Indian Enrollee. An individual who is an Indian (as defined in section 4(c) of the Indian Health Care Improvement Act of 1976 (25 U.S.C. 1603(c)).
Indian Enrollee. An Enrollee who is an Indian (as defined at 25 USC 1603(13), 1603(28), or 1679(a), or who has been determined eligible as an Indian, under 42 C.F.R. § 136.12.). This includes an Enrollee who is a member of a Federally recognized tribe; resides in an urban center and meets one or more of four criteria including: is member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those recognized now or in the future by the State in which they reside, or who is a descendant, in the first or second degree, of any such member; is an Eskimo or Aleut or other Alaska Native; is considered by the Secretary of the Interior to be an Indian for any purpose; or is determined to be an Indian under regulations issued by the Secretary; is considered by the Secretary of the Interior to be an Indian for any purpose; or is considered by the Secretary of Health and Human Services to be an Indian for purposes of eligibility for Indian Health Services, including as an Eskimo, Aleut, or other Alaska Native Enrollee.
Indian Enrollee. An individual who is an Indian (as defined in Section 4(c) of the Indian Health Care Improvement Act of 1976 (25 U.S.C. 1603(c)). Indian Health Care Provider – an Indian Health Care Provider or an Urban Indian Organization as defined in the American Recovery and Reinvestment Act of 2009. Internal Appeal – a request by an Enrollee or the Enrollee’s Appeal Representative made to the Contractor for review of an Adverse Action. Inquiry – any oral or written question by an Enrollee to the Contractor’s Enrollee services department regarding an aspect of Contractor operations that does not express dissatisfaction about the Contractor. Key Contact – Member of Contractor’s staff who liaises with EOHHS and serves as a point of contact for EOHHS for all communications and requests related to this Contract. Long-Term Services and Supports (LTSS) – A wide variety of services and supports that help certain members meet their daily needs for assistance and improve the quality of their lives. Examples include assistance with bathing, dressing and other basic activities of daily life and self-care, as well as support for everyday tasks such as laundry, shopping, and transportation. LTSS are provided over an extended period, predominantly in homes and communities, but also in facility-based settings such as nursing facilities. LTSS CP – Long-Term Services and Supports Community Partner Managed Care Organization (MCO) – any entity that provides, or arranges for the provision of, covered services under a capitated payment arrangement, that is licensed and accredited by the Massachusetts Division of Insurance as a Health Maintenance Organization (HMO), and is organized primarily for the purpose of providing health care services, that (a) meets advance directives requirements of 42 CFR Part 489, subpart I;
Indian Enrollee. An Enrollee who is an Indian (as defined in the Indian Health Care Improvement Act of 1976 (25 U.S.C. §§ 1603(13), 1603 (23), or 1679(a)) or who has been determined as an Indian under 42 C.F.R. § 136.12 and 42 C.F.R. § 447.51. As of September 1, 2017, Indian will be defined as any individual defined at 25 USC 1603(13), 1603(28), or 1679(a), or who has been determined eligible as an Indian, under 42 CFR 136.12.
Indian Enrollee. An Enrollee who is an Indian (as defined in section 4(c) of the Indian Health Care Improvement Act of 1976 (25 U.S.C. 1603(c)). Individualized Care Plan (ICP) — The plan of care developed by an Enrollee and an Enrollee’s Interdisciplinary Care Team. Integrated Care Organization (ICO) — A health plan or provider-based organization contracted to provide and accountable for providing integrated care to Enrollees. All Contractors participating in the Demonstration shall be designated as One Care plans (also known as ICOs). See also One Care plan. Interdisciplinary Care Team (ICT) — A team of Primary Care Provider, Care Coordinator, Independent Living and Long-Term Services and Supports Coordinator and other individuals at the discretion of the Enrollee that work with the Enrollee to develop, implement, and maintain the Individualized Care Plan.
Indian Enrollee. An Enrollee who is an Indian (as defined at 25 USC 1603(13), 1603(28), or 1679(a), or who has been determined eligible as an Indian, under 42 C.F.R. § 136.12.). This includes an Enrollee who is a member of a Federally recognized tribe; resides in an urban center and meets one or more of four criteria including: is member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those recognized now or in the future by the State in which they reside, or who is a descendant, in the first or second degree, of any such member; is an Eskimo or Aleut or other Alaska Native; is considered by the Secretary of the Interior to be an Indian for any purpose; or is determined to be an Indian under regulations issued by the Secretary; is considered by the Secretary of the Interior to be an Indian for any purpose; or is considered by the Secretary of Health and Human Services to be an Indian for purposes of eligibility for Indian Health Services, including as an Eskimo, Aleut, or other Alaska Native Enrollee. Individualized Care Plan (ICP) — The plan of care developed by an Enrollee and an Enrollee‘s Interdisciplinary Care Team. Interdisciplinary Care Team (ICT) — A team of PCP, Care Coordinator, Long- term Supports Coordinator and other individuals at the discretion of the Enrollee that work with the Enrollee to develop, implement, and maintain the Individualized Care Plan.
Indian Enrollee. An individual who is an Indian (as defined in section 4(c) of the Indian Health Care Improvement Act of 1976 (25 U.S.C. 1603(c)). Indian Health Care Provider – an Indian Health Care Provider or an Urban Indian Organization as defined in the American Recovery and Reinvestment Act of 2009. Instrumental Activities of Daily Living (IADLs) – certain basic environmental tasks required for daily living, including the ability to prepare meals, do housework, laundry, and shopping, get around outside, use transportation, manage money, perform care and maintenance of wheelchairs and adaptive devices, and use the telephone. Key Contact – one of the Contractor’s Key Personnel roles, as described in Section 2.5.A. Key Personnel – a defined subset of the Contractor’s staff roles as described in Section 2.5.A. Long-Term Services and Supports (LTSS) – a wide variety of services and supports that help certain members meet their daily needs for assistance and improve the quality of their lives. Examples include assistance with bathing, dressing and other basic activities of daily life and self-care, as well as support for everyday tasks such as laundry, shopping, and transportation. LTSS are provided over an extended period, predominantly in homes and communities, but also in facility-based settings such as nursing facilities. Losses – the amount by which the Contractor’s TCOC Performance exceeds the Contractor’s TCOC Benchmark as described in Section 4.3. LTSS – Long-Term Services and Supports. LTSS CPs – Long-Term Services and Supports Community Partners. Managed Care Organizations (MCO) – any entity that provides, or arranges for the provision of, covered services under a capitated payment arrangement, that is licensed and accredited by the Massachusetts Division of Insurance as a Health Maintenance Organization (HMO), and is organized primarily for the purpose of providing health care services, that (a) meets Advance Directives requirements of 42 CFR Part 489, subpart I;
Indian Enrollee. An individual who is an Indian (as defined in Section 4.2.8 of the Indian Health Care Improvement Act of 1976 (25 U.S.C. 1603(c)) and is enrolled in the Contractor’s SCO plan.
Indian Enrollee. An Enrollee who is an Indian as defined at 25 USC 1603(13), or 1679(a), or who has been determined eligible as an Indian, under 42 C.F.R. § 136.12.
Indian Enrollee. An Enrollee who is an Indian (as defined in section 4(c) of the Indian Health Care Improvement Act of 1976 (25 U.S.C. 1603(c)). Individualized Care Plan (ICP) — The plan of care developed by an Enrollee and an Enrollee’s Interdisciplinary Care Team. Integrated Care Organization (ICO) — A health plan or provider-based organization contracted to provide and accountable for providing integrated care to Enrollees. All Contractors participating in the Demonstration shall be designated as One Care plans (also known as ICOs). See also One Care plan. Interdisciplinary Care Team (ICT) — A team of Primary Care Provider, Care Coordinator, Independent Living and Long-Term Services and Supports Coordinator and other individuals at the discretion of the Enrollee that work with the Enrollee to develop, implement, and maintain the Individualized Care Plan. Long-Term Services and Supports (LTSS) — A wide variety of services and supports that help people with disabilities meet their daily needs for assistance and improve the quality of their lives. Examples include assistance with bathing, dressing and other basic activities of daily life and self-care, as well as support for everyday tasks such as laundry, shopping, and transportation. LTSS are provided over an extended period, predominantly in homes and communities, but also in facility-based settings such as nursing facilities. Marketing, Outreach, and Enrollee Communications — Any informational materials targeted to Enrollees that are consistent with the definition of marketing materials at 42 C.F.R. 422.2260.
