Additional Other Provider Preventable Conditions (Additional OPPCs. Additional OPPCs are State-defined OPPCs that meet the requirements of 42 C.F.R. § 447.26(b). EOHHS has designated certain conditions as Additional OPPCs.
Additional Other Provider Preventable Conditions (Additional OPPCs. Additional OPPCs are State-defined OPPCs that meet the requirements of 42 C.F.R. 447.26(b). EOHHS has designated certain conditions as Additional OPPCs. Passive Enrollment — An enrollment process through which an eligible individual is enrolled by the EOHHS (or its vendor) into a Contractor’s plan following a minimum 60-day advance notification that includes the opportunity to make another enrollment decision prior to the effective date. Personal Care Assistant (PCA) — A person who provides personal care to an Enrollee who requires assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Personal Assistance Services (PAS Services) — Physical assistance, cueing, and/or monitoring with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) provided to an Enrollee by a PCA in accordance with the Enrollee’s Individualized Care Plan. Personal Care Management (PCM) Agency — A public or private entity under contract with EOHHS to provide Personal Care Management Services. Personal Care Management (PCM) Services — Services provided by a Personal Care Management (PCM) Agency to an Enrollee in accordance with the PCM Contract with EOHHS, including, but not limited to, those services described under 130CMR 422.419(A). PCM Services include, but are not limited to: intake and orientation to instruct a new Consumer in the rules, policies, and procedures of the Self-directed PCA program; assessment of the Enrollee’s ability to manage Self-directed PCA Services independently; development and monitoring of Service Agreements; and provision of functional skills training to assist Consumers in developing the skills and resources to maximize the Enrollee’s ability to manage their Self-directed PCA Services. Post-stabilization Services — Covered Services, related to an Emergency Condition that are provided after an Enrollee is stabilized in order to maintain the stabilized condition, and for which the Contractor is responsible when 1) the services are authorized; 2) the services are provided to maintain the Enrollee’s stabilized condition within one hour of a request to the Contractor for service authorization of further Post-stabilization Services; 3) the Contractor could not be contacted; 4) the Contractor did not respond to a service authorization request within one hour; or 5) the Contractor and treating provider are unable to reach agreement regarding the Enrollee’s care. Prevalent Languages — En...
