Alternative Formats provision of Enrollee information in a format that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. Examples of Alternative Formats shall include, but not be limited to, Braille, large font, audio tape, video tape, and Enrollee Information read aloud to an Enrollee by an Enrollee services representative. Alternative Payment Methodologies (APMs) – as further specified by EOHHS, methods of payment, not based on traditional fee-for-service methodologies, that compensate providers for the provision of health care or support services and tie payments to providers to quality of care and outcomes. These include, but are not limited to, shared savings and shared risk arrangements, bundled payments for acute care episodes, bundled payments for chronic diseases, and global payments. Payments based on traditional fee-for-service methodologies shall not be considered Alternative Payment Methodologies. Appeals – EOHHS processes for Members to request review of certain actions pursuant to 130 CMR 610.000. Behavioral Health Director – one of the Contractor’s Key Personnel roles, as described in Section 2.4.A. Behavioral Health Services (or BH Services) - mental health and substance use disorder services that are TCOC Included Services and are set forth in detail in Appendix A. Behavioral Health Vendor -- the entity with which EOHHS contracts to administer EOHHS’s Behavioral Health program for Members enrolled with the Contractor. BH – Behavioral Health. See Behavioral Health Services. BH CPs – Behavioral Health Community Partners. Blue Cross Blue Shield’s Alternative Quality Contract – Blue Cross Blue Shield of Massachusetts’ global payment model. Budgets and Budget Narratives – information provided by the Contractor about the Contractor’s planned spending of DSRIP payments, as described in Section 5.1.B. Business Associate – a person, organization or entity meeting the definition of a “business associate” for purposes of the Privacy and Security Rules (45 CFR §160.103). Care Coordinator – a provider-based clinician or other trained individual who is employed or contracted by the Contractor or an Enrollee’s PCP. The Care Coordinator is accountable for providing care coordination activities, which include ensuring appropriate referrals and timely two-way transmission of useful patient information; obtaining reliable and timely information about services other than those provided by the PCP; par...
Alternative Formats. Provision of Enrollee information in a format that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. Examples of Alternative Formats shall include, but not be limited to, Braille, large font, audio tape, video tape, and Enrollee Information read aloud to an Enrollee by an Enrollee services representative.
Alternative Formats. 2.6.7.2.1.1. The Contractor shall have a mechanism to provide alternative formats of all written materials to Members. Alternative formats include large print, Braille, audio tape and other appropriate materials that take into consideration the special needs of the Member who requests information in an alternative format.
Alternative Formats provision of Enrollee information in a format that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. Examples of Alternative Formats shall include, but not be limited to, Braille, large font, audio tape, video tape, and Enrollee Information read aloud to an Enrollee by an Enrollee services representative. Alternative Payment Methodologies (APMs) – as further specified by EOHHS, methods of payment, not based on traditional fee-for-service methodologies, that compensate providers for the provision of health care or support services and tie payments to providers to quality of care and outcomes. These include, but are not limited to, shared savings and shared risk arrangements, bundled payments for acute care episodes, bundled payments for chronic diseases, and global payments. Payments based on traditional fee-for-service methodologies shall not be considered Alternative Payment Methodologies.
Alternative Formats provision of Enrollee Information in a format that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. Examples of Alternative Formats shall include, but not be limited to, Braille, large font, audio tape, video tape, and Enrollee Information read aloud to an Enrollee by an Enrollee services representative. Appeal – An Enrollee’s request for formal review of an action of the Contractor in accordance with Section 2.8 of the Contract. Appeal Representative - any individual that the Contractor can document has been authorized by the Enrollee in writing to act on the Enrollee’s behalf with respect to all aspects of a Grievance or Appeal (whether internal or external). The Contractor must allow an Enrollee to give a standing authorization to an Appeal Representative to act on his/her behalf for all aspects of Grievances and Internal Appeals. The Enrollee must execute such a standing authorization in writing according to the Contractor’s procedures. The Enrollee may revoke such a standing authorization at any time. When a minor is able, under law, to consent to a medical procedure, that minor can request an Appeal of the denial of such treatment without parental/guardian consent and appoint an Appeal Representative without the consent of a parent or guardian. Capitation Rate - a fixed monthly fee paid prospectively by EOHHS to the Contractor for each Enrollee for all Covered Services actually and properly delivered to the Enrollees in accordance with and subject to the provisions of this Contract and all applicable federal and state laws, regulations, rules, billing instructions, and bulletins, as amended. Centers for Medicare & Medicaid Services (CMS) - the federal agency under the Department of Health and Human Services responsible for administering the Medicare and Medicaid programs under Titles XVIII and XIX of the Social Security Act.
Alternative Formats provision of Attributed Member information in a format that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. Examples of Alternative Formats shall include, but not be limited to, Braille, large font, audio tape, video tape, and information read aloud to an Attributed Member by a member services representative. Appeals – EOHHS processes for Members to request review of certain actions pursuant to 130 CMR 610.000. Approved ACO Agreement – a contract between the Contractor and a MassHealth-contracted MCO approved by EOHHS that delineates responsibilities and establishes financial accountability as described in Section 2.4. Attributed Member – a Member who is enrolled with one of the MassHealth-contracted MCOs with which the Contractor has an Approved ACO Agreement and who is assigned by that MCO to one of the Contractor’s Participating PCPs. Attributed Members with Special Health Care Needs – Attributed Members who meet the following characteristics:
Alternative Formats provision of Attributed Member information in a format that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. Examples of Alternative Formats shall include, but not be limited to, Braille, large font, audio tape, video tape, and information read aloud to an Attributed Member by a member services representative. Appeals – EOHHS processes for Members to request review of certain actions pursuant to 130 CMR 610.000. Approved ACO Agreement – a contract between the Contractor and a MassHealth-contracted MCO approved by EOHHS that delineates responsibilities and establishes financial accountability as described in Section 2.4.
Alternative Formats. 10.11.1.1. Offer every Medicaid Enrollee a Washington Medicaid Behavioral Health Benefit Booklet at Intake which includes information on obtaining the booklet in alternative formats, and inform Enrollee that the booklet is available at: xxxx://xxxx.xx.xxx/dbhr/xxxxxxxxxxxxxxxxx.xxxxx.
Alternative Formats. Formats for the provision of Enrollee information that enhance accessibility. Examples of Alternative Formats shall include, but not be limited to, Braille, large font, audio tape, video tape, American Sign Language video clips, and Enrollee Information read aloud to an Enrollee by an Enrollee services representative.
Alternative Formats. Formats for presenting information other than English or the written word such that information can be understood by individuals with disabilities and those with limited English proficiency.
