MA Enrollees and LTC Services
MA enrollees who request payment of LTC services may already be enrolled in a managed care health plan at the time of their request. In most instances the managed care plan is responsible for the payment of LTC services, even if the enrollee is not enrolled in one of the managed care products we have discussed in this module (MSHO, MSC+ and SNBC). However, the health plan is not responsible for paying an LTCF per diem if the person was residing in the facility at the time of enrollment.
People initially requesting MA and payment of LTC services will have a choice in managed care plans including those discussed in this module. Payment of LTC services for these people will be based on the chosen plan, and whether the client has Medicare or other health care coverage.
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Managed Care - Enrollment Process