Participating Safety Net Hospital a Safety Net Hospital that affiliates with the Contractor for the purposes of this Contract as described in Section 2.2.D. Patient and Family Advisory Committee – a committee that gathers the perspectives of patients and families on the Contractor’s operations and regularly informs the Contractor’s Governing Board. Patient Experience Survey – a survey of Enrollees’ experiences of care, performed to evaluate the Contractor’s performance, as described in Appendix B. PCP Designee – a licensed clinician appointed by an Enrollee’s PCP to participate in the Enrollee’s care planning process and who has contact with the Enrollee’s PCP. The PCP Designee must be a Registered Nurse (RN) or another licensed medical professional such as a Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), Nurse Practitioner (NP), or Physician’s Assistant (PA). If requested by the Enrollee and agreed to by the Enrollee’s PCP, the PCP Designee may also be a specialist, such as an Enrollee’s cardiologist or neurologist, who meets the requirements of a PCP Designee. If agreed to by the Enrollee and by the Enrollee’s PCP, the PCP Designee may also be an ACO clinical staff person who meets the requirements of a PCP Designee. Peer Supports – activities to support recovery and rehabilitation provided by other consumers of behavioral health services. Prevalent Languages – those languages spoken by a significant percentage of Enrollees. EOHHS has determined the current Prevalent Languages spoken by MassHealth Enrollees are Spanish and English. EOHHS may identify additional or different languages as Prevalent Languages at any time during the term of the Contract. Primary Care – the provision of coordinated, comprehensive medical services, on both a first contact and a continuous basis, to an Enrollee. The provision of Primary Care incorporates an initial medical history intake, medical diagnosis and treatment, communication of information about illness prevention, health maintenance, and referral services. Primary Care Clinician (PCC) Plan – a managed care option administered by EOHHS through which enrolled MassHealth Members receive Primary Care and certain other medical services. See 130 CMR 450.118. Primary Care Provider (PCP) – an EOHHS-contracted primary care practitioner participating in the managed care program pursuant to 130 CMR 450.119. PCPs provide comprehensive Primary Care and certain other medical services to Primary Care ACO Enrollees and function as the referral source for ...
Participating Safety Net Hospital. A safety net hospital, as identified by EOHHS, with which the Contractor has a contract for the purpose described in Section 2.7.C.4 and Section 5.
Participating Safety Net Hospital a Safety Net Hospital that affiliates with the Contractor for the purposes of this Contract as described in Section 2.2.D. Patient and Family Advisory Committee – a committee that gathers the perspectives of patients and families on the Contractor’s operations and regularly informs the Contractor’s Governing Board. Patient Experience Survey – a survey of Enrollees’ experiences of care, performed to evaluate the Contractor’s performance, as described in Appendix B. Peer Supports – activities to support recovery and rehabilitation provided by other consumers of behavioral health services. Prevalent Languages – those languages spoken by a significant percentage of Enrollees. EOHHS has determined the current Prevalent Languages spoken by MassHealth Enrollees are Spanish and English. EOHHS may identify additional or different languages as Prevalent Languages at any time during the term of the Contract. Primary Care – the provision of coordinated, comprehensive medical services, on both a first contact and a continuous basis, to an Enrollee. The provision of Primary Care incorporates an initial medical history intake, medical diagnosis and treatment, communication of information about illness prevention, health maintenance, and referral services. Primary Care Clinician (PCC) – an EOHHS-contracted Primary Care Practitioner participating in the Managed Care program pursuant to 130 CMR 450.118. PCCs provide comprehensive Primary Care and certain other medical services to PCC Plan enrollees and function as the referral source for most other MassHealth services. Privacy and Security Rules - the privacy and security regulations promulgated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (45 CFR Parts 160 and 164). Progress Reports – information provided by the Contractor on the Contractor’s activities under this Contract, as described in Section 5.1.C. Providers – an individual, group, facility, agency, institution, organization, or business that furnishes or has furnished medical services to Members. Quality Committee – a committee reporting directly to the Contractor’s Governing Board, which regularly reviews and sets goals to improve the Contractor’s performance on clinical quality or health outcomes, Enrollee experience measures, other Quality Measures, and disparities. Quality Measures – Measures used to evaluate the quality of the Contractor’s Enrollee care as described in Appendix B. Quality Sample – a subset of Enrollees defined b...
Participating Safety Net Hospital a Safety Net Hospital that affiliates with the Contractor for the purposes of this Contract as described in Section 2.2.D.
Participating Safety Net Hospital a Safety Net Hospital that affiliates with the Contractor for the purposes of this Contract as described in Section 2.2.C. Patient and Family Advisory Committee – a committee that gathers the perspectives of patients and families on the Contractor’s operations and regularly informs the Contractor’s Governing Board. Patient Experience Survey – a survey of Attributed Members’ experiences of care, performed to evaluate the Contractor’s performance, as described in Appendix B. Peer Supports – activities to support recovery and rehabilitation provided by other consumers of behavioral health services. Prevalent Languages – those languages spoken by a significant percentage of Attributed Members. EOHHS has determined the current Prevalent Languages spoken by MassHealth Attributed Members are Spanish and English. EOHHS may identify additional or different languages as Prevalent Languages at any time during the term of the Contract. Primary Care – the provision of coordinated, comprehensive medical services, on both a first contact and a continuous basis, to an Attributed Member. The provision of Primary Care incorporates an initial medical history intake, medical diagnosis and treatment, communication of information about illness prevention, health maintenance, and referral services. Primary Care Provider (PCP) – the individual Primary Care Provider or team selected by the Attributed Member, or assigned to the Attributed Member by the Contractor, to provide and coordinate all of the Attributed Member’s health care needs and to initiate and monitor referrals for specialty services when required. PCPs include nurse practitioners practicing in collaboration with a physician under Massachusetts General Laws Chapter 112, Section 80B and its implementing regulations or physicians who are board certified or eligible for certification in one of the following specialties: Family Practice, Internal Medicine, General Practice, Adolescent and Pediatric Medicine, or Obstetrics/Gynecology (for women only). PCPs for persons with disabilities, including but not limited to, persons with HIV/AIDS, may include practitioners who are board certified or eligible for certification in other relevant specialties. Privacy and Security Rules – the privacy and security regulations promulgated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (45 CFR Parts 160 and 164). Progress Reports – information provided by the Contractor on the Contractor’s activities under t...
