Prepaid Mental Health Plan or PMHP means a mental health and/or substance use disorder plan operated under the Department’s freedom-of-choice waiver approved by CMS that allows the Department to require Medicaid Eligible Individuals in certain counties of the State to obtain Covered Services from specified contractors. Primary Care Case Management or PCCM means a system under which a PCCM contracts with the Department to furnish case management services (which include the location, coordination and monitoring of primary health care services) to Medicaid recipients. Provider means a Participating Provider or a Non-Participating Provider. Provider Preventable Condition means a condition that meets the definition of a Health Care- Acquired Condition or an Other Provider-Preventable condition. Risk Contract means a contract under which the contractor assumes risk for the cost of the services covered under the contract; and incurs loss if the cost of furnishing the services exceeds the payments under the contract. XXX means the System for Award Management database.
Prepaid Mental Health Plan or PMHP means a mental health and/or substance use disorder plan operated under the Department’s freedom-of-choice waiver approved by CMS that allows the Department to require Medicaid Eligible Individuals in certain counties of the State to obtain Covered Services from specified contractors. Primary Care Case Management or PCCM means a system under which a PCCM contracts with the Department to furnish case management services (which include the location, coordination and monitoring of primary health care services) to Medicaid recipients. Provider means a Network Provider or a Non-Network Provider. Provider Preventable Condition means a condition that meets the definition of a Health Care- Acquired Condition or an Other Provider-Preventable condition. Quality Assessment and Performance Improvement Program or QAPI or QAPIP means the Contractor’s plan to establish and implement an ongoing comprehensive quality assessment and performance improvement program for the services it furnishes to its Enrollees in accordance with 42 CFR 438.330. Rate Cell means a set of mutually exclusive categories of Enrollees that is defined by one or more characteristics for the purpose of determining the Capitation Rate and making a Capitation Payment; such characteristics may include age, gender, eligibility category, and region or geographic area. Each Enrollee is categorized in one of the Rate Cells for each unique set of mutually exclusive benefits under the Contract. Rating Period means a period of 12 months selected by the Department for which the actuarially sound Capitation Rates are developed and documented in the rate certification submitted to CMS as required by 42 CFR 438.7(a). Readily Accessible means electronic information and services which comply with modern accessibility standards such as section 508 guidelines, section 504 of the Rehabilitation Act, and W3C’s Web Content Accessibility Guidelines (WCAG) 2.0 AA and successor versions. Risk Contract means a contract under which the contractor assumes risk for the cost of the services covered under the contract; and incurs loss if the cost of furnishing the services exceeds the payments under the contract. XXX means the System for Award Management database.
Prepaid Mental Health Plan or PMHP means the Department’s mental health freedom-of- choice waiver approved by CMS that allows the Department to require Medicaid Eligible Individuals in certain counties of the State to obtain Covered Services from specified contractors. Primary Care means all health care services and laboratory services customarily furnished by or through a general practitioner, family physician, internal medicine physician, obstetrician/gynecologist, or pediatrician, to the extent the furnishing of those services is legally authorized in the State in which the practitioner furnishes them. Primary Care Provider or PCP means a health care provider the majority of whose practice is devoted to internal medicine, family/general practice or pediatrics. The Contractor may allow other specialists to be PCPs, when appropriate. PCPs are responsible for delivering Primary Care services, coordinating and managing Enrollees’ overall health, and authorizing referrals for other necessary care. Provider means a Participating Provider or a Non-Participating Provider. Provider Preventable Condition means a condition that meets the definition of a Health Care- Acquired Condition or an Other Provider-Preventable condition. Risk Contract means a contract under which the contractor assumes risk for the cost of the services covered under the contract; and incurs loss if the cost of furnishing the services exceeds the payments under the contract. XXX means the System for Award Management database.