Special Health Care Needs. Each MCP must have mechanisms in place to assess the quality and appropriateness of care furnished to children/members with special health care needs. The MCP must specify the mechanisms used in its annual submission of the QAPI program to ODJFS.
Special Health Care Needs. Enrollees including, at a minimum, those who have or are at increased risk to have chronic physical, developmental, or behavioral health condition(s); require an amount or type of services beyond those typically required for individuals of similar age; and may receive these services from an array of public and/or private providers across health, education and social systems of care. Executive Office of Health and Human Services (EOHHS) — The single State agency that is responsible for the administration of the MassHealth program, pursuant to M.G.L. c. 118E and Titles XIX and XXI of the Social Security Act, the § 1115 MassHealth Demonstration, this Demonstration under § 1115A, and other applicable laws and waivers. Federally-Qualified Health Center (FQHC) — An entity that has been determined by CMS to satisfy the criteria set forth in 42 U.S.C. § 1396d (1)(2)(B).
Special Health Care Needs. The Board and Association acknowledge that certain students with disabilities may be required to be educated in regular education classrooms. Such students may, as a result of their disabilities, require special care or medication during their attendance in the regular education classroom. It is the intent of the parties that persons who are assigned responsibility for providing necessary care or medication for such students shall be trained in the delivery of such care or medication. Trained non-teaching staff will be assigned to provide such care or medication. In the event that non-teaching staff are not available, voluntarily trained teaching staff may be required to provide such care on an emergency basis. Unless otherwise required by an IEP, medication for students with disabilities shall be administered in accordance with the District’s policy governing the administration of medication for students.
Special Health Care Needs. Enrollees with special health care needs must have direct access to a specialist, as appropriate for the individual's health care condition, as specified in 42 CFR 438.208(c)(4).
Special Health Care Needs. Children with or at increased risk for chronic physical, developmental, behavioral, or emotional conditions who also require health and related services of a type or amount beyond that required by children generally. Claim: Bill for services, a line item of service, or all services for one member. Clean Claim: A truthful, complete and accurate claim that does not have to be returned for additional information. Clinical Decision Support Tools: Tools that support informed clinical decision-making by presenting information in an integrated, interactive manner. Cold Call Marketing: Any unsolicited personal contact by the PIHP with a potential member for the purpose of marketing. Communication Materials: Communication materials designed to provide members or potential members with clear and concise information about the PIHP’s program, the PIHP’s network, and resources about the FCMH program. Community Based Health Organizations: Non-profit agencies providing community based health services. These organizations provide important health care services such as HealthCheck screenings, nutritional support, and family planning, targeting such services to high-risk populations. Comprehensive Initial Health Assessment: A comprehensive initial health assessment is required for all children in out-of-home care who are enrolled in the xxxxxx care medical home program and must occur within 30 days of the child’s enrollment in the PIHP. This assessment should be comprehensive with respect to the identification of possible acute and chronic physical health, behavioral/mental health, oral health, and developmental problems; and, must be in compliance with Wisconsin HealthCheck requirements. This assessment should include components of both developmental and behavioral/mental health screenings as indicated for each child based on his/her age and history, including any prior evaluations. This assessment should be performed by a clinician who is knowledgeable about the trauma-informed evaluation and treatment of children in out-of- home care.
Special Health Care Needs. AHCCCS has specified in its Quality Strategy certain populations with special health care needs including members enrolled in DDD, CRS and those receiving behavioral health services. The Contractor shall have in place a mechanism to identify and stratify all members with special health care needs [42 CFR 438.240(b)(4)]. The Contractor shall implement mechanisms to assess each member identified as having special health care needs, in order to identify any ongoing special conditions of the member which require a course of treatment, or regular care monitoring. The assessment mechanisms shall use appropriate health care professionals [42 CFR 438.208(c)(2)]. The Contractor shall share with other entities providing services to that member the results of its identification and assessment of that member’s needs so that those activities need not be duplicated [42 CFR 438.208(b)(3)]. For members with special health care needs determined to need a specialized course of treatment or regular care monitoring, the Contractor must have procedures in place to allow members to directly access a specialist (for example through a standing referral or an approved number of visits) as appropriate for the member’s condition and identified needs [42 CFR 438.208(c)(4)]. The Contractor shall have a methodology to identify providers willing to provide medical home services and make reasonable efforts to offer access to these providers. The American Academy of Pediatrics (AAP) describes care from a medical home as: • Accessible • Continuous • Coordinated • Family-centered • Comprehensive • Compassionate • Culturally effective The Contractor shall ensure that populations with ongoing medical needs, including but not limited to dialysis, radiation and chemotherapy, have coordinated, reliable, medically necessary transportation to ensure members arrive on-time for regularly scheduled appointments and are picked up upon completion of the entire scheduled treatment. See Section D, Paragraph 33, Appointment Standards.
Special Health Care Needs those children who have or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type and amount beyond that required by children generally. CHRONIC ILLNESS--a disease or condition of long duration (repeated inpatient hospitalizations, out of work or school at least three months within a twelve-month period, or the necessity for continuous health care on an ongoing basis), sometimes involving very slow progression and long continuance. Onset is often gradual and the process may include periods of acute exacerbation alternating with periods of remission. CLINICAL PEER--a physician or other health care professional who holds a non-restricted license in New Jersey and is in the same or similar specialty as typically manages the medical condition, procedure, or treatment under review. CNM OR CERTIFIED NURSE MIDWIFE--a registered professional nurse who is legally authorized under State law to practice as a nurse-midwife, and has completed a program of study and clinical experience for nurse-midwives or equivalent. CNP OR CERTIFIED NURSE PRACTITIONER--a registered professional nurse who is licensed by the New Jersey Board of Nursing and meets the advanced educational and clinical practice requirements beyond the two to four years of basic nursing education required of all registered nurses. CNS OR CLINICAL NURSE SPECIALIST--a person licensed to practice as a registered professional nurse who is licensed by the New Jersey State Board of Nursing or similarly licensed and certified by a comparable agency of the state in which he/she practices. COLD CALL MARKETING-any unsolicited personal contact with a potential enrollee by an employee or agent of the contractor for the purpose of influencing the individual to enroll
Special Health Care Needs. Characteristics of an Enrollee who:
Special Health Care Needs. Children with or at increased risk for chronic physical, developmental, behavioral, or emotional conditions who also require health and related services of a type or amount beyond that required by children generally. Chronic Illness & Disability Payment System (CDPS): A diagnostic classification system used to make health-based capitated payments for Medicaid beneficiaries. Claim: Xxxx for services, a line item of service, or all services for one member. Clean Claim: A truthful, complete and accurate claim that does not have to be returned for additional information. Clinical Decision Support Tools: Tools that support informed clinical decision-making by presenting information in an integrated, interactive manner. Cold Call Marketing: Any unsolicited personal contact by the PIHP with a potential member for the purpose of marketing. Community Based Health Organizations: Non-profit agencies providing community based health services. These organizations provide important health care services such as HealthCheck screenings, nutritional support, and family planning, targeting such services to high-risk populations. Complaint: A general term used to describe a member’s oral expression of dissatisfaction with the PIHP. It can include access problems such as difficulty getting an appointment or receiving appropriate care; quality of care issues such as long waiting times in the reception area of a provider’s office, rude providers or provider staff; or denial or reduction of a service. A complaint may become a grievance or appeal if it is subsequently submitted in writing. Comprehensive Initial Health Assessment: A comprehensive initial health assessment is required for all children in out-of-home care who are enrolled in the xxxxxx care medical home program and must occur within 30 days of the child’s enrollment in the PIHP. This assessment should be comprehensive with respect to the identification of possible acute and chronic physical health, behvavioral/mental health, oral health, and developmental problems; and, must be in compliance with Wisconsin HealthCheck requirements. This assessment should include components of both developmental and behavioral/mental health screenings as indicated for each child based on his/her age and history, including any prior evaluations. This assessment should be performed by a clinician who is knowledgeable about the trauma-informed evaluation and treatment of children in out-of- home care. Comprehensive HealthCheck/EPSDT: Hea...
Special Health Care Needs. For all Medicaid eligible populations receiving services under this Contract, the Contractor shall:
