Highest Needs Members definition

Highest Needs Members. Members with complex needs, multiple comorbidities, and/or a history of frequent emergency department visits or inpatient admissions during the previous 12 months as identified by the HMO’s needs-stratification process. HIPAA: The Health Insurance Portability and Accountability Act of 1996, federal legislation that is designed to improve the portability and continuity of health insurance. HMO: The Health Maintenance Organization or its parent corporation with a Certificate of Authority to do business in Wisconsin as an HMO, that is obligated under this Contract. A separate Certificate of Authority and HMO Certification Application must be submitted for each contract the HMO intends to enter into with the Wisconsin Medicaid program (if, for example, an HMO offers multiple product lines, does business under another name, etc.). HMO Administrative Services: The health plan’s performance of services or functions, other than the direct delivery of Covered Services, necessary for the management of the delivery of and payment for Covered Services, including: network adequacy, service utilization, clinical or quality management, service authorization, claims processing, management information systems operation, and reporting. This term also includes the infrastructure development for, preparation of, and delivery of, all required Deliverables under the Contract, outside of the Covered Services. HMO Technical Workgroup: A workgroup composed of HMO technical staff, contract administrators, claims processing, eligibility, and/or other HMO staff, who meet as necessary; with Department staff from the Division of Medicaid Services (DMS), and staff from the Department’s Fiscal Agent. Homeless: An individual who lacks a fixed and regular nighttime residence or an individual whose primary nighttime residence is:
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Highest Needs Members. Members with complex needs, multiple comorbidities, and/or a history of frequent emergency department visits or inpatient admissions during the previous 12 months as identified by the HMO’s needs-stratification process. HHS: The federal Department of Health and Human Services. HIPAA: The Health Insurance Portability and Accountability Act of 1996, federal legislation that is designed to improve the portability and continuity of health insurance.
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Highest Needs Members. Members with complex needs, multiple comorbidities, and/or a history of frequent emergency department visits or inpatient admissions during the previous 12 months as identified by the HMO’s needs-stratification process. Information Gathering and Assessment (for Medicaid SSI members only): A detailed evaluation where the care management staff collects all relevant information about the member’s health care, and cultural and socioeconomic needs to conduct needs-stratification and to develop the Comprehensive Care Plan. Member: An individual who has been determined eligible for BadgerCare Plus or Medicaid.
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More Definitions of Highest Needs Members

Highest Needs Members. Members with complex needs, multiple comorbidities, and/or a history of frequent emergency department visits or inpatient admissions during the previous 12 months as identified by the HMO’s needs-stratification process. HIPAA: The Health Insurance Portability and Accountability Act of 1996, federal legislation that is designed to improve the portability and continuity of health insurance. HMO: The Health Maintenance Organization or its parent corporation with a Certificate of Authority to do business in Wisconsin as an HMO, that is obligated under this Contract. A separate Certificate of Authority and HMO Certification Application must be submitted for each contract the HMO intends to enter into with the Wisconsin Medicaid program (if, for example, an HMO offers multiple product lines, does business under another name, etc.).
Sample 1
Highest Needs Members. Members with complex needs, multiple comorbidities, and/or a history of frequent emergency department visits or inpatient admissions during the previous 12 months as identified by the HMO’s needs-stratification process. HIPAA: The Health Insurance Portability and Accountability Act of 1996, federal legislation that is designed to improve the portability and continuity of health insurance. HMO: The Health Maintenance Organization or its parent corporation with a Certificate of Authority to do business in Wisconsin as an HMO, that is obligated under this Contract. A separate Certificate of Authority and HMO Certification Application must be submitted for each contract the HMO intends to enter into with the Wisconsin Medicaid program. HMO Administrative Services: The health plan’s performance of services or functions, other than the direct delivery of Covered Services, necessary for the management of the delivery of and payment for Covered Services, including: network adequacy, service utilization, clinical or quality management, service authorization, claims processing, management information systems operation, and reporting. This term also includes the infrastructure development for, preparation of, and delivery of, all required Deliverables under the Contract, outside of the Covered Services. HMO Technical Workgroup: A workgroup composed of HMO technical staff, contract administrators, claims processing, eligibility, and/or other HMO staff, who meet as necessary; with Department staff from the Division of Medicaid Services (DMS), and staff from the Department’s Fiscal Agent. Homeless: An individual who lacks a fixed and regular nighttime residence or an individual whose primary nighttime residence is:
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Related to Highest Needs Members

  • Team Members means the members of the Team, jointly and severally;

  • Participating Entities and “Participating Entity” are defined on the Coversheet.

  • Class Members means all individuals in the Settlement Class, including the Class Representatives.

  • Members means the persons who are duly registered as the holders from time to time of shares in the register including persons who are jointly so registered.

  • Students means students, their parents, guardians or other legal representatives.

  • Graduate medical education and disproportionate share fund or “GME/DSH fund” means a reimbursement fund developed as an adjunct reimbursement methodology to directly reimburse qualifying hospitals for the direct and indirect costs associated with the operation of graduate medical education programs and the costs associated with the treatment of a disproportionate share of poor, indigent, nonreimbursed or nominally reimbursed patients for inpatient services.

  • New Members As Defined By the Public Employees’ Pension Reform Act of 2013 (PEPRA)

  • Household members means those persons who reside in the same home, who have reciprocal duties to and do provide financial support for one another. This term shall include xxxxxx children and legal wards even if they do not live in the household. The term does not include persons sharing the same general house, when the living style is primarily that of a dormitory or commune;

  • PBS means the Pharmeceutical Benefits Schedule (PBS) that is a list of all the medicines that receive a government subsidy.

  • Founding Members means the collective reference to American Multi-Cinema, Inc., a Missouri corporation, Cinemark Media, Inc., a Delaware corporation, and Regal CineMedia Holdings, LLC, a Delaware limited liability company.

  • Class A Members means those Members who have purchased Class A Interests.

  • Basic health plan services means that schedule of covered

  • Teaching staff member means an employee who holds a position for which a certificate issued by the New Jersey State Board of Examiners is required.

  • Student athlete means an individual who engages in, is eligible to engage in, or may be eligible in the future to engage in, any intercollegiate sport. If an individual is permanently ineligible to participate in a particular intercollegiate sport, the individual is not a student-athlete for purposes of that sport.

  • Participating Companies means any insurance company (including Insurance Company) that offers variable annuity and/or variable life insurance contracts to the public and that has entered into an agreement with one or more of the Funds.

  • 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.

  • Medical personnel means those persons assigned, by a Party to the conflict, exclusively to the medical purposes enumerated under sub-paragraph (e) or to the administration of medical units or to the operation or administration of medical transports. Such assignments may be either permanent or temporary. The term includes:

  • HSP’s Personnel and Volunteers means the Controlling Shareholders (if any), directors, officers, employees, agents, volunteers and other representatives of the HSP. In addition to the foregoing, HSP’s Personnel and Volunteers shall include the contractors and subcontractors and their respective shareholders, directors, officers, employees, agents, volunteers or other representatives;

  • Volunteers means GM or non-GM Canola plants, which have not been intentionally grown.

  • Entities means event and competition organisers/promoters/managers, land and track owners/managers/administrators/lessees, CAMS affiliated clubs, state and territory governments and insured listed in CAMS’ public/product/professional indemnity insurance policies and each of their related bodies corporate (including their related bodies corporate) and each of their organs and agencies, officers/president/directors/executives, employees, servants, agents, partners, providers, members, competitors, drivers, co-drivers, navigators, officials, crew members, pit crew, delegates, licence holders, representatives, commissions, committees, advisers, trustees, councils, panels, shareholders, volunteers, officials, appointees, delegated bodies and sponsors.

  • Designated Center means a State Development and Redevelopment Plan Center as designated by the State Planning Commission such as urban, regional, town, village, or hamlet.

  • Project Staff means the personnel of Contractor and Subcontractors who provide the Work.

  • Remaining Members has the meaning set forth in Section 11.2.

  • Volunteer firefighter means a firefighter whose position normally requires less than 600

  • Medical cannabis pharmacy means the same as that term is defined in Section 26-61a-102.

  • Hosting Partners means companies who entered into an agreement with CIPC in the areas of application management; application hosting, application service provision, and marketplace hosting are incorporated in this category.