Notice of Action shall have the meaning set forth in Section 7.1C.
Notice of Action has the meaning set forth in (S) 8(b).
Notice of Action means written notification to an Enrollee and written or verbal notification to a Provider when applicable, of an Action that will be taken by the Contractor. Notice of Appeal Resolution means written notification to an Enrollee, and a Provider when applicable, of the Contractor’s resolution of an Appeal. Other Disclosing Entity means any other Medicaid disclosing entity and any entity that does not participate in Medicaid but is required to disclose certain ownership and control information because of participation in any of the programs established under Title V, XVIII, or XX of the Social Security Act. This includes:
Examples of Notice of Action in a sentence
The MCOP shall maintain a written record that the criteria were met, or if not met, the MCOP shall maintain documentation that a Notice of Action was issued in accordance with OAC 5160-58-08.4. In accordance with OAC rule 5160-3-14, the preadmission screening and resident review (PASRR) process must be completed before a level of care determination can be issued.
While the MCO may offer the ODM standardized appeal form for member use (e.g., as an attachment to a Notice of Action or as a form available on the MCO website), the MCO must not reject an appeal on the basis that the member did not use or complete the ODM standardized appeal form and must document the member appeal onto the ODM standardized appeal form.
More Definitions of Notice of Action
Notice of Action means a Denial, Termination, or Reduction of Service Notice (DTR) or other Action as defined in section 2.3.
Notice of Action means a formal communication of any action, as defined above and consistent with 42 CFR 438.404 and 438.10.
Notice of Action has the meaning set forth in Section 11.02(ii) below.
Notice of Action. As defined in OAC rule 5160-26-08.4, the written notice an MCO must provide to members when an MCO adverse benefit determination has occurred or will occur. Ohio Children’s Initiative Child and Adolescent Needs and Strengths (CANS) – A multiple purpose information integration tool developed for children's services to support decision-making, including level of care and service planning, facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services. CANS is designed to be the output of an assessment process. The Brief and Comprehensive CANS assessments are designed to be the output of a functional assessment process. Ohio Resilience through Integrated Systems and Excellence (OhioRISE) – A program designed to provide, manage, and coordinate comprehensive behavioral health care for children with serious or complex behavioral health needs who are at risk of involvement or are involved in multiple child-serving systems. Eligibility for OhioRISE and enrollment in the OhioRISE Plan is determined by ODM. OhioRISE Plan – The prepaid inpatient health plan contracted with ODM to administer the OhioRISE program. Oral Interpretation – Services provided to an eligible individual or member with limited English proficiency to ensure that the eligible individual or member receives MCO information that is orally translated into their primary language. Pending Member – As defined in OAC rule 5160-26-01, an eligible individual who has selected or been assigned to an MCO but whose MCO membership is not yet effective. Performance Improvement Project (PIP) – A type of quality improvement (QI) project in which MCO works collaboratively with the ODM-contracted clinical lead, QI lead, and recruited practices to improve an outcome. The MCO conducts at least one PIP per year in a topic chosen by ODM. PIPs are validated by ODM's contracted EQRO in accordance with 42 CFR 438.330. Performance Measure – An assessment tool that aggregates data to assess the structure, processes, and outcomes of care within and between entities; typically, specifies a numerator (what/how/when), denominator (who/where/when), and exclusions (not).
Notice of Action means a form provided to a household informing them of an action which has been or will be taken concerning the household's eligibility status or level of benefits.
Notice of Action means the notice (as specified in RCW 43.21C.080) of the time for commencing an appeal of a SEPA determination that the City or the applicant may give following final City action upon an application for a permit or ap- proval when the permit or approval does not have a time period set by statute or ordinance for commencing an appeal.
Notice of Action means the notice issued by MAD, the MCO or their designees of their intent to take an adverse action against an eligible recipient or a member in the form an adverse determination is made with regard to the preadmission or annual resident review requirements.