Common use of Indian Enrollee Clause in Contracts

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 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 XXXXX 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 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;; (b) makes the services it provides to its Enrollees as accessible (in terms of timeliness, amount, duration, and scope) as those services are to other Members within the area served by the entity; (c) meets the EOHHS’s solvency standards; (d) assures that Enrollees will not be liable for the Contractor’s debts if the Contractor becomes insolvent; (e) is located in the United States; (f) is independent from EOHHS’ enrollment broker, as identified by EOHHS; and (g) is not an excluded entity described in 42 CFR 438.808(b) Marketing – any communication from the Contractor, its employees, Providers, agents or Material Subcontractors to a Member who is not enrolled in the Contractor’s Plan that EOHHS can reasonably interpret as influencing the Member to enroll in the Contractor’s Plan or either not to enroll in, or to disenroll from, another MassHealth-contracted MCO, Accountable Care Partnership Plan, other MassHealth-contracted accountable care organization, , or the PCC Plan. Marketing shall not include any personal contact between a Provider and a Member who is a prospective, current or former patient of that Provider regarding the provisions, terms or requirements of MassHealth as they relate to the treatment needs of that particular member. Marketing Materials – Materials that are produced in any medium, by or on behalf of the Contractor and that EOHHS can reasonably interpret as Marketing to Members. This includes the production and dissemination by or on behalf of the Contractor of any promotional material or activities by any medium including, but not limited to, oral presentations and statements, community events, print media, audio visual tapes, radio, television, billboards, online, Yellow Pages, and advertisements that explicitly or implicitly refer to MassHealth Managed Care or Title XIX and Title XXI of the Social Security Act, and are targeted in any way toward Members. Massachusetts Health Information Highway (Mass HIway) – Massachusetts’ statewide electronic health information exchange. Massachusetts Health Quality Partners (MHQP) – a broad-based coalition of physicians, hospitals, health plans, purchasers, consumers, and government agencies working together to promote improvement in the quality of health care services in Massachusetts. MassHealth – the medical assistance or benefit programs administered by EOHHS. MassHealth CarePlus – a MassHealth Coverage Type that offers health benefits to certain individuals at least the age of 21 and under the age of 65 who qualify under EOHHS’s MassHealth CarePlus eligibility criteria. MassHealth CommonHealth – a MassHealth Coverage Type that offers health benefits to certain disabled children under age 18, and certain working or non-working disabled adults between the ages of 18 and 64.