Common use of Care Plan Clause in Contracts

Care Plan. An Enrollee-centered, goal-oriented, culturally relevant, and logical, written plan of care with a service plan component, if necessary, that assures that the Enrollee receives, to the extent applicable, medical, medically-related, social, behavioral, and necessary Covered Services, including long-term services and supports, in a supportive, effective, efficient, timely and cost-effective manner that emphasizes prevention and continuity of care. Center for Medicare and Medicaid Innovation (CMMI) - Established by Section 3021 of the Affordable Care Act, CMMI was established to test innovative payment and service delivery models to reduce program expenditures under Medicare and Medicaid while preserving or enhancing the quality of care furnished to individuals under such titles. CMS - Centers for Medicare & Medicaid Services. Comprehensive Third Party Insurance - As defined by the State’s HFS Bureau of Collections, major medical coverage that at least includes physician and hospital services. Consumer Assessment of Healthcare Providers and Systems (CAHPS) - Beneficiary survey tool developed and maintained by the Agency for Healthcare Research and Quality to support and promote the assessment of beneficiary experiences with health care. Contract Management Team - A group of CMS and HFS representatives responsible for overseeing the Three-way Contract. Covered Services - The set of Medicare and Medicaid services the Demonstration Plans are required to offer. Cultural Competence - Understanding those values, beliefs, and needs that are associated with age, gender identity, sexual orientation, and/or racial, ethnic, or religious backgrounds. Cultural Competence also includes a set of competencies, which are required to ensure appropriate, culturally sensitive health care to persons with congenital or acquired disabilities. Demonstration Plan - A managed care organization that enters into a Three-way Contract with CMS and the State to provide Covered Services and any chosen flexible benefits and be accountable for providing integrated care to Medicare-Medicaid Enrollees. Disenrollment – The process by which an Enrollee’s participation in the Demonstration is terminated. Reasons for disenrollment include death, loss of eligibility for the Demonstration, or choice not to participate in the Demonstration. Disenrollment at the direction of the Enrollee may also be referred to as “opt-out.”