Level of Care Re-Determinations. The PO shall develop procedures to assure that all members have a current and accurate level of care as determined by the LTCFS. Level of care re- determinations may only be completed by an individual trained and certified to administer the LTCFS. The responsibility to assure that all members have a current and accurate level of care shall include: a. Post-Enrollment Re-Determination The PO 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. The PO shall consult with the ADRC or Tribal ADRS (if applicable) if the PO re-determines level of care for a newly enrolled member or when a newly enrolled member is found to be functionally ineligible or eligibility changes to a non-nursing home level of care within six (6) months of the submission of the most recent pre-enrollment screen. The PO shall review and compare the screens, attempt to resolve the differences, and contact the Department’s LTCFS staff if differences cannot be resolved.
Appears in 2 contracts
Sources: Pace Contract, Pace Contract
Level of Care Re-Determinations. The PO shall develop procedures to assure that all members have a current and accurate level of care as determined by the LTCFStheLTCFS. Level of care re- determinations may only be completed by an individual trained and certified to administer the LTCFStheLTCFS. The responsibility to assure that all members have a current and accurate level of care shall include:
a. : Post-Enrollment Re-Determination The PO 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. The PO shall consult with the ADRC or Tribal ADRS (if applicable) if the PO re-determines level of care for a newly enrolled member or when a newly enrolled member is found to be functionally ineligible or eligibility changes to a non-nursing home level of care within six (6) months of the submission of the most recent pre-enrollment screen. The PO shall review and compare the screens, attempt to resolve the differences, and contact the Department’s LTCFS staff Department or its designee if differences cannot be resolved.
Appears in 1 contract
Sources: Pace Contract