Common use of Culturally and Linguistically Appropriate Services Clause in Contracts

Culturally and Linguistically Appropriate Services. Health care services that are respectful of and responsive to cultural and linguistic needs, and that are characterized by cultural and linguistic competence, as described in the Culturally and Linguistically Appropriate Services (CLAS) standards set forth by the Office of Minority Health of the U.S. Department of Health and Human Services. More detail on CLAS standards may be found here: xxxx://xxxxxxxxxxxxxx.xxx.xxx/assets/pdf/checked/finalreport.pdf Customer Service Center (CSC) Enrollment Vendor – EOHHS’s enrollment broker that provides Members with a single point of access to a wide range of customer services, including enrolling Members into ACOs, MassHealth-contracted MCOs and the PCC Plan, authorizing non-emergency transportation services, and providing Members with information about Non-MCO Covered Services. Date of Action – the effective date of an Adverse Action. DCF – the Massachusetts Department of Children and Families. DDS – the Massachusetts Department of Developmental Services Discharge Planning – the evaluation of an Enrollee’s medical and Behavioral Health care needs and coordination of any other support services in order to arrange for safe and appropriate care and living situation after discharge from one care setting (e.g., acute hospital, inpatient behavioral health facility) to another care setting (e.g., rehabilitation hospital, group home), including referral to and coordination of appropriate services. Disease Management – the Contractor’s disease or condition specific packages of ongoing services and assistance for specific disease and/or conditions. Services include specific interventions and education/outreach targeted to Enrollees with, or at risk for, these conditions. Division of Insurance (DOI) – The Massachusetts Division of Insurance. DMH – the Massachusetts Department of Mental Health. DMH Case Management Services – Targeted Case Management (TCM) provided by DMH to DMH clients. The core elements of DMH Case Management Services include assessment, development of a care plan, service coordination and referral, monitoring, and client advocacy. DMH Case Manager – the individual responsible for implementing DMH Case Management Services. DMH Client – an Enrollee who DMH has determined is eligible for DMH Community-Based Services according to DMH Clinical Criteria. DMH Community-Based Services – DMH non-acute mental health care services, provided to DMH Clients, such as community aftercare, housing and support services, and non-acute residential services. DPH – the Massachusetts Department of Public Health. Drug Rebate (Medicaid Drug Rebate Program) – a program authorized by Section 1927 of the Social Security Act involving CMS, state Medicaid agencies, and approximately 600 participating drug manufacturers that helps to offset the federal and state costs of most outpatient prescription drugs dispensed to Medicaid patients. Drug and Non-Drug Pharmacy Product Rebate Data – a dataset provided by the Contractor related to the Drug Rebate and Non-Drug Pharmacy Product rebates. As further specified by EOHHS, Drug and Non-Drug Pharmacy Product Rebate Data shall include pharmacy claims data, 837 medication claims data, pharmacy Provider Network data, and the MassHealth Rebate File Submission Reports (see Appendix A and Appendix E). Dually Eligible – individuals determined eligible for both Medicaid and Medicare. DYS – the Massachusetts Department of Youth Services. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) – the delivery of health care services to MassHealth Standard and CommonHealth Members under the age of 21, pursuant to 42 USC 1396d(a)(4), 42 CFR Part 441, Subpart B, 130 CMR 450.140-149 and § 1115 Medicaid Research and Demonstration Waiver. Early Intervention Provider – a provider licensed and/or certified by the Massachusetts Department of Public Health to provide Early Intervention Services.

Culturally and Linguistically Appropriate Services. Health care services that are respectful of and responsive to cultural and linguistic needs, and that are characterized by cultural and linguistic competence, as described in the Culturally and Linguistically Appropriate Services (CLAS) standards set forth by the Office of Minority Health of the U.S. Department of Health and Human Services. More detail on CLAS standards may be found here: xxxx://xxxxxxxxxxxxxx.xxx.xxx/assets/pdf/checked/finalreport.pdf Customer Service Center (CSC) Enrollment Vendor – EOHHS’s enrollment broker that provides Members with a single point of access to a wide range of customer services, including enrolling Members into ACOs, MassHealth-contracted MCOs and the PCC Plan, authorizing non-emergency transportation services, and providing Members with information about Non-MCO Covered Services. Date of Action – the effective date of an Adverse Action. DCF – the Massachusetts Department of Children and Families. DDS – the Massachusetts Department of Developmental Services Discharge Planning – the evaluation of an Enrollee’s medical and Behavioral Health care needs and coordination of any other support services in order to arrange for safe and appropriate care and living situation after discharge from one care setting (e.g., acute hospital, inpatient behavioral health facility) to another care setting (e.g., rehabilitation hospital, group home), including referral to and coordination of appropriate services. Disease Management – the Contractor’s disease or condition specific packages of ongoing services and assistance for specific disease and/or conditions. Services include specific interventions and education/outreach targeted to Enrollees with, or at risk for, these conditions. Division of Insurance (DOI) – The Massachusetts Division of Insurance. DMH – the Massachusetts Department of Mental Health. DMH Case Management Services – Targeted Case Management (TCM) provided by DMH to DMH clients. The core elements of DMH Case Management Services include assessment, development of a care plan, service coordination and referral, monitoring, and client advocacy. DMH Case Manager – the individual responsible for implementing DMH Case Management Services. DMH Client – an Enrollee who DMH has determined is eligible for DMH Community-Based Services according to DMH Clinical Criteria. DMH Community-Based Services – DMH non-acute mental health care services, provided to DMH Clients, such as community aftercare, housing and support services, and non-acute residential services. DPH – the Massachusetts Department of Public Health. Drug Rebate (Medicaid Drug Rebate Program) – a program authorized by Section 1927 of the Social Security Act involving CMS, state Medicaid agencies, and approximately 600 participating drug manufacturers that helps to offset the federal and state costs of most outpatient prescription drugs dispensed to Medicaid patients. Drug and Non-Drug Pharmacy Product Rebate Data – a dataset provided by the Contractor related to the Drug Rebate and Non-Drug Pharmacy Product rebates. As further specified by EOHHS, Drug and Non-Drug Pharmacy Product Rebate Data shall include pharmacy claims data, 837 medication claims data, pharmacy Provider Network data, and the MassHealth Rebate File Submission Reports (see Appendix A and Appendix EA). Dually Eligible – individuals determined eligible for both Medicaid and Medicare. DYS – the Massachusetts Department of Youth Services. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) – the delivery of health care services to MassHealth Standard and CommonHealth Members under the age of 21, pursuant to 42 USC 1396d(a)(4), 42 CFR Part 441, Subpart B, 130 CMR 450.140-149 and § 1115 Medicaid Research and Demonstration Waiver. Early Intervention Provider – a provider licensed and/or certified by the Massachusetts Department of Public Health to provide Early Intervention Services.

Culturally and Linguistically Appropriate Services. Health care services that are respectful of and responsive to cultural and linguistic needs, and that are characterized by cultural and linguistic competence, as described in the Culturally and Linguistically Appropriate Services (CLAS) standards set forth by the Office of Minority Health of the U.S. Department of Health and Human Services. More detail on CLAS standards may be found here: xxxx://xxxxxxxxxxxxxx.xxx.xxx/assets/pdf/checked/finalreport.pdf Customer Service Center (CSC) Enrollment Vendor – EOHHS’s enrollment broker that provides Members with a single point of access to a wide range of customer services, including enrolling Members into ACOs, MassHealth-contracted MCOs and the PCC Plan, authorizing non-emergency transportation services, and providing Members with information about Non-MCO Covered Services. Date of Action – the effective date of an Adverse Action. DCF – the Massachusetts Department of Children and Families. DDS – the Massachusetts Department of Developmental Services Discharge Planning – the evaluation of an Enrollee’s medical and Behavioral Health care needs and coordination of any other support services in order to arrange for safe and appropriate care and living situation after discharge from one care setting (e.g., acute hospital, inpatient behavioral health facility) to another care setting (e.g., rehabilitation hospital, group home), including referral to and coordination of appropriate services. Disease Management – the Contractor’s disease or condition specific packages of ongoing services and assistance for specific disease and/or conditions. Services include specific interventions and education/outreach targeted to Enrollees with, or at risk for, these conditions. Division of Insurance (DOI) – The Massachusetts Division of Insurance. DMH – the Massachusetts Department of Mental Health. DMH Case Management Services – Targeted Case Management (TCM) provided by DMH to DMH clients. The core elements of DMH Case Management Services include assessment, development of a care plan, service coordination and referral, monitoring, and client advocacy. DMH Case Manager – the individual responsible for implementing DMH Case Management Services. DMH Client – an Enrollee who DMH has determined is eligible for DMH Community-Based Services according to DMH Clinical Criteria. DMH Community-Based Services – DMH non-acute mental health care services, provided to DMH Clients, such as community aftercare, housing and support services, and non-acute residential services. DPH – the Massachusetts Department of Public Health. Drug Rebate (Medicaid Drug Rebate Program) – a program authorized by Section 1927 of the Social Security Act involving CMS, state Medicaid agencies, and approximately 600 participating drug manufacturers that helps to offset the federal and state costs of most outpatient prescription drugs dispensed to Medicaid patients. Drug and Non-Drug Pharmacy Product Rebate Data – a dataset provided by the Contractor related to the Drug Rebate and Non-Drug Pharmacy Product rebatesRebate. As further specified by EOHHS, Drug and Non-Drug Pharmacy Product Rebate Data shall include pharmacy claims data, 837 medication claims data, pharmacy Provider Network data, and the MassHealth Drug Rebate File Submission Reports Report (see Appendix A and Appendix EM). Dually Eligible – individuals determined eligible for both Medicaid and Medicare. DYS – the Massachusetts Department of Youth Services. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) – the delivery of health care services to MassHealth Standard and CommonHealth Members under the age of 21, pursuant to 42 USC 1396d(a)(4), 42 CFR Part 441, Subpart B, 130 CMR 450.140-149 and § 1115 Medicaid Research and Demonstration Waiver. Early Intervention Provider – a provider licensed and/or certified by the Massachusetts Department of Public Health to provide Early Intervention Services.