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 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. 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 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. 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; participating in the Enrollee’s Comprehensive Assessment, if any; and supporting safe transitions in care for Enrollees moving between settings in accordance with the Contractor’s Transitional Care Management program. The Care Coordinator may serve on one or more care teams, and coordinates and facilitates meetings and other activities of those care teams.
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. 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 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. 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 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.
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
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. 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 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 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. 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.
10.11.1.2. The Contractor and affiliated service providers shall post a translated copy of the Washington Medicaid Behavioral Health Benefits Booklet’s section entitled “Your Rights as a Person Receiving Medicaid BehavioralHealth Services” in each of the DSHS-prevalent languages. The DSHS Prevalent languages are Cambodian, Chinese, Korean, Laotian, Russian, Somali, Spanish and Vietnamese.
10.11.1.3. The Contractor and affiliated service providers shall post a multilingual notice in each of the DSHS prevalent languages, which advises Enrollees that information is available in other languages and how to access this information.
10.11.1.4. The Contractor shall provide written translations of all written information including, at minimum, applications for services, consent forms, and Notices of Action in each of the DSHS-prevalent languages that are spoken by five percent (5%) or more of the population of the State of Washington; based on the most recent U.S. census. DSHS has determined based on this criteria that Spanish is the currently required language. The Contractor must provide maintain availability of translated documents at all times for the Contractor and its contracted BHAs to distribute.
10.11.1.5. The Contractor shall provide copies of the generally available materials including at minimum, applications for services, consent forms, and Notices of Action in alternative formats that take into consideration the needs of those who have limited vision or impaired reading proficiency.
10.11.1.6. The Contractor and affiliated service providers shall maintain a log of all Enrollee requests for interpreter services, or translated written material.
