Bureau of TennCare. The division of the Tennessee Department of Finance and Administration (the single state Medicaid agency) that administers the TennCare program. For the purposes of this Agreement, Bureau of TennCare shall mean the State of Tennessee and its representatives. Business Day – Monday through Friday, except for State of Tennessee holidays. CAHPS (Consumer Assessment of Healthcare Providers and Systems) – A comprehensive and evolving family of surveys that ask consumers and patients to evaluate various aspects of health care.
Bureau of TennCare. When a LEA suspects that a TennCare enrolled child may have a particular medical or behavioral health problem and the child is up-to-date on his/her EPSDT screenings, the LEA should refer the child to the child's PCP for an EPSDT inter-periodic screening. It should be noted that both the periodic nor and the inter-periodic screening are only a portion of the complete IDEA evaluation. The results of the medical evaluation may be incorporated into the LEA’s evaluation of the child with the permission of the Parents of legal guardians. However, the LEA must complete the evaluation process within the timelines promulgated by DOE in Rules, Regulations and Minimum Standards for the Governance of Tennessee Public Schools. This provision does not alter the timeliness requirements for EPSDT screenings by which the MCCs are bound. Although the PCPs are not parties to this Agreement, TennCare is the Participating Agency with oversight of PCPs through its contracts with the MCCs. Therefore, whenever a PCP is designated herein to carry out a specific function or is tasked with a specific obligation, it is understood by the parties hereto that TennCare, through its MCCs, shall be responsible for the PCP performing such function or obligation.
Bureau of TennCare. The division of the Tennessee Department of Finance and Administration (the single state Medicaid agency) that administers the TennCare program. For the purposes of this Agreement, Bureau of TennCare shall mean the State of Tennessee and its representatives. Business Day – Monday through Friday, except for State of Tennessee holidays. CAHPS (Consumer Assessment of Healthcare Providers and Systems) – A comprehensive and evolving family of surveys that ask consumers and patients to evaluate various aspects of health care. Capitation Payment – The fee that is paid by TENNCARE to the CONTRACTOR for each member covered by this Agreement, whether or not the member utilizes services during the payment period. The CONTRACTOR is at financial risk as specified in Section 3 of this Agreement for the payment of services incurred in excess of the amount of the capitation payment. “Capitation Payment” includes Base Capitation Rate payments, Priority Add-on rate payments, and State Only and Judicials rate payments, unless otherwise specified. Capitation Rate – The amount established by TENNCARE pursuant to the methodology described in Section 3 of this Agreement, including the base capitation rate, priority add-on rate, and State Only and Judicials rate. Centers of Excellence (CXX) for AIDS – Integrated networks designated by the State as able to provide a standardized and coordinated delivery system encompassing a range of services needed by TennCare enrollees with HIV or AIDS. Centers of Excellence (CXX) for Behavioral Health – COEs that provide a limited range of direct services to children in and at risk for state custody (i.e., not just DCS children/youth). These services are to augment the existing service system. Therefore, COEs for Behavioral Health typically only provide services where there is sufficient complexity in the case to warrant the CXX for Behavioral Health resources and/or all other means to provide the service in the TennCare network have been exhausted. CFR – Code of Federal Regulations. Clean Claim – A claim received by the CONTRACTOR for adjudication that requires no further information, adjustment, or alteration by the provider of the services in order to be processed and paid by the CONTRACTOR. Clinical Practice Guidelines – Systematically developed tools or standardized specifications for care to assist practitioners and patient decisions about appropriate care for specific clinical circumstances. Such guidelines are typically developed throug...
Bureau of TennCare. The division of the Tennessee Department of Finance and Administration (the single state Medicaid agency) that administers TennCare. For the purposes of the State Contract, the Agreement and this Appendix, Bureau of TennCare shall mean the State of Tennessee and its representatives.
Bureau of TennCare. The division of the Tennessee Department of Finance and Administration (the single state Medicaid agency) that administers the TennCare program. For the purposes of this Agreement, Bureau of TennCare shall mean the State of Tennessee and its representatives. Business Day – Monday through Friday, except for State of Tennessee holidays. CAHPS (Consumer Assessment of Healthcare Providers and Systems) – A comprehensive and evolving family of surveys that ask consumers and patients to evaluate various aspects of health care. Capitation Payment – The fee that is paid by TENNCARE to the CONTRACTOR for each member covered by this Agreement. The CONTRACTOR is at financial risk as specified in Section 3 of this Agreement for the payment of services incurred in excess of the amount of the capitation payment. “Capitation Payment” includes Base Capitation Rate payments and Priority Add-on rate payments, unless otherwise specified. Capitation Rate – The amount established by TENNCARE pursuant to the methodology described in Section 3 of this Agreement, including the base capitation rates and priority add-on rate. Care Coordination Team – If an MCO elects to use a care coordination team, the care coordination team shall consist of a care coordinator and specific other persons with relevant expertise and experience who are assigned to support the care coordinator in the performance of care coordination activities for a CHOICES member as specified in this Agreement and in accordance with Section 2.9.6.
