Enrollees with special health care needs definition

Enrollees with special health care needs means enrollees having chronic and disabling conditions and the conditions:
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Enrollees with special health care needs means enrollees 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 or amount beyond that required by adults and children generally.
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Enrollees with special health care needs. ((—))((Per- sons)) means enrollees having chronic and disabling condi- tions((, including persons with special health care needs that meet all of the following)) and the conditions:
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Examples of Enrollees with special health care needs in a sentence

  • Enrollees with special health care needs must have direct access to a specialist as appropriate for the individual's health care condition.

  • 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 C.F.R. §438.208(c)(4).

  • 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 C.F.R. 438.208(c)(4).

  • The transition of care team will consist of skilled personnel with extensive knowledge and experience transitioning Enrollees with 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).

  • The team will consist of skilled personnel with extensive knowledge and experience transitioning Enrollees with special health care needs.

  • Identification of Enrollees with special health care needs and processes in place to assure adequate, ongoing risk assessments, treatment plans developed with the Enrollee’s participation in consultation with any specialists caring for the Enrollee, to the extent possible, the appropriateness and quality of care, and if approval is required, such approval occurs in a timely manner.

  • The DEPARTMENT’s Health Program Representatives are responsible to forward information, including risk assessments, that identify Enrollees with special health care needs and limited language proficiency needs to the CONTRACTOR in a timely manner, coinciding with the daily Eligibility Transmission as much as possible.

  • At least every two years, the CONTRACTOR in conjunction with the DEPARTMENT will survey a sample of Enrollees with special health care needs using a national consumer assessment questionnaire to evaluate their perceptions of services they have received.

  • The CONTRACTOR individual with knowledge of coordination of care for Enrollees with special health care needs will make a good faith effort to contact Enrollees within ten working days after identification to begin coordination of health care needs, if necessary.


More Definitions of Enrollees with special health care needs

Enrollees with special health care needs means))- Persons having chronic and disabling conditions, including persons with special health care needs that meet all of the fol- lowing conditions:
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Related to Enrollees with special health care needs

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • Health care facility or "facility" means hospices licensed

  • Licensed health care practitioner means a physician, as defined in Section 1861(r)(1) of the Social Security Act, a registered professional nurse, licensed social worker or other individual who meets requirements prescribed by the Secretary of the Treasury.

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • Behavioral health provider means a person licensed under 34 chapter 18.57, 18.57A, 18.71, 18.71A, 18.83, 18.205, 18.225, or 18.79

  • Respiratory care practitioner means a person who is

  • Health Care Operations shall have the meaning given to such term under the HIPAA 2 Privacy Rule in 45 CFR § 164.501.

  • Community mental health center or "CMHC" means a facility offering a comprehensive array of community-based mental health services, including but not limited to, inpatient treatment, outpatient treatment, partial hospitalization, emergency care, consultation and education; and, certain services at the option of the center, including, but not limited to, prescreening, rehabilitation services, pre-care and aftercare, training programs, and research and evaluation.