Common use of Care Plan Clause in Contracts

Care Plan. the plan of care developed by the Enrollee and other individuals involved in the Enrollee’s care or Care Management, as described in Section 2.3.D.2. Chief Financial Officer – one of the Contractor’s Key Personnel roles, as described in Section 2.4.A. Chief Medical Officer/Medical Director – one of the Contractor’s Key Personnel roles, as described in Section 2.4.A. Children’s Behavioral Health Initiative (CBHI) -- an interagency undertaking by EOHHS and MassHealth whose mission is to strengthen, expand and integrate Behavioral Health Services for Members under the age of 21 into a comprehensive system of community-based, culturally competent care. Children’s Behavioral Health Initiative Services (CBHI Services) – any of the following services: Intensive Care Coordination (ICC), Family Support and Training, In-Home Behavioral Services (including Behavior Management Therapy and Behavior Management Monitoring) and Therapeutic Mentoring Services, In-Home Therapy Services (including Therapeutic Clinical Intervention and Ongoing Therapeutic Training and Support), and Mobile Crisis Intervention. Clinical Advice and Support Line – a phone line that provides Enrollees with information to support access to and coordination of appropriate care, as described in Section 2.3.C.3. Clinical Care Manager – a licensed Registered Nurse or other individual, employed by the Contractor or an Enrollee’s PCC and licensed to provide clinical care management, including intensive monitoring, follow-up, and care coordination, and clinical management of high-risk Enrollees, as further specified by EOHHS. Clinical Quality Measures – clinical information from Enrollees’ medical records used to determine the overall quality of care received by Enrollees or Members. Clinical Quality Measures are a subset of Quality Measures and are set forth in Appendix B. Cold-call Marketing – any unsolicited personal contact by the Contractor, its employees, Providers, agents or Material Subcontractors with a Member who is not enrolled in the Contractor’s plan that EOHHS can reasonably interpret as influencing the Member to enroll in the Contractor’s plan or either not to enroll in, or to disenroll from, another MassHealth-contracted Accountable Care Organization, MassHealth-contracted MCO, or the PCC Plan. Cold-call Marketing shall not include any personal contact between a Provider and a Member who is a prospective, current or former patient of that Provider regarding the provisions, terms or requirements of MassHealth as they relate to the treatment needs of that particular member. Community Partners (CPs) – entities certified by EOHHS to work with ACOs and MCOs to ensure integration of care, as further specified by EOHHS. Includes BH CPs and LTSS CPs. Community Partner Assigned Enrollee – an Enrollee who is assigned to a BH or LTSS CP (BH CP- Assigned Enrollee and LTSS CP-Assigned Enrollee, respectively). Community Partner Engaged Enrollee – • BH CP-Engaged Enrollee – a BH CP-Assigned Enrollee for whom the BH CP has completed a Comprehensive Assessment and person-centered treatment plan, and the person-centered treatment plan has been approved by the BH CP-Assigned Enrollee and the BH CP-Assigned Enrollee’s PCP or PCP designee (or legal authorized representative, as appropriate). • LTSS CP-Engaged Enrollee – an LTSS CP-Assigned Enrollee for whom the LTSS CP has completed the LTSS component of the LTSS CP-Assigned Enrollee’s Care Plan, and the LTSS component of the LTSS CP-Assigned Enrollee’s Care Plan has been signed by the Enrollee (or legal authorized representative, as appropriate) and approved by the LTSS CP-Assigned Enrollee’s PCP or PCP designee. Community Partner Identified Enrollee – an Enrollee who is identified by EOHHS for assignment to a BH or LTSS CP (BH CP-Identified Enrollee and LTSS CP-Identified Enrollee, respectively). Community Partner Referred Enrollee – an Enrollee who is recommended for BH or LTSS CP supports by the Enrollee, a PCP, a provider, or others as further specified by EOHHS (BH CP-Referred Enrollee and LTSS CP-Referred Enrollee, respectively). Community Service Agency (CSA) – a community-based Behavioral Health provider organization whose function is to facilitate access to the continuum of Behavioral Health services by providing an organized pathway to care for children and families where the child is referred for Intensive Care Coordination. A primary mechanism through which CSAs serve this function is as the provider of Intensive Care Coordination and Family Support and Training Services, which are defined as a BH Service.

Care Plan. the plan of care developed by the Enrollee and other individuals involved in the Enrollee’s care or Care Management, as described in Section 2.3.D.2. Chief Financial Officer – one of the Contractor’s Key Personnel roles, as described in Section 2.4.A. Chief Medical Officer/Medical Director – one of the Contractor’s Key Personnel roles, as described in Section 2.4.A. Children’s Behavioral Health Initiative (CBHI) -- an interagency undertaking by EOHHS and MassHealth whose mission is to strengthen, expand and integrate Behavioral Health Services for Members under the age of 21 into a comprehensive system of community-based, culturally competent care. Children’s Behavioral Health Initiative Services (CBHI Services) – any of the following services: Intensive Care Coordination (ICC), Family Support and Training, In-Home Behavioral Services (including Behavior Management Therapy and Behavior Management Monitoring) and Therapeutic Mentoring Services, In-Home Therapy Services (including Therapeutic Clinical Intervention and Ongoing Therapeutic Training and Support), and Mobile Crisis Intervention. Clinical Advice and Support Line – a phone line that provides Enrollees with information to support access to and coordination of appropriate care, as described in Section 2.3.C.3. Clinical Care Manager – a licensed Registered Nurse or other individual, employed by the Contractor or an Enrollee’s PCC and licensed to provide clinical care management, including intensive monitoring, follow-up, and care coordination, and clinical management of high-risk Enrollees, as further specified by EOHHS. Clinical Quality Measures – clinical information from Enrollees’ medical records used to determine the overall quality of care received by Enrollees or Members. Clinical Quality Measures are a subset of Quality Measures and are set forth in Appendix B. Cold-call Marketing – any unsolicited personal contact by the Contractor, its employees, Providers, agents or Material Subcontractors with a Member who is not enrolled in the Contractor’s plan that EOHHS can reasonably interpret as influencing the Member to enroll in the Contractor’s plan or either not to enroll in, or to disenroll from, another MassHealth-contracted Accountable Care Organization, MassHealth-contracted MCO, or the PCC Plan. Cold-call Marketing shall not include any personal contact between a Provider and a Member who is a prospective, current or former patient of that Provider regarding the provisions, terms or requirements of MassHealth as they relate to the treatment needs of that particular member. Community Partners (CPs) – entities certified by EOHHS to work with ACOs and MCOs to ensure integration of care, as further specified by EOHHS. Includes BH CPs and LTSS CPs. Community Partner Assigned Enrollee – an Enrollee who is assigned to a BH or LTSS CP (BH CP- Assigned Enrollee and LTSS CP-Assigned Enrollee, respectively). Community Partner Engaged Enrollee – •  BH CP-Engaged Enrollee – a BH CP-Assigned Enrollee for whom the BH CP has completed a Comprehensive Assessment and person-centered treatment plan, and the person-centered treatment plan has been approved by the BH CP-Assigned Enrollee and the BH CP-Assigned Enrollee’s PCP or PCP designee (or legal authorized representative, as appropriate). •  LTSS CP-Engaged Enrollee – an LTSS CP-Assigned Enrollee for whom the LTSS CP has completed the LTSS component of the LTSS CP-Assigned Enrollee’s Care Plan, and the LTSS component of the LTSS CP-Assigned Enrollee’s Care Plan has been signed by the Enrollee (or legal authorized representative, as appropriate) and approved by the LTSS CP-Assigned Enrollee’s PCP or PCP designee. Community Partner Identified Enrollee – an Enrollee who is identified by EOHHS for assignment to a BH or LTSS CP (BH CP-Identified Enrollee and LTSS CP-Identified Enrollee, respectively). Community Partner Referred Enrollee – an Enrollee who is recommended for BH or LTSS CP supports by the Enrollee, a PCP, a provider, or others as further specified by EOHHS (BH CP-Referred Enrollee and LTSS CP-Referred Enrollee, respectively). Community Service Agency (CSA) – a community-based Behavioral Health provider organization whose function is to facilitate access to the continuum of Behavioral Health services by providing an organized pathway to care for children and families where the child is referred for Intensive Care Coordination. A primary mechanism through which CSAs serve this function is as the provider of Intensive Care Coordination and Family Support and Training Services, which are defined as a BH Service.