accurate level of care as determined by the LTC FS. Level of care re- determinations may only be completed by an individual trained and certified to administer the LTC FS. The responsibility to assure that all members have a current and accurate level of care shall include: a. Post-Enrollment Re-Determination The MCO may re-determine level of care for a new member shortly after enrollment if the interdisciplinary team believes that different or additional information has come to light as a result of the initial comprehensive assessment.