Long Term Care Placement

This policy covers long‑term residential care placement for members who require custodial or higher‑intensity services, including skilled nursing or specialized residential programs (e.g., dementia/wandering, dementia with behaviors, dialysis, respiratory/ventilator, bariatric) when care requires qualified licensed personnel. Placement is determined by documented level‑of‑need and required intensity of services rather than diagnosis, excludes routine non‑medical ADL or custodial care as a medical benefit, is not appropriate for hospital‑level care, and requires adherence to specific admission, ventilator and ongoing criteria with discharge when criteria are no longer met.

"Long term residential care for members who require basic custodial care."

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