PATIENT CENTERED MEDICAL HOME Sample Clauses

PATIENT CENTERED MEDICAL HOME. (PCMH) is a type of healthcare delivery model used by primary care providers (PCPs). In this model, a PCP leads a team of healthcare professionals, including a nurse care manager and, in some cases, a nutritionist, behavioral health provider, and/or other specialists, in helping patients improve their health and coordinate their care. For the purpose of this plan, your copayment may differ or vary depending on whether you receive care from a PCP that uses the PCMH model or a PCP that does not use the PCMH model of care.

PATIENT CENTERED MEDICAL HOME. A Patient-Centered Medical Home (PCMH) provides and coordinates the provision of comprehensive and continuous medical care and required support services to patients with the goals of improving access to needed care and maximizing outcomes. To be recognized as a PCMH, a practice must meet the three-part definition established by the Office of the Health Insurance Commissioner (OHIC), which requires demonstration of practice transformation, implementation of cost management initiatives, and clinical improvement. Updated definitions, standards, quality measures, and an updated list of recognized practices can be found at the following link; xxxx://xxx.xxxx.xx.xxx/ohic-reformandpolicy-pcmhinfo.php

PATIENT CENTERED MEDICAL HOME. “a health care setting that facilitates partnerships between individual patients and their personal physicians and, when appropriate, the patients’ families and communities. A patient-centered medical home integrates patients as active participants in their own health and well-being. Patients are cared for by a physician or physician practice that leads a multidisciplinary health team, which may include, but is not limited to, nurse practitioners (NP), nurses, physician assistants (PA), behavioral health providers, pharmacists, social workers, physical therapists, dental and eye care providers and dieticians to meet the needs of the patient in all aspects of preventive, acute, chronic care and end-of-life care using evidence- based medicine and technology. At the point in time that CMS includes the NP as a leader of the multidisciplinary health team, this state will automatically implement this change (§16-29 H-9 of the West Virginia State Code).” Patient Protection and Affordable Care Act (PPACA) – the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), together known as the Affordable Care Act (ACA). Periodicity Schedule – the requirements and frequency by which periodic screening services are provided and covered. Schedule must meet current standards of pediatric medical and dental practice and specify screening services applicable at each stage of the enrollee's life, beginning with a neonatal examination, up to the age at which an individual is no longer eligible for EPSDT services. Person Centered Service Planning Team (PCSPT) – a team formed when a member enrolled in the CSED waiver turns fifteen (15) and that is responsible for developing measurable outcomes that guide the member toward transition or graduation from waiver enrollment. Persons with Special Health Care Needs (SHCN) – individuals who have chronic physical, developmental, behavioral or emotional conditions. Such needs are of a type or amount beyond that generally required by individuals in that age range. Physician Services – health care services that a licensed medical physician provides or coordinates. Post-stabilization Services – services subsequent to an emergency medical condition that a treating physician views as Medically Necessary after an enrollee’s condition has been stabilized in order to maintain the stabilized condition or to improve or resolve the enrollee’s condi...

PATIENT CENTERED MEDICAL HOME. A Patient Centered Medical Home, also referred to as a “PCMH” or “Medical Care Panel”, is a group of PCPs formed in one of the following Panel types, which must meet the requirements on size and composition established in the PCMH Program Guidelines:

PATIENT CENTERED MEDICAL HOME. If Physician is a primary care physician, Physician shall, with the assistance of CDA, use commercially reasonable efforts to become a patient-centered medical home recognized or accredited by the National Committee for Quality Assurance (“NCQA”), URAC (formerly Utilization Review Accreditation Commission), Joint Commission (“JC”) or the Accreditation Association for Ambulatory Health Care (“AAAHC”).

PATIENT CENTERED MEDICAL HOME. A health care delivery model whereby the Member receives treatment coordinated through their primary care provider, who acts as the Patient-Centered Medical Home, to ensure that the Member receives the necessary care when and where they need it, in a manner that the Member understands. Care is facilitated through partnerships between the Member, all of the Member’s health care providers, the Member’s family, the Contractor (including the Member’s Care Manager), and any other organizations (including community-based organizations) that can facilitate comprehensive care for the Member.

PATIENT CENTERED MEDICAL HOME. “a health care setting that facilitates partnerships between individual patients and their personal physicians and, when appropriate, the patients’ families and communities. A patient-centered medical home integrates patients as active participants in their own health and well-being. Patients are cared for by a physician or physician practice that leads a multidisciplinary health team, which may include, but is not limited to, nurse practitioners, nurses, physician’s assistants, behavioral health providers, pharmacists, social workers, physical therapists, dental and eye care providers and dieticians to meet the needs of the patient in all aspects of preventive, acute, chronic care and end-of-life care using evidence- based medicine and technology. At the point in time that the Center for Medicare and Medicaid Services includes the nurse practitioner as a leader of the multidisciplinary health team, this state will automatically implement this change (§16-29 H-9 of the West Virginia State Code).” Post-stabilization Services - services subsequent to an emergency medical condition that a treating physician views as medically necessary after an enrollee’s condition has been stabilized in order to maintain the stabilized condition or to improve or resolve the enrollee’s condition. Potential Enrollee - a Medicaid recipient who is subject to mandatory enrollment or may voluntarily elect to enroll in a given managed care program, but is not yet an enrollee of a specific MCO. Primary Care Provider (PCP) - a specific clinician responsible for coordinating the health care needs of certain enrollees. Provider - a health care provider who meets the requirements of the West Virginia Medicaid Program and is a member of the MCO’s network. Prior Authorization - approval granted for payment purposes by the MCO for its active, specified enrollees or the Medicaid Program to a provider to render specified services to a specified recipient.

PATIENT CENTERED MEDICAL HOME. “a health care setting that facilitates partnerships between individual patients and their personal physicians and, when appropriate, the patients’ families and communities. A patient-centered medical home integrates patients as active participants in their own health and well-being. Patients are cared for by a physician or physician practice that leads a multidisciplinary health team, which may include, but is not limited to, nurse Pharmacy Benefit Manager (PBM) – a third party administrator of prescription drug programs. Post-stabilization Services – services subsequent to an emergency medical condition that a treating physician views as medically necessary after an enrollee’s condition has been stabilized in order to maintain the stabilized condition or to improve or resolve the enrollee’s condition. Potential Enrollee – a Medicaid recipient who is subject to mandatory enrollment or may voluntarily elect to enroll in a given managed care program, but is not yet an enrollee of a specific MCO. Preferred Drug List (PDL) – a part of the MCO formulary managed by the Department. It contains a list of drugs with preferred or non-preferred status as recommended to the Department by the Medicaid Pharmaceutical and Therapeutics (P & T) Committee and approved by the Secretary of the Department of Health and Human Resources. The drugs that are indicated as "preferred" have been selected for their clinical significance and overall efficiencies. The MCO is required to follow the guidance provided in the PDL. Pregnant Women or Pregnancy-Related Services – All women receiving related services and services for other conditions that might complicate the pregnancy, unless specifically identified in the State Plan as not being related to the pregnancy. This includes counseling and drugs for cessation of tobacco use and services during the postpartum period. The pregnancy period for which these services must be covered includes the prenatal period through the postpartum period (including the 60-day postpartum period following the end of pregnancy; see 42 CFR 440.210(a)(3)). Primary Care Provider (PCP) – a specific clinician responsible for coordinating the health care needs of certain enrollees. Primary Services – basic or general health services rendered by general practitioners, family practitioners, internists, obstetricians, and pediatricians. Provider – a health care provider who meets the requirements of the West Virginia Medicaid Program and is a member of the MCO’s ...

PATIENT CENTERED MEDICAL HOME. A Patient-Centered Medical Homes (PCMH) provides and coordinates the provision of comprehensive and continuous medical care and required support services to patients with the goals of improving access to needed care and maximizing outcomes. PCMH are certified by NCQA and the State requires the inclusion of PCMH’s as primary care providers in this procurement.

PATIENT CENTERED MEDICAL HOME. Patient’s Responsibilities: