PCMH+ member definition

PCMH+ member means a member assigned by the department to a participating entity for purposes of PCMH+ for a performance year;
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Examples of PCMH+ member in a sentence

  • Participating Entities do not need to deliver all defined benefits; rather, the cost of all benefits provided to an assigned PCMH+ member, regardless of the specific provider that performed each service, will be included in the shared savings calculation.

  • In addition, to avoid unwanted bias due to outlier cases, for each PCMH+ member, annual claims will be truncated at $100,000, so that expenses above $100,000 will not be included in the calculation.

  • Additionally, during Wave 2 CHNCT will run a monthly check of the PCMH+ member population for members that may meet the criteria for one of the exclusion categories.

  • Response: It is true that PCMH patients that fall into one of the exclusion categories will be excluded from PCMH+ member roster before the start of the program.

  • Participating entities are not required to provide any specific level or amount of enhanced care coordination activities (and, for FQHCs, also care coordination add-on payment activities) to each PCMH+ member.

  • DSS will also conduct a PCMH+ member survey to evaluate the first Performance Year.

  • DSS will include all Medicaid claim costs for covered services provided by any provider to a PCMH+ member in the shared savings calculation described in subsection (a) of this section, except for: hospice; long-term services and supports, including institutional and home and community-based services; and non-emergency medical transportation services.

  • The data points that DSS monitors under this approach include, but are not limited to: PCMH+ member grievances, provider performance on quality measures (particularly preventive care service measures), service utilization and service cost reporting and member movement to, from and within participating entities.

  • In order to avoid unwanted bias due to outlier cases, for each PCMH+ member, annual claims will be truncated at a level specified in writing by the department for the performance year and in accordance with the Medicaid State Plan or other applicable PCMH+ FFP authority, as applicable, so that expenses above that level will not be included in the calculation.

  • If, over the course of a Performance Year, a PCMH+ member Medicaid eligibility or moves into a population that is not eligible for PCMH+ (see Attachment 3.1-A), that change has the same effect as if an individual opts out of assignment to a PCMH+ Participating Entity, as described immediately above.

Related to PCMH+ member

  • ☐ - MULTI-MEMBER The “Capital Account” for each Member shall mean the account created and maintained for the Member in accordance with Section 704(b) of the Internal Revenue Code and Treasury Regulation Section 1.704-1(b)(2)(iv).

  • Founding Member means any individual who is either:

  • crew member means a person assigned by an operator to duty on an aircraft during a flight duty period;

  • Class B Member means a Member holding one or more Class B Ordinary Shares.

  • New member means a person first employed on or after Septem- ber 1, 2005, including a former member who withdrew retirement contributions under Government Code 822.003 and is reemployed on or after September 1, 2005.

  • Staff member means a staff member as defined in section 1(1) of the Public Service Act, 1995 (Act No. 13 of 1995);

  • Panel Member ’ means a member of a panel;

  • Managing Member is defined in the recitals to this Agreement.

  • lay member means a member of the Authority, who is not, nor has been:

  • A Member means a companion, fellow, member, honorary member, associate or affiliate of the Society

  • Non-Managing Member means any Member other than the Managing Member.

  • Bona fide member means an individual who participates in activities of a qualified organization

  • Service member means a member of the armed forces, a reserve branch of the armed forces, or the Michigan national guard.

  • Class A Member means a Member holding one or more Class A Ordinary Shares.

  • Full Member means any person who is in one of the categories of membership referred to in Rule 10.3.

  • Other Member means a Voting Member who is not an Eligible Account Holder or a Supplemental Eligible Account Holder.

  • Equity Member means each member of the Respondent team that will contribute equity as part of the financing of the Project.

  • Founding Members means the collective reference to American Multi-Cinema, Inc., a Missouri corporation, Cinemark Media, Inc., a Delaware corporation, and Regal CineMedia Holdings, LLC, a Delaware limited liability company.

  • Voting Member means a Member holding one or more Voting Shares.

  • Life Member means an Individual appointed as a Life Member of the Club under clause 5.2.

  • Council Member means a member of the Council;

  • Individual Member means a registered, financial Member of the Club who is at least 18 years of age.

  • Initial Member has the meaning set forth in the introductory paragraph.

  • Limited Partner means, prior to the admission of the first Additional Limited Partner to the Partnership, the Initial Limited Partner, and thereafter any Person named as a Limited Partner in Exhibit A, as such Exhibit may be amended from time to time, upon the execution and delivery by such Person of an additional limited partner signature page, or any Substituted Limited Partner or Additional Limited Partner, in such Person’s capacity as a Limited Partner of the Partnership.

  • Preferred Member means a Member holding Preferred Units.

  • Support staff member means an employee who holds a position for which no certificate issued by the New Jersey State Board of Examiners is required.