Health Care Benefits For Nursing Facility Members

Nursing Facility All Members:

Acute Care:

  • Preventive Care
  • Primary Care
  • Other medical care provided under the direction of a physician for a condition having a relatively short duration.

NF Add-on Services: the types of services that are provided in the Facility setting by the Provider or another network provider, but are not included in the NF Unit Rate.

  • Emergency Dental
  • Occupational Therapy (OT) Rehabilitative Service and Assessment
  • Physical Therapy (PT) Rehabilitative Service and Assessment
  • Speech Therapy (ST) Rehabilitative Service and Assessment
  • Durable Medical Equipment (DME)
  • Custom Powered/Manual Wheelchair

Nursing Facility Medicaid Only:

Nursing Facility (NF) Unit Rate: the types of services included in the DADS daily rate for nursing facility providers, such as:

  • Room and board
  • Medical Supplies and Equipment
  • Personal Needs Items
  • Social Services, and Over-the-Counter Drugs

Nursing Facility Dual:

Nursing Facility (NF) Unit Rate: Medicare will continue to be primary for skilled nursing facility (SNF) services, and the MCO will be secondary.