Disability Competency Sample Clauses

Disability Competency. The demonstration that an entity or individual has the capacity to understand the diverse nature of disabilities and the impact that different disabilities can have on a Participant, access to services, and experience of care. Disease Management — An integrated treatment approach that includes the collaboration and coordination of patient care delivery systems and that focuses on measurably improving clinical outcomes for a particular medical condition through the use of appropriate clinical resources such as preventive care, treatment guidelines, patient counseling, education, and outpatient care; and that includes evaluation of the appropriateness of the scope, setting, and Disenrollment — The process by which a Participant’s ability to receive services from a CHC-MCO is terminated. Drug Efficacy Study Implementation — Drug products that have been classified as less-than-effective by the FDA. Dual Eligible — An individual who is enrolled in both Medicare and MA. Dual Eligible Special Needs Plan – A Medicare Advantage Plan that primarily or exclusively enrolls individuals who are entitled to both Medicare and MA. Eligibility Period — A period of time during which an individual is eligible to receive MA benefits. An Eligibility Period is indicated by the eligibility start and end dates in CIS. A blank eligibility end date signifies an open-ended Eligibility Period. Eligibility Verification System — An automated system available to Providers and other specified organizations for automated verification of MA eligibility, CHC-MCO Enrollment, PCP assignment, TPR, and scope of benefits. Emergency Medical Condition — A medical condition manifesting 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: (a) 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, (b) serious impairment to bodily functions, or (c) serious dysfunction of any bodily organ or part. Emergency Participant Issue — A problem of a CHC-MCO Participant, including problems related to whether an individual is a Participant, the resolution of which should occur immediately or before the beginning of the next business day in order to prevent a denial or significant delay in care to the Participant that could precipitate an Emergen...

Disability Competency. The demonstration that an entity or individual has the capacity to understand the diverse nature of disabilities and the impact that different disabilities can have on a Participant, access to services, and experience of care. It includes a demonstrated willingness and ability to make necessary accommodations in providing services, to employ appropriate language when referring to and talking with people with disabilities, and to understand communication, transportation, scheduling, structural, and attitudinal barriers to accessing services.‌ Disease Management — An integrated treatment approach that includes the collaboration and coordination of patient care delivery systems and that focuses on measurably improving clinical outcomes for a particular medical condition through the use of appropriate clinical resources such as preventive care, treatment guidelines, patient counseling, education, and outpatient care; and that includes evaluation of the appropriateness of the scope, setting, and level of care‌ in relation to clinical outcomes and cost of a particular condition.‌ Disenrollment — The process by which a Participant’s ability to receive services from a CHC-MCO is terminated.‌ Drug Efficacy Study Implementation (DESI) — Drug products that have been classified as less-than-effective by the Food and Drug Administration (FDA).‌ Dual Eligible — An individual who is enrolled in both Medicare and Medicaid.‌ Dual Eligible Special Needs Plan (D-SNPs) – A Medicare Advantage Plan that primarily or exclusively enrolls individuals who are entitled to both Medicare and Medicaid from a State Plan under Title XIX (Medicaid).‌ Early and Periodic Screening, Diagnosis and Treatment (EPSDT) — Items and services which must be made available to persons under the age of twenty- one‌