One Care definition

One Care. A demonstration project among CMS, the State and managed care organizations for the coordination and delivery of covered Medicare, Medicaid and expanded services for Medicare-Medicaid enrollees in the Commonwealth of Massachusetts.

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One Care. A comprehensive managed care program implemented by EOHHS in collaboration with CMS for the purpose of delivering and coordinating all Medicare- and Medicaid-covered benefits for MassHealth Members eligible for both programs. Services are developed and delivered based on an Enrollee’s person-centered assessment and care plan.

One Care means One Care (BNSSG) C.I.C. – company number: 10355565

Examples of One Care in a sentence

• The Contractor shall operate a Consumer Advisory Board for its One Care plan, with a scope and purview specific to the One Care plan, and inclusive of both the Medicaid managed care entity and this Contract, and of the Medicare contracted D-SNP organization and Medicare D-SNP Contract.

• The Contractor shall report the identification of any overpayments related to One Care Covered Services that were represented to be delivered by Providers but not received by Enrollees in the following reports as set forth in Appendix A: Fraud and Abuse Notification, Notification of Provider Overpayments, and Summary of Provider Overpayments report.

• This process is only permissible in circumstances where the Member enrolls with the One Care plan offered by their MassHealth health plan upon receiving Medicare eligibility.

• The date on which a Contractor first provides Covered Services through a One Care Plan, which shall be January 1, 2026.

• One Care Implementation Council – A consumer-led working committee that advises EOHHS on One Care and on related matters.

• The One Care Implementation Council holds a key role in monitoring access to health care and compliance with the Americans with Disabilities Act (ADA), tracking quality of services, and promoting accountability and transparency.

• The first calendar day of the month following the receipt of Enrollee’s enrollment into a One Care Plan.

• The determination to continue to provide Medicare coverage for an individual who no longer meets the State eligibility criteria for enrollment into a One Care Plan, as long as the individual can reasonably be expected to regain One Care eligibility in accordance with the State criteria within a specified period of time.

• The Contractor shall demonstrate to EOHHS’s satisfaction that the Contractor and its Material Subcontractors, if any, are ready and able to meet Readiness Review requirements in sufficient time prior to the Contractor engaging in marketing of its One Care Plan and enrolling members; both of which shall be prior to the Contract Operational Start Date.

• This may include enrolling in and receiving services from a One Care Plan.

More Definitions of One Care

One Care means ONE CARE Home and Community Support Services;