Common use of Alternative Formats Clause in Contracts

Alternative Formats. provision of Enrollee information in a format that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. Examples of Alternative Formats shall include, but not be limited to, Braille, large font, audio tape, video tape, and Enrollee Information read aloud to an Enrollee by an Enrollee services representative. Alternative Payment Methodologies (APMs) – as further specified by EOHHS, methods of payment, not based on traditional fee-for-service methodologies, that compensate providers for the provision of health care or support services and tie payments to providers to quality of care and outcomes. These include, but are not limited to, shared savings and shared risk arrangements, bundled payments for acute care episodes, bundled payments for chronic diseases, and global payments. Payments based on traditional fee-for-service methodologies shall not be considered Alternative Payment Methodologies. Appeals – EOHHS processes for Members to request review of certain actions pursuant to 130 CMR 610.000. Behavioral Health Director – one of the Contractor’s Key Personnel roles, as described in Section 2.4.A. Behavioral Health Services (or BH Services) - mental health and substance use disorder services that are TCOC Included Services and are set forth in detail in Appendix A. Behavioral Health Vendor -- the entity with which EOHHS contracts to administer EOHHS’s Behavioral Health program for Members enrolled with the Contractor. BH – Behavioral Health. See Behavioral Health Services. BH CPs – Behavioral Health Community Partners. Blue Cross Blue Shield’s Alternative Quality Contract – Blue Cross Blue Shield of Massachusetts’ global payment model. Budgets and Budget Narratives – information provided by the Contractor about the Contractor’s planned spending of DSRIP payments, as described in Section 5.1.B. Business Associate – a person, organization or entity meeting the definition of a “business associate” for purposes of the Privacy and Security Rules (45 CFR §160.103). Care Coordinator – a provider-based clinician or other trained individual who is employed or contracted by the Contractor or an Enrollee’s PCP. The Care Coordinator is accountable for providing care coordination activities, which include ensuring appropriate referrals and timely two-way transmission of useful patient information; obtaining reliable and timely information about services other than those provided by the PCP; participating in the Enrollee’s Comprehensive Assessment, if any; and supporting safe transitions in care for Enrollees moving between settings in accordance with the Contractor’s Transitional Care Management program. The Care Coordinator may serve on one or more care teams, and coordinates and facilitates meetings and other activities of those care teams. Care Management – the provision of person-centered, coordinated activities to support Enrollees’ goals as described in Section 2.3.E.

Alternative Formats. provision of Enrollee information in a format that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. Examples of Alternative Formats shall include, but not be limited to, Braille, large font, audio tape, video tape, and Enrollee Information read aloud to an Enrollee by an Enrollee services representative. Alternative Payment Methodologies (APMs) – as further specified by EOHHS, methods of payment, not based on traditional fee-for-service methodologies, that compensate providers for the provision of health care or support services and tie payments to providers to quality of care and outcomes. These include, but are not limited to, shared savings and shared risk arrangements, bundled payments for acute care episodes, bundled payments for chronic diseases, and global payments. Payments based on traditional fee-for-service methodologies shall not be considered Alternative Payment Methodologies. Appeals – EOHHS processes for Members to request review of certain actions pursuant to 130 CMR 610.000. Behavioral Health Director – one of the Contractor’s Key Personnel roles, as described in Section 2.4.A. Behavioral Health Services (or BH Services) - mental health and substance use disorder services that are TCOC Included Services and are set forth in detail in Appendix A. Behavioral Health Vendor -- the entity with which EOHHS contracts to administer EOHHS’s Behavioral Health program for Members enrolled with the Contractor. BH – Behavioral Health. See Behavioral Health Services. BH CPs – Behavioral Health Community Partners. Blue Cross Blue Shield’s Alternative Quality Contract – Blue Cross Blue Shield of Massachusetts’ global payment model. Budgets and Budget Narratives – information provided by the Contractor about the Contractor’s planned spending of DSRIP payments, as described in Section 5.1.B. Business Associate – a person, organization or entity meeting the definition of a “business associate” for purposes of the Privacy and Security Rules (45 CFR §160.103). Care Coordinator – a provider-based clinician or other trained individual who is employed or contracted by the Contractor or an Enrollee’s PCP. The Care Coordinator is accountable for providing care coordination activities, which include ensuring appropriate referrals and timely two-way transmission of useful patient information; obtaining reliable and timely information about services other than those provided by the PCP; participating in the Enrollee’s Comprehensive Assessment, if any; and supporting safe transitions in care for Enrollees moving between settings in accordance with the Contractor’s Transitional Care Management program. The Care Coordinator may serve on one or more care teams, and coordinates and facilitates meetings and other activities of those care teams. Care Management – the provision of person-centered, coordinated activities to support Enrollees’ goals as described in Section 2.3.E.5.1.B.