One Care definition

One Care. A demonstration project among CMS, the State and managed care organizations for the coordination and delivery of covered Medicare, Medicaid and expanded services for Medicare-Medicaid enrollees in the Commonwealth of Massachusetts.
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One Care means One Care (BNSSG) C.I.C. – company number: 10355565
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One Care means ONE CARE Home and Community Support Services;
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Examples of One Care in a sentence

  • If a One Care plan offers to pay a non-network Hospital a rate equal to the amount allowed under original Medicare less any amount for graduate medical education for all Emergency and Post-Stabilization Services for all of the One Care plan’s enrollees, that non-network Hospital must accept the One Care plan’s rate offer as payment in full.

  • EOHHS will apply intelligent methodologies, to the extent approved by CMS, to assign Eligible Beneficiaries to a One Care plan.

  • This requirement does not prohibit a One Care plan from negotiating to pay any non-network Hospital at rates lower than original Medicare less any amount for graduate medical education for Emergency and Post-Stabilization Services.

  • Hospitals are not entitled to any payment from EOHHS, and may not claim such reimbursement for any services that are One Care plan-covered services or are otherwise reimbursable by the One Care plan.

  • Eligible Medicare-Medicaid Beneficiaries who do not select a One Care plan or who do not opt out of the Demonstration will be assigned to a One Care plan during Passive Enrollment.

  • Hospitals that provide medically necessary One Care plan-covered services, including Emergency and Post-Stabilization Services, qualify for payment solely by the One Care plan for services to Members enrolled with the One Care plan pursuant to contracts between the One Care plan and each contracting Hospital.

  • Individuals currently enrolled in PACE may not be passively enrolled into a One Care plan.

  • EOHHS and CMS reserve the right to adjust expenditures for services that are reimbursed at more than five (5%) percent above the average reimbursement rate of all One Care Plans.

  • If either Medicare or MassHealth provides more expansive services than the other program does for a particular condition, type of illness, or diagnosis, the One Care Plan must provide the most expansive set of services required by either program.

  • One Care plans will receive three monthly payments for each enrollee: one amount from CMS reflecting coverage of Medicare Parts A/B services, one amount from CMS reflecting coverage of Medicare Part D services, and a third amount from MassHealth reflecting coverage of Medicaid services.


More Definitions of One Care

One Care. A comprehensive managed care program implemented by EOHHS in collaboration with CMS for the purpose of delivering and coordinating all Medicare - and Medicaid-covered benefits for MassHealth Members eligible for both programs. Services are developed and delivered based on an Enrollee’s person-centered assessment and care plan.
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Related to One Care

  • Hospice Care means a coordinated program of active professional

  • Routine care means medical care which is not urgent or emergent in nature and can wait for a regularly scheduled physician appointment without risk of permanent damage to the patient’s life or health status. The condition requiring routine care is not likely to substantially worsen without immediate clinical intervention.

  • Respite care means care anticipated to be provided for a period of 28 days or less for the purpose of temporarily relieving a family member or other caregiver from his or her daily caregiv- ing duties.

  • Home care means care and treatment of an insured under a plan of care established, approved in writing and reviewed at least every 2 months by the attending physician, unless the attend- ing physician determines that a longer interval between reviews is sufficient, and consisting of one or more of the following:

  • Pharmacy care means medications prescribed by a licensed physician and any health-related services considered medically necessary to determine the need or effectiveness of the medications.

  • Acute care means a short course of intensive diagnostic and therapeutic services provided immediately following a work injury with a rapid onset of pronounced symptoms.

  • Child care means continuous care and supervision of five or more qualifying children that is:

  • Medical care means amounts paid for:

  • Day Care means the care, assistance, and supervision of an individual who does not stay overnight. Individuals receiving day care services are included in the licensed capacity of a home as described in OAR 411-360-0060.

  • Palliative care means medical service rendered to reduce or moderate temporarily the intensity of an otherwise stable medical condition, but does not include those medical services ren- dered to diagnose, heal or permanently alleviate or eliminate a medical condition.

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

  • Substitute care means the out-of-home placement of a child or young adult who is in the legal or physical custody and care of the Department.

  • Primary care giver" means a person who assumes the principal role of providing care and attention to a child.

  • Home care services means skilled or personal care

  • In Patient Care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.

  • Title IV-E Foster Care means a federal program authorized under §§ 472 and 473 of the Social

  • Shelter care means the temporary care of children in physically unrestricting facilities.

  • Day-care services means care of a child for a portion of the day which is less

  • Palliative and supportive care means care and support aimed mainly at lessening or controlling pain or symptoms; it makes no attempt to cure the Covered Person's terminal Illness or terminal Injury.

  • Foster care means substitute care furnished on a 24-hour-a-day basis to an eligible child in a licensed or approved facility by a person or agency other than the child’s parent or guardian but does not include care provided in a family home through an informal arrangement for a period of 20 days or less. Child foster care shall include but is not limited to the provision of food, lodging, training, education, supervision, and health care.

  • Long-term care services means services provided through the department of social and health services either in a hospital or skilled nursing facility, or in another setting under a home and community-based waiver authorized under 42 U.S.C. Sec. 1396n.

  • Health care means any of the following intended for use in the diagnosis, treatment, mitigation, or prevention of a human ailment or impairment:

  • Community support services means services authorized,

  • Standard fertility preservation services means procedure based upon current evidence-based standards of care established by the American Society for Reproductive Medicine, the American Society for Clinical Oncology, or other national medical associations that follow current evidence-based standards of care.

  • After-care means care, treatment and services provided a patient, as defined herein, on convalescent status or conditional release.

  • Continuum of care means a full range of economic, physical, psychological, social and support programs and services necessary to maintain or restore older individuals to their optimal environment.