Massachusetts Health Information Highway. (Mass HIway) –– Massachusetts’ statewide electronic health information exchange. MassHealth – the medical assistance or benefit programs administered by EOHHS. MassHealth ACO Program – collectively, MassHealth’s Accountable Care Partnership Plans, MassHealth’s Primary Care ACOs, and MassHealth’s MCO-Administered ACOs. XxxxXxxxxx Executive Director – one of the Contractor’s Key Personnel roles, as described in
Massachusetts Health Information Highway. (Mass HIway) –– Massachusetts’ statewide electronic health information exchange. Material Subcontractor – any entity from which the Contractor procures, re-procures, or proposes to subcontract with, for the provision of all, or part, of its responsibilities under this Contract for Care Delivery, Care Coordination and Care Management, data analysis, enrollee services and/or risk stratification, and any other Contract responsibilities as specified by EOHHS. Medicaid – see MassHealth. Medically Necessary – in accordance with 130 CMR 450.204, Medically Necessary services are those services (1) which are reasonably calculated to prevent, diagnose, prevent the worsening of, alleviate, correct, or cure conditions in the Enrollee that endanger life, cause suffering or pain, cause physical deformity or malfunction, threaten to cause or to aggravate a disability, or result in illness or infirmity; and (2) for which there is no other medical service or site of service, comparable in effect, available, and suitable for the Enrollee requesting the service, that is more conservative or less costly. Medically Necessary services must be of a quality that meets professionally recognized standards of health care, and must be substantiated by records including evidence of such medical necessity and quality. Medicare ACO – accountable care contracts administered by the Medicare program, including the Medicare Shared Savings Program, the Pioneer ACO program, and the CMS Next Generation ACO program. Member – a person determined by EOHHS to be eligible for MassHealth. Mobile Crisis Intervention (MCI) – services provided by the ESPs listed in Appendix C to individuals under age 21. MCI services include a short-term mobile, on-site, and face-to-face therapeutic service provided for youth experiencing a behavioral health crisis and for the purpose of identifying, assessing, treating, and stabilizing the situation and reducing the immediate risk of danger to the youth or others consistent with the youth’s risk management/safety plan, if any. Mobile Crisis Intervention utilizes a multidisciplinary model, with both professional and paraprofessional staff. Services are available 24 hours a day, 7 days a week. New Enrollee – any Enrollee enrolled by EOHHS pursuant to Section 2.5 who has not been previously enrolled in the Contractor within the preceding 12 months, or within another timeframe as determined by EOHHS.
