Other Provider Preventable Conditions. (OPPC) — A condition that meets the requirements of an “Other Provider Preventable Condition” pursuant to 42 C.F.R. 447.26(b). OPPCS may occur in any health care setting and are divided into two sub-categories: National Coverage Determinations (NCDs) – The NCDs are mandatory OPPCs under 42 C.F.R. 447.26(b) and consist of the following: Wrong surgical or other invasive procedure performed on a patient; Surgical or other invasive procedure performed on the wrong body part; Surgical or other invasive procedure performed on the wrong patient; For each of a through c above, the term “surgical or other invasive procedure” is defined in CMS Medicare guidance on NCDs. Additional Other Provider Preventable Conditions (Additional OPPCs) – Additional OPPCs are State-defined OPPCs that meet the requirements of 42 C.F.R. 447.26(b). EOHHS has designated certain conditions as Additional OPPCs. Passive Enrollment — An enrollment process through which an eligible individual is enrolled by the EOHHS (or its vendor) into a Contractor’s plan following a minimum 60-day advance notification that includes the opportunity to make another enrollment decision prior to the effective date. Personal Care Assistant (PCA) — A person who provides personal care to an Enrollee who requires assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).
Other Provider Preventable Conditions. (OPPC) — A condition that meets the requirements of an “Other Provider Preventable Condition” pursuant to 42 C.F.R. 447.26(b). OPPCS may occur in any health care setting and are divided into two sub-categories:
