Care Coordination Platform. An electronic platform supported by web-based technology that will manage communication and information flow regarding referrals, care transitions, and care delivery; facilitate timely and thorough coordination and communication among the Enrollee, ICO, PIHP, the primary care provider, LTSS Supports Coordinators and other providers; provide prior authorization information for services; and house the Integrated Care Bridge Record.
Care Coordination Platform. An electronic platform supported by web-based technology that will manage communication and information flow regarding referrals, care transitions, and care delivery; facilitate timely and thorough coordination and communication among the Enrollee, ICO, PIHP, the primary care provider, LTSS Supports Coordinators and other providers; provide prior authorization information for services; and house the Integrated Care Bridge Record. Center for Medicare and Medicaid Innovation (CMMI) – Established by Section 3021 of the Affordable Care Act, CMMI was established to test innovative payment and service delivery models to reduce program expenditures under Medicare and Medicaid while preserving or enhancing the quality of care furnished to individuals under such titles. Centers for Medicare & Medicaid Services (CMS) — The federal agency under Department of Health and Human Services responsible for administering the Medicare and Medicaid programs, among other programs. Claim - An itemized statement of services rendered by health care providers (such as hospitals, physicians, dentists, etc.), billed electronically or on the CMS-1500 or UB-04, or their successor forms. LTSS providers may submit Claims via paper or electronic invoice or a cash register receipt or a service/work log. CMS - See Centers for Medicare & Medicaid Services (CMS).
Care Coordination Platform. An electronic platform supported by web-based technology that will manage communication and information flow regarding referrals, care transitions, and care delivery; facilitate timely and thorough coordination and communication among the enrollee, ICO, PIHP, the primary care provider, LTSS Supports Coordinators and other providers; provide prior authorization information for services; and house the Integrated Care Bridge Record. Center for Medicare and Medicaid Innovation (CMMI) – Established by Section 3021 of the Affordable Care Act, CMMI was established to test innovative payment and service delivery models to reduce program expenditures under Medicare and Medicaid while preserving or enhancing the quality of care furnished to individuals under such titles. CMS – The Centers for Medicare & Medicaid Services. Consumer Assessment of Healthcare Providers and Systems (CAHPS) - Beneficiary survey tool developed and maintained by the Agency for Healthcare Research and Quality to support and promote the assessment of consumers’ experiences with health care. Contract Management Team – A group of CMS and Michigan Medicaid representatives responsible for overseeing the contract. Covered Individuals – Individuals enrolled in the Demonstration, including the duration of any month in which their eligibility for the Demonstration ends. Covered Services – The set of required services offered by the ICOs. Cultural Competence – Understanding those values, beliefs, and needs that are associated with an individual’s age, gender identity, sexual orientation, and/or racial, ethnic, or religious backgrounds. Cultural Competence also includes a set of competencies which are required to ensure appropriate, culturally sensitive health care to persons with congenital or acquired disabilities. Enrollee – See Covered Individuals. Enrollee Communications – Materials designed to communicate to enrollee’s plan benefits, policies, processes and/or enrollee rights. Enrollment – The processes by which an individual who is eligible for the Demonstration is enrolled in an ICO. External Quality Review Organization (EQRO) – An independent entity that contracts with the State and evaluates the access, timeliness, and quality of care delivered by managed care organizations to their Medicaid enrollees.
