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 Accountable Care Partnership Plan, MassHealth- contracted accountable care organization, MassHealth-contracted MCO, 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.
Long-Term Services and Supports (LTSS). The services and supports set forth in Appendix A-2. These services 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. MassHealth - the medical assistance and benefit programs administered by the Executive Office of Health and Human Services pursuant to Title XIX of the Social Security Act (42 USC 1396), M.G.L. c. 118E, and other applicable laws and regulations (Medicaid). MassHealth Member - for this Contract, a person who is age 65 or over, enrolled in MassHealth, and eligible for MassHealth Standard. MassHealth Standard - a MassHealth coverage type that offers a full range of Medicaid health benefits to eligible MassHealth Members. Medicare - Title XVIII of the Social Security Act, federal health insurance program for people age 65 and older, certain younger disabled people, and people with kidney failure. Medicare Part A provides coverage of inpatient hospital services and services of other institutional Providers, such as skilled nursing facilities and home health agencies. Medicare Part B provides supplementary medical insurance that covers physician services, outpatient services, some home health care, durable medical equipment, and laboratory services and supplies, generally for the diagnosis and treatment of illness or injury. Medicare Part C provides Medicare beneficiaries with the option of receiving Part A and Part B services through a private health plan. Medicare Part D provides coverage for most pharmaceuticals. Medicare Advantage - the Medicare managed care options that are authorized under Title XVIII of the Social Security Act as specified at Part C, and 42 CFR §422. Medically Necessary or Medical Necessity – in accordance with 130 CMR 450.204, Medically Necessary services are those services (1) which are reasonably calculated to prevent, diagnose, prevent the worsening of, alleviate, correct, or cure conditions in the Enrollee that endanger life, cause suffering or pain, cause physical deformity or malfunction, threaten to cause or to aggravate a disability, or result in illness or infirmity; and (2) for which there is no other medical service or site of ser...
Long-Term Services and Supports (LTSS). These services can be either institutional or non-institutional. When offered as an HCBS service, the LTSS service is an alternative to an institutional setting. These are an array of services are largely non-medical in nature that are provided to members who have functional limitations that have the primary purpose of supporting the ability of the member to live or work in the most appropriate, least restrictive, and most integrated setting that also protects their health and safety in a cost-effective manner. The actual services to a member will be described in the member’s PCSP.
Long-Term Services and Supports (LTSS). Providers. Any LTSS Covered Services under the State Contract that could be authorized through a waiver under section 1915(c) of the Social Security Act (the “Act”) or a State Program amendment authorized through sections 1915(i) or 1915(k) of the Act must be delivered in settings consistent with 42 C.F.R. § 441.301(c)(4).
Long-Term Services and Supports (LTSS). 2.6.1. Contractor will ensure access to, provision of, and payment for: 1) CBAS for Enrollees who meet eligibility criteria for CBAS as defined in Section 2.6.2.1 , MSSP for Enrollees who meet the eligibility criteria for MSSP pursuant to WIC, Section 9560; and, 3) IHSS for Enrollees who meet the eligibility criteria for IHSS pursuant to WIC, Section 12305.6.
Long-Term Services and Supports (LTSS). An individual employed by a community-based organization (CBO) contracted by a Contractor to ensure that an independent resource is assigned to and available to the Enrollee to perform the responsibilities in Section 2.7, including assisting with the coordination of the Enrollee’s LTSS needs, community-based Behavioral Health Needs, and providing expertise on community supports to the Enrollee and the Enrollee’s care team.
Long-Term Services and Supports (LTSS). Services and supports provided to members of all ages who have functional limitations and/or chronic illnesses that have the primary purpose of supporting the ability of the member to live or work in the setting of their choice, which may include the member’s home, a worksite, a provider-owned or controlled residential setting, a nursing facility, or other institutional setting. The PASSE program provides LTSS as an alternative to living in an institutional setting.
Long-Term Services and Supports (LTSS) are Medi-Cal programs that provide assistance with Activities of Daily Living, and include a range of home and community based services, such as: In-Home Supportive Services; Community- Based Adult Services; an Multipurpose Senior Services Program, in addition to care in nursing facility services when needed.
Long-Term Services and Supports (LTSS). 2.1.58.1 “Long Term Services and Supports (LTSS)” means nursing facility services, all four of NH’s Home and Community Based Care waivers, and services provided to children and families through the Division for Children, Youth and Families (DCYF).
Long-Term Services and Supports (LTSS). Providers
