Common use of Definitions and Acronyms Clause in Contracts

Definitions and Acronyms. ‌ This contract is between the Wisconsin Department of Health Services (the Department) and the Health Maintenance Organization (HMO) participating in the State of Wisconsin BadgerCare Plus and/or Medicaid SSI programs. These programs are approved by the Secretary of the United States Department of Health and Human Services pursuant to the provisions of the Social Security Act. An HMO is an insurer offering comprehensive health care services delivered by providers. These providers may be both employees and partners of the HMO, or they may have entered into a referral or contractual agreement with the HMO for the purpose of providing contract-related services for enrolled members. HMOs should work with providers for the further specific purpose of promoting coordination and continuity of preventive health services and other medical care related to behavioral health, emergency care, and social determinants of health. In exchange for making contract-covered services available to enrolled members, the HMO will receive periodic fixed payments from the Department. The HMO is required to hold a certificate of authority to do business in Wisconsin; a separate certificate of authority must be submitted for each contract the HMO intends to enter into with the Medicaid program. This requirement applies to HMOs offering multiple product lines and doing business under another name. The HMO is not required to contract for both programs, and if they are not contracted for both, only the provisions applicable to their program apply. The HMO does herewith agree:

Definitions and Acronyms. ‌ Amend the first paragraph to read: This contract is between the Wisconsin Department of Health Services (the Department) and the Health Maintenance Organization (HMO) participating in the State of Wisconsin BadgerCare Plus and/or Medicaid SSI programs. These programs are approved by the Secretary of the United States Department of Health and Human Services pursuant to the provisions of the Social Security Act. An HMO is an insurer offering comprehensive health care services delivered by providers. These providers may be both employees and partners of the HMO, or they may have entered into a referral or contractual agreement with the HMO for the purpose of providing contract-related services for enrolled members. HMOs should work with providers for the further specific purpose of promoting coordination and continuity of preventive health services and other medical care related to behavioral health, emergency care, and social determinants of health. In exchange for making contract-covered services available to enrolled members, the HMO will receive periodic fixed payments from the Department. The HMO is required to hold a certificate of authority to do business in Wisconsin; a separate certificate of authority must be submitted for each contract the HMO intends to enter into with the Medicaid program. This requirement applies to HMOs offering multiple product lines and doing business under another name. The HMO is not required to contract for both programs, and if they are not contracted for both, only the provisions applicable to their program apply. The HMO does herewith agree: