Common use of Coverage Type Clause in Contracts

Coverage Type. a scope of medical services, other benefits, or both, that are available to members who meet specific MassHealth eligibility criteria. EOHHS’s current Coverage Types with Members who may be enrolled with the Contractor are: Standard, Family Assistance, CarePlus and CommonHealth. See 130 CMR 450.105 for an explanation of each Coverage Type. Covered Entity – shall have the meaning given to this term in the Privacy and Security Rules. Cultural and Linguistic Competence – competence, understanding, and awareness with respect to Culturally and Linguistically Appropriate Services. Customer Service Center (CSC) Vendor – EOHHS’s enrollment broker that provides Members with a single point of access to a wide range of customer services, including enrolling Members into MCOs and the PCC Plan. DCF – the Massachusetts Department of Children and Families. DDS – the Massachusetts Department of Developmental Services. Department of Mental Health (DMH) – the department within the Massachusetts Executive Office of Health and Human Services designated as the Commonwealth’s mental health authority pursuant to M.G.L. c. 19 and DPH – the Massachusetts Department of Public Health. DTA – the Massachusetts Department of Transitional Assistance. DYS – the Massachusetts Department of Youth Services. Digital Quality Measures (dQMs) – quality measures expressed in a digital format using standardized language and data definitions that enable sharing of the specified measure electronically between systems. dQMs are Discharge Planning – the evaluation of an Enrollee’s medical and Behavioral Health care needs and coordination of any other support services in order to arrange for safe and appropriate care and living situation after discharge from one care setting (e.g., acute hospital, inpatient behavioral health facility) to another care setting (e.g., rehabilitation hospital, group home), including referral to and coordination of appropriate services. Disease Management – the Contractor’s ongoing services and assistance for specific disease and/or conditions. Services include specific interventions, education and outreach targeted to Enrollees with, or at risk for, these diseases or conditions. Division of Insurance (DOI) – The Massachusetts Division of Insurance. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) – the delivery of health care services to MassHealth Standard and CommonHealth Members under the age of 21, pursuant to 42 USC 1396d(a)(4), 42 CFR Part 441, Subpart B, 130 CMR 450.140-149 and § 1115 Medicaid Research and Demonstration Waiver. Effective Date of Disenrollment – up to 11:59 p.m. on the last day, as determined by EOHHS, on which the Contractor is responsible for providing the activities described in this Contract to an Enrollee, as further defined by EOHHS. Effective Date of Enrollment – as of 12:01 a.m. on the first day on which the Contractor is responsible for providing the activities described in this Contract to an Enrollee, as further defined by EOHHS. Electronic Clinical Quality Measure (eCQM) – quality measures expressed in a digital format using standardized language and data definitions that enable sharing of the specified measure electronically between systems. eCQMs were originally developed for the Centers for Medicare & Medicaid Services and are designed for eligible providers or hospitals and primarily use EHR data for calculating results. Electronic Clinical Data System (ECDS) – the network of data structured such that automated quality measurement queries can be consistently and reliably executed. Data systems that may be eligible for ECDS reporting include, but are not limited to, administrative claims, clinical registries, health information exchanges, immunization information systems, disease/case management systems and electronic health records. Electronic Health Record (EHR) – A digital version of a patient's paper chart. EHRs are real-time, patient- centered records that make information available instantly and securely to authorized users, often including a patient's medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and/or laboratory and test results. EHR systems are able to share patient information with other authorized health care providers and organizations. Eligible Clinicians – Eligible clinician means “eligible professional” as defined in section 1848(k)(3) of the Social Security Act, as identified by a unique TIN and NPI combination and, includes any of the following:

Coverage Type. a scope of medical services, other benefits, or both, that are available to members who meet specific MassHealth eligibility criteria. EOHHS’s current Coverage Types with Members who may be enrolled with the Contractor are: Standard, Family Assistance, CarePlus and CommonHealth. See 130 CMR 450.105 for an explanation of each Coverage Type. Covered Entity – shall have the meaning given to this term in the Privacy and Security Rules. Cultural and Linguistic Competence – competence, understanding, and awareness with respect to Culturally and Linguistically Appropriate Services. Customer Service Center (CSC) Vendor – EOHHS’s enrollment broker that provides Members with a single point of access to a wide range of customer services, including enrolling Members into MCOs and the PCC Plan. DCF – the Massachusetts Department of Children and Families. DDS – the Massachusetts Department of Developmental Services. Department of Mental Health (DMH) – the department within the Massachusetts Executive Office of Health and Human Services designated as the Commonwealth’s mental health authority pursuant to M.G.L. c. 19 and DPH – the Massachusetts Department of Public Health. DTA – the Massachusetts Department of Transitional Assistance. DYS – the Massachusetts Department of Youth Services. Digital Quality Measures (dQMs) – quality measures expressed in a digital format using standardized language and data definitions that enable sharing of the specified measure electronically between systems. dQMs are developed for HEDIS measure reporting. Discharge Planning – the evaluation of an Enrollee’s medical and Behavioral Health care needs and coordination of any other support services in order to arrange for safe and appropriate care and living situation after discharge from one care setting (e.g., acute hospital, inpatient behavioral health facility) to another care setting (e.g., rehabilitation hospital, group home), including referral to and coordination of appropriate services. Disease Management – the Contractor’s ongoing services and assistance for specific disease and/or conditions. Services include specific interventions, education and outreach targeted to Enrollees with, or at risk for, these diseases or conditions. Division of Insurance (DOI) – The Massachusetts Division of Insurance. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) – the delivery of health care services to MassHealth Standard and CommonHealth Members under the age of 21, pursuant to 42 USC 1396d(a)(4), 42 CFR Part 441, Subpart B, 130 CMR 450.140-149 and § 1115 Medicaid Research and Demonstration Waiver. Effective Date of Disenrollment – up to 11:59 p.m. on the last day, as determined by EOHHS, on which the Contractor is responsible for providing the activities described in this Contract to an Enrollee, as further defined by EOHHS. Effective Date of Enrollment – as of 12:01 a.m. on the first day on which the Contractor is responsible for providing the activities described in this Contract to an Enrollee, as further defined by EOHHS. Electronic Clinical Quality Measure (eCQM) – quality measures expressed in a digital format using standardized language and data definitions that enable sharing of the specified measure electronically between systems. eCQMs were originally developed for the Centers for Medicare & Medicaid Services and are designed for eligible providers or hospitals and primarily use EHR data for calculating results. Electronic Clinical Data System (ECDS) – the network of data structured such that automated quality measurement queries can be consistently and reliably executed. Data systems that may be eligible for ECDS reporting include, but are not limited to, administrative claims, clinical registries, health information exchanges, immunization information systems, disease/case management systems and electronic health records. Electronic Health Record (EHR) – A digital version of a patient's paper chart. EHRs are real-time, patient- patient-centered records that make information available instantly and securely to authorized users, often including a patient's medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and/or laboratory and test results. EHR systems are able to share patient information with other authorized health care providers and organizations. Eligible Clinicians – Eligible clinician means “eligible professional” as defined in section 1848(k)(3) of the Social Security Act, as identified by a unique TIN and NPI combination and, includes any of the following: