|
Long-Term
Care
The LEOFF-1 Plan offers long-term care services for its members
on a case-by-case basis as long as the Board has approved the services
in advance. To expedite preapproval, contact the member's employer to help you with the preapproval process.
The Board will review and consider for approval the placement and
payment of charges for LEOFF-1 member care in an adult family home,
boarding home or nursing home under the following conditions:
- A physician or advanced registered nurse practitioner prescribes
placement;
- The facility has a current license for adult family care, boarding
home care or nursing home care in the state of Washington;
- If the facility
is located outside Washington state, the facility is licensed in the
state or country where it’s located and the licensing requirements
are similar, equal to or greater than those required by the State
of Washington (the LEOFF-1 member is responsible for providing
documentary evidence of such licensing);
- If placement
exceeds six months, the facility provides the Board with a treatment
plan, followed by updated progress reports from a treating physician
every six months;
- The LEOFF-1 member is eligible for Medicare and has either applied
for or begun receiving both Part A and Part B Medicare coverage,
whether paid for by the employer or the member (the Board must authorize reimbursements from Part B); and
- The provider
or member submits claims for payment directly to the member's
insurance, third-party payor or employer, and the member shows the Board proof of submission.
For more information,
contact Curt Nakata, Board Administrator.
|
