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:
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.
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:
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.).
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.