Mountain Health Trust definition

Mountain Health Trust the name of West Virginia’s Medicaid mandatory managed care program for TANF and TANF-related children and adults who are eligible to participate in managed care. National Committee for Quality Assurance (NCQA) – the independent organization that accredits MCOs, managed behavioral health organizations, and accredits and certifies Disease Management programs. Non-Emergency Services - any care or services that are not considered emergency services as defined in this Contract. This does not include any services furnished in a hospital emergency department that are required to be provided as an appropriate medical screening examination or stabilizing examination and treatment under section 1867 of the Social Security Act. Open Panel - PCPs who are accepting new patients for the MCO. 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).” 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 recipient's life, beginning with a neonatal examination, up to the age at which an individual is no longer eligible for EPSDT services. Post-stabilization Services – services subsequent to...

Mountain Health Trust. The name of West Virginia’s Medicaid mandatory managed care program for TANF and TANF-related children and adults who are eligible to participate in managed care. National Committee for Quality Assurance (NCQA) – the independent organization that accredits MCOs, managed behavioral health organizations, and accredits and certifies Disease Management programs. Non-Emergency Services - Any care or services that are not considered emergency services as defined in this Contract. This does not include any services furnished in a hospital emergency department that are required to be provided as an appropriate medical screening examination or stabilizing examination and treatment under section 1867 of the Social Security Act.

Mountain Health Trust the name of West Virginia’s Medicaid mandatory managed care program for TANF and TANF-related children and adults who are eligible to participate in managed care. National Committee for Quality Assurance (NCQA) – the independent organization that accredits MCOs, managed behavioral health organizations, and accredits and certifies Disease Management programs. Non-Emergency Services - any care or services that are not considered emergency services as defined in this Contract. This does not include any services furnished in a hospital emergency department that are required to be provided as an appropriate medical screening examination or stabilizing examination and treatment under section 1867 of the Social Security Act. Non-Participating Provider - a doctor, hospital, facility, or other licensed health care professional who has not signed a contract or had a contract signed on his/her behalf agreeing to provide services to the MCO’s members. Open Panel - PCPs who are accepting new patients for the MCO. Overpayment - money paid to a Provider by an MCO for a claim or claims, which exceeds the amount which should have been paid by the MCO.

Examples of Mountain Health Trust in a sentence

• Under Mountain Health Trust and West Virginia Health Bridge, the MCO must provide tobacco cessation benefits for pregnant women, adults, and children respectively.

• Medicaid beneficiaries who lose eligibility for the West Virginia Mountain Health Trust or West Virginia Health Bridge programs and regain eligibility within one year will be automatically re- enrolled in the same MCO in which they were previously enrolled.

• Written MCO responses to a Request for Quotes and the Mountain Health Trust and West Virginia Health Bridge Medicaid MCO Provider Application, (including the Department’s written responses to oral and written questions, appendices, amendments, and addenda) and/or to other formal requests by the Department for information and documents are hereby incorporated by reference as part of the Contract having the full force and effect as if specifically contained herein.

• Written MCO responses to a Request for Quotes and the Mountain Health Trust (MHT) and West Virginia Health Bridge (WVHB) Medicaid MCO Provider Application, (including BMS’ written responses to oral and written questions, appendices, amendments, and addenda) and/or to other formal requests by BMS’ for information and documents are hereby incorporated by reference as part of the Contract having the full force and effect as if specifically contained herein.

• Mountain Health Trust (MHT) – the name of West Virginia’s Medicaid mandatory managed care program for Temporary Assistance to Needy Families (TANF) and TANF-related children and adults who are eligible to participate in managed care.

• Written MCO responses to a Request for Proposals [BMS2000000002] (hearafter “RFP”) and the Mountain Health Trust (MHT) Medicaid MCO Provider Application, (including BMS’ written responses to oral and written questions, appendices, amendments, and addenda) and/or to other formal requests by BMS for information and documents are hereby incorporated by reference as part of the Contract having the full force and effect as if specifically contained herein.

• The MCO should refer to the fee-for- service Medicaid provider manuals available on the WV DHHR website for an explanation of service limitations under the Mountain Health Trust or West Virginia Health Bridge.

• The MCO should refer to the fee-for-service Medicaid provider manuals available on the WV DHHR website for an explanation of service limitations under the Mountain Health Trust or West Virginia Health Bridge.

• The WV Bureau for Medical Services (Medicaid) currently operates Mountain Health Trust (MHT), the Medicaid managed care program that has operated in the State of West Virginia since 1996.

• West Virginia Medicaid’s managed care program began in 1996 and is referred to as Mountain Health Trust (MHT).

More Definitions of Mountain Health Trust

Mountain Health Trust the name of West Virginia’s Medicaid mandatory managed care program for TANF and TANF-related children and adults who are eligible to participate in managed care. National Committee for Quality Assurance (NCQA) – the independent organization that accredits MCOs, managed behavioral health organizations, and accredits and certifies Disease Management programs. Non-Emergency Services - Any care or services that are not considered emergency services as defined in this Contract. This does not include any services furnished in a hospital emergency department that are required to be provided as an appropriate medical screening examination or stabilizing examination and treatment under section 1867 of the Social Security Act. Open Panel - PCPs who are accepting new patients for the MCO.

Mountain Health Trust the name of West Virginia’s Medicaid mandatory managed care program for TANF and TANF-related children and adults who are eligible to participate in managed care. National Committee for Quality Assurance (NCQA) – the independent organization that accredits MCOs, managed behavioral health organizations, and accredits and certifies Disease Management programs.