High Needs Population ACO definition

High Needs Population ACO means a REACH ACO that focuses on Beneficiaries with complex, high needs, including dually eligible individuals, and is approved by CMS to participate in the Model as a High Needs Population ACO prior to the Effective Date, and has not subsequently been approved by CMS to participate in the Model as a New Entrant ACO or a Standard ACO pursuant to Article VIII. A High Needs Population ACO qualifies for the alternative Beneficiary alignment minimums specified in Section 5.03.C and qualifies for the methodology for calculating the Performance Year Benchmark described in Section III of Appendix B of the Agreement.
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Examples of High Needs Population ACO in a sentence

  • If the ACO is a High Needs Population ACO, the ACO may select to participate in the Model as a Standard ACO in advance of the ACO’s second Performance Year or any subsequent Performance Year.

  • If the ACO is a Standard ACO or a New Entrant ACO, the ACO may not be owned by an individual or entity that also owns another REACH ACO that is High Needs Population ACO that is participating in the Model and that operates in the same ACO Service Area, as defined in Section 5.04.

  • If the ACO is a High Needs Population ACO, the ACO may select to participate in the Model as a New Entrant ACO in advance of the ACO’s second Performance Year.

  • Organizations that serve a sub-population of FFS Medicare beneficiaries for which a targeted total cost of care initiative does not exist should further consider whether it is appropriate to apply to the ACO REACH Model as a High Needs Population ACO.

  • Beneficiaries may be aligned to a Standard ACO, New Entrant ACO, or High Needs Population ACO in two ways: 1.

  • Starting in PY2021, once a beneficiary is determined to be High Needs-eligible and is aligned to an ACO, that beneficiary will be considered High Needs-eligible for the duration of the model performance period as long as the beneficiary remains aligned to the same High Needs Population ACO.

  • For individuals to be eligible to be aligned to a High Needs Population ACO, they must meet at least one of the criteria listed at the bottom of page 63 in the ACO REACH Model RFA.

  • Beneficiaries who do not currently meet the High Needs Population ACO-specific beneficiary eligibility criteria, but who would otherwise be aligned to a High Needs Population ACO either through claims or voluntary alignment, will have up to four chances to become eligible for alignment to the High Needs Population ACO each PY.

  • Each Standard ACO, New Entrant ACO, or High Needs Population ACO must contract with one or more Participant Providers.

  • CMS will align individuals to a High Needs Population ACO if they meet the high needs criteria prior to initial alignment and are otherwise eligible for alignment to an ACO via voluntary alignment or claims- based alignment.

Related to High Needs Population ACO

  • Population means the population as ascertained at the last preceding census of which the relevant figures have been published;

  • Target Population means persons with low incomes who have one or more disabilities, including mental illness, HIV or AIDS, substance abuse, or other chronic health condition, or individuals eligible for services provided pursuant to the Lanterman Developmental Disabilities Services Act (Division 4.5 (commencing with Section 4500) of the Welfare and Institutions Code) and may include, among other populations, adults, emancipated minors, families with children, elderly persons, young adults aging out of the foster care system, individuals exiting from institutional settings, veterans, and homeless people.

  • Special needs child means a child with needs for emotional care, behavioral care, or physical and personal care which require additional skill, knowledge, or responsibility on the part of the foster parents, as measured by Form 470-4401, Foster Child Behavioral Assessment. See subrule 156.6(4).

  • Nursing home-type patients means a patient who has been in hospital more than 35 days, no longer requires acute hospital care, cannot live independently at home or be looked after at home, and either cannot be placed in a nursing home or a nursing home place is not available.

  • High radiation area means an area, accessible to individuals, in which radiation levels from radiation sources external to the body could result in an individual receiving a dose equivalent in excess of one mSv (0.1 rem) in one hour at 30 centimeters from any source of radiation or 30 centimeters from any surface that the radiation penetrates.

  • Very high radiation area means an area, accessible to individuals, in which radiation levels from radiation sources external to the body could result in an individual receiving an absorbed dose in excess of 5 Gy (500 rad) in one hour at one meter from a source of radiation or one meter from any surface that the radiation penetrates.

  • Modular home means a modular unit as defined in Section 15A-1-302.

  • All-terrain type II vehicle means the same as that term is defined in Section 41-22-2.

  • Special Needs beneficiary is one who needs additional time to complete his/ her education due to physical, mental or emotional limitations. In addition, as discussed below, a beneficiary may roll over contributions to another Xxxxxxxxx Education Savings Account until he or she attains age 30. A beneficiary may also roll over his or her Xxxxxxxxx Education Savings Account to a new beneficiary who is a member of his or her family so long as the recipient has not attained age 30.

  • Adult foster care facility means an adult foster care facility licensed under the adult foster care facility licensing act, 1979 PA 218, MCL 400.701 to 400.737.

  • Energy Use Intensity (EUI means the kBTUs (1,000 British Thermal Units) used per square foot of gross floor area.

  • General purpose radiographic x-ray system means any radiographic x-ray system which, by design, is not limited to radiographic examination of specific anatomical regions.

  • Established geographic service area means a geographic area, as approved by the Commissioner and based on the carrier's certificate of authority to transact insurance in this state, within which the carrier is authorized to provide coverage;

  • All-terrain type I vehicle means the same as that term is defined in Section 41-22-2.

  • High global warming potential hydrofluorocarbons means any hydrofluorocarbons in a particular end use for which EPA’s Significant New Alternatives Policy (SNAP) program has identified other acceptable alternatives that have lower global warming potential. The SNAP list of alternatives is found at 40 CFR Part 82 subpart G with supplemental tables of alternatives available at (http://www.epa.gov/snap/).

  • Statewide popular election means a general election in which votes are cast for

  • Deportation or forcible transfer of population means forced displacement of the persons concerned by expulsion or other coercive acts from the area in which they are lawfully present, without grounds permitted under international law;

  • Child in need of services means (i) a child whose behavior, conduct or condition presents or results

  • Signaling Transfer Point (“STP”) means a signaling point that performs message routing functions and provides information for the routing of messages between signaling points within or between CCIS networks. A STP transmits, receives and processes CCIS messages.

  • Rate Center Area means the following in each applicable area:

  • Harvest batch means a specifically identified quantity of dried flower or trim, leaves, and other cannabis plant matter that is uniform in strain, harvested at the same time, and, if applicable, cultivated using the same pesticides and other agricultural chemicals, and harvested at the same time.

  • In-stream Waste Concentration or "(IWC)" means the concentration of a discharge in the receiving water after mixing has occurred in the allocated zone of influence.

  • Cardiopulmonary resuscitation or "CPR" means artificial ventilation or external chest compression applied to a person who is unresponsive and not breathing.

  • Step therapy means a program for Insureds who take Prescription Drugs for an ongoing medical condition, such as arthritis, asthma or high blood pressure, which ensures the Insured receives the most appropriate and cost-effective drug therapy for their condition. The Step Therapy program requires that before benefits are payable for a high cost Covered Drug that may have initially been prescribed, the Insured try a lower cost first-step Covered Drug. If the prescribing Physician has documented with SHL why the Insured’s condition cannot be stabilized with the first-step Covered Drug, SHL will review a request for Prior Authorization to move the Insured to a second-step drug, and so on, until it is determined by SHL that the prescribed Covered Drug is Medically Necessary and eligible for benefit payment.

  • Small Diversity business concern means a small business concern that is at least fifty-one (51) percent unconditionally owned by one or more individuals who are both socially and economically diverse, or a publicly owned business that has at least fifty-one (51) percent of its stock unconditionally owned by one or more socially and economically diverse individuals and that has its management and daily business controlled by one or more such individuals. This term also means a small business concern that is at least fifty-one (51) percent unconditionally owned by an economically diverse Indian tribe or Native Hawaiian Organization, or a publicly owned business that has at least fifty-one (51) percent of its stock unconditionally owned by one of these entities, that has its management and daily business controlled by members of an economically diverse Indian tribe or Native Hawaiian organization.

  • Adult foster care means room and board, supervision, and special services to an adult who has a