Common use of Participating Safety Net Hospital Clause in Contracts

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 most other MassHealth services. Privacy and Security Rules - the privacy, security and related regulations promulgated under the Health Insurance Portability and Accountability Act of 1996, as amended (HIPAA) (found at 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. Protected Information (PI) – shall mean any Protected Health Information, any “personal data” as defined in M.G.L. c. 66A, any “patient identifying information” as used in 42 CFR Part 2, any “personally identifiable information” as used in 45 CFR §155.260, “personal information” as defined in X.XX. c. 93H, and any other individually identifiable information that is treated as confidential under Applicable Law or agreement (including, for example, any state and federal tax return information) that the Contractor uses, maintains, discloses, receives, creates, transmits or otherwise obtains from EOHHS. Information, including aggregate information, is considered PI if it is not fully de-identified in accord with 45 CFR §§164.514(a)-(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 by EOHHS used for measurement of Clinical Quality Measures as set forth in Appendix B. Quality Score – a score calculated by EOHHS based on the Contractor’s performance on Quality Measures, as described in Appendix B. Rating Category (RC) – An identifier used by EOHHS to identify a specific grouping of Enrollees for which a discrete TCOC applies pursuant to the Contract. Rating Categories include RC I Adult, RC I Child, XX XX Adult, XX XX Child, RC IX, and XX X. XX XX Adult, as used in Section 4, includes Enrollees who are disabled, age 21 to 64, and in MassHealth Standard or CommonHealth as described in 130 CMR 505. Referral Circle – a subset of Affiliated Providers for whom Participating PCP referral requirements are modified as set forth in 130 CMR 450.119 and as described in Section 3.2. Region – A geographic area used for the purpose of the development of TCOC. See Section 4.

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. 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 EnrolleesAttributed Members’ experiences of care, performed to evaluate the Contractor’s performance, as described in Appendix B. PCP Designee – a licensed clinician appointed by an EnrolleeAttributed Member’s PCP to participate in the EnrolleeAttributed Member’s care planning process and who has face-to-face contact with the EnrolleeAttributed Member’s PCPPCP and serves on the Attributed Member’s Care Team. 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 The PCP Designee may also be a specialist, such as an EnrolleeAttributed Member’s cardiologist or neurologist, who meets if requested by the requirements of a PCP Designee. If Attributed Member and agreed to by the Enrollee and by the EnrolleeAttributed Member’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 EnrolleesAttributed Members. EOHHS has determined the current Prevalent Languages spoken by MassHealth Enrollees 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 EnrolleeAttributed 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 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 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 practitioner participating in the managed care program pursuant needs and to 130 CMR 450.119initiate and monitor referrals for specialty services when required. PCPs provide comprehensive Primary Care include nurse practitioners practicing in collaboration with a physician under Massachusetts General Laws Chapter 112, Section 80B and certain 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 medical services to Primary Care ACO Enrollees and function as the referral source for most other MassHealth servicesrelevant specialties. Privacy and Security Rules - – the privacy, privacy and security and related regulations promulgated under the Health Insurance Portability and Accountability Act of 1996, as amended 1996 (HIPAA) (found at 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. 4.1.C. Protected Information (PI) – shall mean - any Protected Health Information“protected health information” (PHI) as used in the Privacy and Security Rules, any “personal data” as defined in M.G.L. c. 66A, any “patient identifying information” as used in 42 CFR Part 2, any “personally identifiable information” as used in 45 CFR §155.260, “personal information” as defined in X.XX. c. 93H, and 155.260 and/or any other individually identifiable information that is treated as confidential under Applicable Law applicable privacy or agreement (including, for example, any state and federal tax return information) security law or regulation that the Contractor uses, maintains, discloses(or its subcontractor or agent) creates, receives, createsacquires, uses, transmits or otherwise obtains from EOHHSmaintains in connection with its provision of CP Supports and/or its performance of a function or activity for or on behalf of EOHHS under the Contract or an ACO or MCO under a ACO/MCO and CP Agreement. Information, including aggregate information, is considered PI if it is not fully de-identified in accord with 45 CFR §§164.514(a)-(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 Attributed Member experience measures, other Quality Measures, and disparities. Quality Measures – Measures used to evaluate the quality of the Contractor’s Enrollee Attributed Members’ care as described in Appendix B. Quality Sample – a subset of Enrollees Members defined by EOHHS used for measurement of Clinical Quality Measures as set forth in Appendix B. Quality Score – a score calculated by EOHHS based on the Contractor’s performance on Quality Measures, as described in Appendix B. Rating Category (RC) – An identifier used by EOHHS to identify a specific grouping of Enrollees for which a discrete TCOC applies pursuant to the Contract. Rating Categories include RC I Adult, RC I Child, XX XX Adult, XX XX Child, RC IX, and XX X. XX XX Adult, as used in Section 42.7, includes Enrollees who are disabled, age 21 to 64, and in MassHealth Standard or CommonHealth as described in 130 CMR 505. Referral Circle – a subset of Affiliated Providers for whom Participating PCP referral requirements are modified as set forth in 130 CMR 450.119 and as described in Section 3.2. Region – A geographic area used for the purpose of the development of TCOC. See Section 4.2.7. Risk Track – one of the financial accountability arrangements described in Section 2.7.B.