Prepaid Ambulatory Health Plan (PAHP) definition

Prepaid Ambulatory Health Plan (PAHP). An entity that:
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Prepaid Ambulatory Health Plan (PAHP) means an entity that--
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Prepaid Ambulatory Health Plan (PAHP) means an entity that provides medical services to enrollees under contract with the state agency, and on the basis of prepaid capitation payments, or other payment arrangements that do not use state plan payment rates; does not provide or arrange for, and is not otherwise responsible for the provision of any inpatient hospital or institutional services for its enrollees; and does not have a comprehensive risk contract.
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Examples of Prepaid Ambulatory Health Plan (PAHP) in a sentence

  • IPRO’s findings are presented in a manner consistent with the subparts in the BBA regulations explained in the Protocol, i.e., Subpart D – MCO, Prepaid Inpatient Health Plan (PIHP) and Prepaid Ambulatory Health Plan (PAHP) Standards and Subpart E – Quality Measurement and Improvement.

  • PROGRAM DESCRIPTION AND OBJECTIVES Florida’s current 1115 demonstration allows the state to operate a comprehensive Medicaid managed care program and a Prepaid Ambulatory Health Plan (PAHP).

  • The following terms are defined in 42 CFR 438.2.• Health Insuring Organization (HIO)• Prepaid Inpatient Health Plan (PIHP)• Managed Care Organization (MCO)• Primary Care Case Manager (PCCM)• Prepaid Ambulatory Health Plan (PAHP) Ownership interest means the possession of equity in the capital, the stock, or the profits of the disclosing entity.

  • However, in cases where BFEs increase in the restudied area, communities have the responsibility to ensure that new or substantially improved/ substantial damaged structures are protected, particularly if the increases in BFEs are significant.

  • Platino Plans to be reviewed for January 1, 2019 – December 31, 2021 are: Triple-S Medicare, Humana, MMM and MCS.The SECOND PARTY will include as part of the compliance review for Medicaid and Platino Plans validation of compliance with Program Integrity contractual requirements.The contract requires that the SECOND PARTY validate MCO, PIHP, or Prepaid Ambulatory Health Plan (PAHP) network adequacy during the preceding 12 months to comply with requirements for network adequacy standards.

  • For purposes of this section Non- Emergency Medical Transportation (NEMT) Prepaid Ambulatory Health Plan (PAHP) means an entity that pro- vides only NEMT services to enrollees under contract with the State, and on the basis of prepaid capitation pay- ments, or other payment arrangements that do not use State plan payment rates.

  • The EQRO’s findings are presented in a manner consistent with the subparts in the BBA regulations explained in the Protocol, i.e., Subpart D – MCO, Prepaid Inpatient Health Plan (PIHP) and Prepaid Ambulatory Health Plan (PAHP) Standards and Subpart E – Quality Measurement and Improvement.

  • Dental benefits are provided through a single Dental Benefit Manager operating as a Prepaid Ambulatory Health Plan (PAHP) with 1915(b) waiver authority.

  • Prepaid Ambulatory Health Plan (PAHP) means an entity that provides medical services to Enrollees under contract with the Department and on the basis of prepaid Capitation Payments, or other payment arrangements that do not use State Plan payment rates; does not provide or arrange for, and is not otherwise responsible for the provision of any inpatient hospital or institutional services for its Enrollees; and does not have a Comprehensive Risk Contract.

  • At the direction of CMS during the last renewal application, HHSC changed the TMWP delivery system from a Prepaid Ambulatory Health Plan (PAHP) to a PCCM and FFS Selective Contracting system.

Related to Prepaid Ambulatory Health Plan (PAHP)

  • Nursing home-type patients means a patient who has been in hospital more than 35 days, no longer requires acute hospital care, cannot live independently at home or be looked after at home, and either cannot be placed in a nursing home or a nursing home place is not available.

  • Ambulatory review means utilization review of health care services performed or provided in an outpatient setting.

  • Ambulatory means the condition of a person who immediately and without aid of another is physically or mentally capable of traveling a normal path to safety, including the ascent and descent of stairs.

  • Licensed mental health professional or "LMHP" means a physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, certified psychiatric clinical nurse specialist, licensed behavior analyst, or licensed psychiatric/mental health nurse practitioner.

  • Ambulatory surgical center means any public or private State licensed and approved (whenever required by law) establishment with an organized medical staff of Physicians, with permanent facilities that are equipped and operated primarily for the purpose of performing Surgical Procedures, with continuous Physician services and registered professional nursing service whenever a patient is in the facility, and which does not provide service or other accommodations for patients to stay overnight.

  • Basic health plan services means that schedule of covered

  • Ambulatory surgical facility means a facility that:  Is licensed by the state where it is located.  Is equipped and operated mainly to provide for surgeries or obstetrical deliveries.  Allows patients to leave the facility the same day the surgery or delivery occurs.

  • Home health aide services means the personal care and maintenance activities provided to individuals for the purpose of promoting normal standards of health and hygiene.

  • graduate psychiatric nurse means a person whose name is entered on the register of graduate psychiatric nurses of the College of Registered Psychiatric Nurses of Manitoba. The terms of this Agreement shall be applicable to the graduate nurse, the graduate practical nurse, graduate psychiatric nurse, and graduate nurse practitioner, except as otherwise specified in the Collective Agreement.

  • Non-Administrator Ambulatory Surgical Facility means an Ambulatory Surgical Facility which does not meet the definition of an Administrator Ambulatory Surgical Facility.

  • Hospice patient s family" means a hospice patient's immediate family members, including a spouse, brother, sister, child, or parent, and any other relative or individual who has significant personal ties to the patient and who is designated as a member of the patient's family by mutual agreement of the patient, the relative or individual, and the patient's interdisciplinary team.

  • Radiation therapist means a person, other than a Licensed Practitioner or Nuclear Medicine Technologist, who applies radiation to humans for therapeutic purposes under the supervision of a Licensed Practitioner;

  • Moving beam radiation therapy means radiation therapy with any planned displacement of radiation field or patient relative to each other, or with any planned change of absorbed dose distribution. It includes arc, skip, conformal, intensity modulation and rotational therapy.

  • Designated mental health professional means a mental health

  • Nonambulatory means a person who immediately and without the aid of another is not physically and mentally capable of traveling a normal path to safety, including the ascent and descent of stairs.

  • Dialysis solution means either the commercially available, unopened, sterile solutions whose

  • Behavioral therapy means interactive therapies derived from evidence-based research, including applied behavior analysis, which includes discrete trial training, pivotal response training, intensive intervention programs, and early intensive behavioral intervention.

  • Cannabis wholesaler means any licensed person or entity that purchases or otherwise obtains, stores, sells or otherwise transfers, and may transport, cannabis items for the purpose of resale or other transfer to either another cannabis wholesaler or to a cannabis retailer, but not to consumers.

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • Clinical nurse specialist means a registered nurse with relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field and who satisfies the local criteria.

  • Orthodontic means a type of specialist dental treatment carried out by an orthodontist that diagnoses, prevents and corrects mispositioned teeth and jaws and misaligned bite patterns.

  • Diagnosis of autism spectrum disorders means assessments, evaluations, or tests, including the autism diagnostic observation schedule, performed by a licensed physician or a licensed psychologist to diagnose whether an individual has 1 of the autism spectrum disorders.

  • Community mental health program means all mental health

  • Qualified mental health professional means a licensed medical practitioner or any other person meeting the qualifications specified in OAR 309-019-0125.

  • Health service area or “HSA” refers to the distinct geographic regions described in Section 4.1.4 or the Vermont Blueprint for Health Manual.

  • Clinic means a facility that provides hemodialysis or peritoneal dialysis services to patients suffering from kidney disease.