Care Team Point of Contact. A member of a BH CP-Engaged Enrollee’s care team responsible for ongoing communication with the care team. The Care Team Point of Contact may be the Enrollee’s PCP or PCP Designee, or the Contractor’s staff member that has face-to-face contact with the PCP or the care team. Centers for Medicare and Medicaid Services (CMS) – the federal agency which oversees state Medical Assistance programs under Titles XIX and XXI of the Social Security Act and waivers thereof. Child and Adolescent Needs and Strengths (CANS) Tool – a tool that provides a standardized way to organize information gathered during Behavioral Health Clinical Assessments and during the Discharge Planning process from Inpatient Mental Health Services and Community Based Acute Treatment Services as described in Appendix C. A Massachusetts version of the CANS Tool has been developed and is intended to be used as a treatment decision support tool for Behavioral Health Providers serving Enrollees under the age of 21. 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 Enrollees under the age of 21 into a comprehensive system of community-based, culturally competent care. Children’s Behavioral Health Initiative Services or 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 Youth Mobile Crisis Intervention. CBHI Services Medical Necessity Criteria – the criteria used to determine the amount, duration or scope of services to ensure the provision of Covered Services that are Medically Necessary. Claim – a Provider’s bill for services performed per Enrollee, by line item, including but not limited to services performed, units of service and billing charges. Claim Attachment – a supplemental document submitted in conjunction with a Claim, that provides additional information that concurs with the services billed. Clean Claim – a Claim that can be processed without obtaining additional information from the provider of the service or from a third party, with or without Claim Attachment(s). It may include a Claim with errors originating from the Contractor’s claims ...
Care Team Point of Contact. A member of a BH CP-Engaged Enrollee’s care team responsible for ongoing communication with the care team. The Care Team Point of Contact may be the Enrollee’s PCP or PCP Designee, or the Contractor’s staff member that has face-to-face contact with the PCP or the care team. Centers for Medicare and Medicaid Services (CMS) – the federal agency which oversees state Medical Assistance programs under Titles XIX and XXI of the Social Security Act and waivers thereof.
Care Team Point of Contact. A member of a BH CP-Engaged Enrollee’s care team responsible for ongoing communication with the care team. The Care Team Point of Contact may be the Enrollee’s PCP or PCP Designee, or the Contractor’s staff member that has face-to-face contact with the PCP or the care team. Centers for Medicare and Medicaid Services (CMS) – the federal agency which oversees state Medical Assistance programs under Titles XIX and XXI of the Social Security Act and waivers thereof. Child and Adolescent Needs and Strengths (CANS) Tool – a tool that provides a standardized way to organize information gathered during Behavioral Health Clinical Assessments and during the Discharge Planning process from Inpatient Mental Health Services and Community Based Acute Treatment Services as described in Appendix C. A Massachusetts version of the CANS Tool has been developed and is intended to be used as a treatment decision support tool for Behavioral Health Providers serving Enrollees under the age of 21.
Care Team Point of Contact. A member of a BH CP-Engaged Attributed Member’s Care Team responsible for ongoing communication with the Care Team. The Care Team Point of Contact may be the Enrollee’s PCP or PCP Designee, or the Contractor’s staff member that has face-to-face contact with the PCP or the Care Team. Chief Financial Officer – one of the Contractor’s Key Personnel roles, as described in Section 2.3.A. Chief Medical Officer/Medical Director – one of the Contractor’s Key Personnel roles, as described in Section 2.3.A. Child and Adolescent Needs and Strengths (CANS) Tool – a tool that provides a standardized way to organize information gathered during Behavioral Health Clinical Assessments and during the Discharge Planning process from Inpatient Mental Health Services and Community Based Acute Treatment Services as described in Appendix A. A Massachusetts version of the CANS Tool has been developed and is intended to be used as a treatment decision support tool for Behavioral Health providers serving Attributed Members under the age of 21. 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 Attributed Members with information to support access to and coordination of appropriate care, as described in Section 2.5.C.3. Clinical Care Manager – a licensed Registered Nurse or other individual, employed by the Contractor or an Attributed Member’s PCP and licensed to provide clinical care management, including intensive monitoring, follow-up, and care coordination, and clinical management of high-risk Attributed Members, as further specified by EOHHS. Clinical Quality Measures – clinical information from Attributed Members’ medical records used to determine the overall quality of care received by Attributed Members or Members. Clinical Quality Measures...
