Demonstration Year. Demonstration Year 1 runs from the first Effective Enrollment Date through December 31, 2014; Demonstration Year 2 runs from January 1, 2015 through December 31, 2015; Demonstration Year 3 runs from January 1, 2016 through December 31, 2016; Demonstration Year 4 runs from January 1, 2017 through December 31, 2017; Demonstration Year 5 runs from January 1, 2018 through December 31, 2018; Demonstration Year 6 runs from January 1, 2019 through December 31, 2019; Demonstration Year 7 runs from January 1, 2020 through December 31, 2020; Demonstration Year 8 runs from January 1, 2021 through December 31, 2021; and Demonstration Year 9 runs from January 1, 2022 through December 31, 2022.
Demonstration Year. Demonstration Year 1 runs from the first Effective Enrollment Date through December 31, 2014; Demonstration Year 2 runs from January 1, 2015 through December 31, 2015; and Demonstration Year 3 runs from January 1, 2016 through December 31, 2016. Effective Enrollment Date — The first calendar day of the month following receipt of Enrollee’s enrollment into an ICO by EOHHS or CMS, or their designee. Eligible Beneficiary — For the purpose of this contract, and as laid out in Section III.C.1 of the Memorandum of Understanding between CMS and the Commonwealth of Massachusetts dated August 22, 2012 (MOU), a Consumer who is eligible to enroll in the Demonstration but has not yet done so. This includes individuals who are enrolled in Medicare Part A and B and eligible for and receiving MassHealth Standard or CommonHealth, have no other comprehensive private or public health coverage, and who meet all other Demonstration eligibility criteria. Emergency Condition — A medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: (1) placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; (2) serious impairment to bodily functions; or (3) serious dysfunction of any bodily organ or part.
Demonstration Year. Demonstration Year 1 runs from the first Effective Enrollment Date through December 31, 2014; Demonstration Year 2 runs from January 1, 2015 through December 31, 2015; and Demonstration Year 3 runs from January 1, 2016 through December 31, 2016. Effective Enrollment Date — The first calendar day of the month following receipt of Enrollee’s enrollment into an ICO by EOHHS or CMS, or their designee. Eligible Beneficiary — For the purpose of this contract, and as laid out in Section III.C.1 of the Memorandum of Understanding between CMS and the Commonwealth of Massachusetts dated August 22, 2012 (MOU), a Consumer who is eligible to enroll in the Demonstration but has not yet done so. This includes individuals who are enrolled in Medicare Part A and B and eligible for and receiving MassHealth Standard or CommonHealth, have no other comprehensive private or public health coverage, and who meet all other Demonstration eligibility criteria.
Demonstration Year. Demonstration Year 1 runs from the first Effective Enrollment Date through December 31, 2014; Demonstration Year 2 runs from January 1, 2015 through December 31, 2015; and Demonstration Year 3 runs from January 1, 2016 through December 31, 2016. Effective Enrollment Date — The first calendar day of the month following receipt of Enrollee’s enrollment into an ICO by EOHHS or CMS, or their designee. Eligible Beneficiary — For the purpose of this contract, and as laid out in Section III.C.1 of the Memorandum of Understanding between CMS and the Commonwealth of Massachusetts dated August 22, 2012 (MOU), a Consumer who is eligible to enroll in the Demonstration but has not yet done so. This includes individuals who are enrolled in Medicare Part A and B and eligible for and receiving MassHealth Standard or CommonHealth, have no other comprehensive private or public health coverage, and who meet all other Demonstration eligibility criteria. Emergency Condition — A medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: (1) placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; (2) serious impairment to bodily functions; or (3) serious dysfunction of any bodily organ or part. Emergency Services — Inpatient and outpatient services covered under this Contract that are furnished by a provider qualified to furnish such services and that are needed to evaluate or stabilize an Enrollee’s Emergency Condition. Emergency Services include Post-stabilization Services provided after an emergency is stabilized in order to maintain the stabilized condition or to improve or resolve the Enrollee’s condition. Emergency Services Program (ESP) — Services provided through designated, contracted providers which are available seven days per week, 24 hours per day to provide treatment of any individual who is experiencing a mental health crisis. An ESP encounter includes, at a minimum, crisis assessment, intervention and stabilization. Enrollee — Any Medicare-Medicaid eligible individual who is enrolled with a Contractor. Enrollee Communications — Materials designed to communicate plan benefits, policies, processes and/or Enrollee rights to Enrollees. This includes pre-enrollment, post-...
