Long-Term Care
MSHO NOTIFICATION FORM: Instructions and a sample completed form can be found on our website under Partners & Providers>Resources>Other forms.
Therapy Caps: PrimeWest Health members residing in an SNF and receiving rehabilitation therapy at the nursing home have no therapy caps for Physical, Occupational, or Speech Therapy. Therapy caps refer to dollar limit as well as unit limit on therapy. If a PrimeWest Health member over age 65 receives outpatient therapy in a nursing home but that member lives at home, then the therapy threshold does apply. If the member is in MSC+, and Medicare is their primary insurance, PrimeWest Health is not the payer for the Medicare portion. You will need to follow Medicare rules on therapy caps. (10/31/08)
120% Enhanced Rate: PrimeWest will follow the DHS guideline of paying 120% enhanced rate for the first 30 days on admission. This is based on calendar days and not paid days. Eligible days are counted starting on the day of admission and ends 30 days later, even if there are unpaid days during that period. Please refer to DHS bulletin #03-62-01 for more information. Please click here for the link. (10/04/06)
180 Separation: Thefollowing days apply toward the 180-day SNF/NF benefit: Medicare Skilled Nursing Facility (SNF) days, Medicaid Nursing Facility Days, NF Bed Hold days- 36 therapeutic and 18 hospital bed. Hold day are allowed per year towards the 180-day SNF/NF liability (as allowed per DHS policy).