Common use of Early Intervention Services Clause in Contracts

Early Intervention Services. a comprehensive program for children between the ages of birth and three years whose developmental patterns are atypical, or are at serious risk to become atypical through the influence of certain biological or environmental factors. Early Intervention Services include a set of integrated community- based developmental services which use a family centered approach to facilitate developmental progress. Early Intervention Program regulations are found at 130 CMR 440.000. Effective Date of Enrollment – as of 12:01 a.m. on the first day, as determined by EOHHS, on which the Contractor is responsible for providing MCO Covered Services to an Enrollee and as reflected in the HIPAA 834 Outbound Enrollment File. Effective Date of Disenrollment – up to 11:59 p.m. on the last day, as determined by EOHHS, on which the Contractor is responsible for providing MCO Covered Services to an Enrollee and as reflected in the HIPAA 834 Outbound Enrollment File. Eligibility Verification System (EVS) [formerly known as the Recipient Eligibility Verification System (REVS)] – the online and telephonic system Providers must access to verify eligibility, managed care enrollment, and available third party liability information about Members. Emergency Aid to the Elderly, Disabled, and Children (EAEDC) – a cash assistance program administered by the Massachusetts Department of Transitional Assistance. Individuals receiving EAEDC cash assistance are eligible for MassHealth Basic coverage upon Managed Care enrollment in accordance with the requirements of 130 CMR 508.000. Families receiving EAEDC are eligible for MassHealth Standard coverage. Emergency Medical Condition – a medical condition, whether physical or mental, manifesting itself by symptoms of sufficient severity, including severe pain, that, in the absence of prompt medical attention, could reasonably be expected by a prudent layperson who possesses an average knowledge of health and medicine to result in placing the health of an Enrollee or another person or, in the case of a pregnant individual, the health of the individual or their unborn child, in serious jeopardy, serious impairment to bodily function, or serious dysfunction of any body organ or part; or, with respect to a pregnant individual, as further defined in Section 1867(e)(1)(B) of the Social Xxxxxxxx Xxx, 00 X.X.X. § 0000xx(x)(0)(X). Emergency Services – covered inpatient and outpatient services, including Behavioral Health Services, which are furnished to an Enrollee by a Provider that is qualified to furnish such services under Title XIX of the Social Security Act, and are needed to evaluate or stabilize an Enrollee’s Emergency Medical Condition. Emergency Services Programs (ESPs) – Medically necessary services provided through designated, contracted providers, and which are available seven (7) days per week, twenty-four (24) hours per day to provide treatment of any individual who is experiencing a mental health or substance use disorder crisis, or both. An ESP encounter includes, at a minimum, crisis assessment, intervention and stabilization, as described in Appendix C. In addition to contracted ESPs, ESP Encounter services (not Youth Mobile Crisis Intervention services) may also be provided by outpatient hospital emergency departments as further directed by EOHHS. Encounter Data – a dataset provided by the Contractor that records every service provided to an Enrollee. This dataset shall be developed in the format specified by EOHHS and shall be updated electronically according to protocols and timetables established by EOHHS in accordance with Appendix E. Enrollee – a Member enrolled in the Contractor’s Plan, either by choice, or assignment by EOHHS. A Member shall be considered an Enrollee beginning on the Effective Date of Enrollment in the Contractor’s Plan, including retroactive enrollment periods. A Member shall not be considered an Enrollee during any period following the Effective Date of Disenrollment from the Contractor’s Plan, including retroactive disenrollment periods. Enrollee Days – the sum of the number of days each Enrollee is enrolled in the Contractor’s Plan. Enrollee Incentive – any compensation in cash or cash equivalent, or in-kind gifts, granted to an Enrollee as a result of engagement, or lack of engagement, in a targeted behavior, such as guideline-recommended clinical screenings, Primary Care Provider (PCP) visits, or Wellness Initiatives. Enrollee Information – information about a Managed Care Organization (MCO) for Enrollees that includes, but is not limited to, a Provider directory that meets the requirements of Section 2.7.E., and an Enrollee handbook that contains all of the information in Section 2.4.B.2.f. Enrollees with Special Health Care Needs – Enrollees who meet the following characteristics:

Early Intervention Services. a comprehensive program for children between the ages of birth and three years whose developmental patterns are atypical, or are at serious risk to become atypical through the influence of certain biological or environmental factors. Early Intervention Services include a set of integrated community- based developmental services which use a family centered approach to facilitate developmental progress. Early Intervention Program regulations are found at 130 CMR 440.000. Effective Date of Enrollment – as of 12:01 a.m. on the first day, as determined by EOHHS, on which the Contractor is responsible for providing MCO Covered Services to an Enrollee and as reflected in the HIPAA 834 Outbound Enrollment File. Effective Date of Disenrollment – up to 11:59 p.m. on the last day, as determined by EOHHS, on which the Contractor is responsible for providing MCO Covered Services to an Enrollee and as reflected in the HIPAA 834 Outbound Enrollment File. Eligibility Verification System (EVS) [formerly known as the Recipient Eligibility Verification System (REVS)] – the online and telephonic system Providers must access to verify eligibility, managed care enrollment, and available third party liability information about Members. Emergency Aid to the Elderly, Disabled, and Children (EAEDC) – a cash assistance program administered by the Massachusetts Department of Transitional Assistance. Individuals receiving EAEDC cash assistance are eligible for MassHealth Basic coverage upon Managed Care enrollment in accordance with the requirements of 130 CMR 508.000. Families receiving EAEDC are eligible for MassHealth Standard coverage. Emergency Medical Condition – a medical condition, whether physical or mental, manifesting itself by symptoms of sufficient severity, including severe pain, that, in the absence of prompt medical attention, could reasonably be expected by a prudent layperson who possesses an average knowledge of health and medicine to result in placing the health of an Enrollee or another person or, in the case of a pregnant individual, the health of the individual or their unborn child, in serious jeopardy, serious impairment to bodily function, or serious dysfunction of any body organ or part; or, with respect to a pregnant individual, as further defined in Section 1867(e)(1)(B) of the Social Xxxxxxxx Xxx, 00 X.X.X. § 0000xx(x)(0)(X). Emergency Services – covered inpatient and outpatient services, including Behavioral Health Services, which are furnished to an Enrollee by a Provider that is qualified to furnish such services under Title XIX of the Social Security Act, and are needed to evaluate or stabilize an Enrollee’s Emergency Medical Condition. Emergency Services Programs (ESPs) – Medically necessary services provided through designated, contracted providers, and which are available seven (7) days per week, twenty-four (24) hours per day to provide treatment of any individual who is experiencing a mental health or substance use disorder crisis, or both. An ESP encounter includes, at a minimum, crisis assessment, intervention and stabilization, as described in Appendix C. In addition to contracted ESPs, ESP Encounter services (not Youth Mobile Crisis Intervention services) may also be provided by outpatient hospital emergency departments as further directed by EOHHS. Encounter Data – a dataset provided by the Contractor that records every service provided to an Enrollee. This dataset shall be developed in the format specified by EOHHS and shall be updated electronically according to protocols and timetables established by EOHHS in accordance with Appendix E. Enrollee – a Member enrolled in the Contractor’s Plan, either by choice, or assignment by EOHHS. A Member shall be considered an Enrollee beginning on the Effective Date of Enrollment in the Contractor’s Plan, including retroactive enrollment periods. A Member shall not be considered an Enrollee during any period following the Effective Date of Disenrollment from the Contractor’s Plan, including retroactive disenrollment periods. Enrollee Days – the sum of the number of days each Enrollee is enrolled in the Contractor’s Plan. Enrollee Incentive – any compensation in cash or cash equivalent, or in-kind gifts, granted to an Enrollee as a result of engagement, or lack of engagement, in a targeted behavior, such as guideline-recommended clinical screenings, Primary Care Provider (PCP) visits, or Wellness Initiatives. Enrollee Information – information about a Managed Care Organization (MCO) for Enrollees that includes, but is not limited to, a Provider directory that meets the requirements of Section 2.7.E., and an Enrollee handbook that contains all of the information in Section 2.4.B.2.f. Enrollees with Special Health Care Needs – Enrollees who meet the following characteristics:.

Early Intervention Services. a comprehensive program for children between the ages of birth and three years whose developmental patterns are atypical, or are at serious risk to become atypical through the influence of certain biological or environmental factors. Early Intervention Services include a set of integrated community- community-based developmental services which use a family centered approach to facilitate developmental progress. Early Intervention Program regulations are found at 130 CMR 440.000. Effective Date of Enrollment – as of 12:01 a.m. on the first day, as determined by EOHHS, on which the Contractor is responsible for providing MCO Covered Services to an Enrollee and as reflected in the HIPAA 834 Outbound Enrollment File. Effective Date of Disenrollment – up to 11:59 p.m. on the last day, as determined by EOHHS, on which the Contractor is responsible for providing MCO Covered Services to an Enrollee and as reflected in the HIPAA 834 Outbound Enrollment File. Eligibility Verification System (EVS) [formerly known as the Recipient Eligibility Verification System (REVS)] – the online and telephonic system Providers must access to verify eligibility, managed care enrollment, and available third party liability information about Members. Emergency Aid to the Elderly, Disabled, and Children (EAEDC) – a cash assistance program administered by the Massachusetts Department of Transitional Assistance. Individuals receiving EAEDC cash assistance are eligible for MassHealth Basic coverage upon Managed Care enrollment in accordance with the requirements of 130 CMR 508.000. Families receiving EAEDC are eligible for MassHealth Standard coverage. Emergency Medical Condition – a medical condition, whether physical or mental, manifesting itself by symptoms of sufficient severity, including severe pain, that, in the absence of prompt medical attention, could reasonably be expected by a prudent layperson who possesses an average knowledge of health and medicine to result in placing the health of an Enrollee or another person or, in the case of a pregnant individualwoman, the health of the individual woman or their her unborn child, in serious jeopardy, serious impairment to bodily function, or serious dysfunction of any body organ or part; or, with respect to a pregnant individualwoman, as further defined in Section 1867(e)(1)(B) of the Social Xxxxxxxx Xxx, 00 X.X.X. § 0000xx(x)(0)(X). Emergency Services – covered inpatient and outpatient services, including Behavioral Health Services, which are furnished to an Enrollee by a Provider that is qualified to furnish such services under Title XIX of the Social Security Act, and are needed to evaluate or stabilize an Enrollee’s Emergency Medical Condition. Emergency Services Programs (ESPs) – Medically necessary services provided through designated, contracted providers, and which are available seven (7) days per week, twenty-four (24) hours per day to provide treatment of any individual who is experiencing a mental health or substance use disorder crisis, or both. An ESP encounter includes, at a minimum, crisis assessment, intervention and stabilization, as described in Appendix C. In addition to contracted ESPs, ESP Encounter services (not Youth Mobile Crisis Intervention services) may also be provided by outpatient hospital emergency departments as further directed by EOHHS. Encounter Data – a dataset provided by the Contractor that records every service provided to an Enrollee. This dataset shall be developed in the format specified by EOHHS and shall be updated electronically according to protocols and timetables established by EOHHS in accordance with Appendix E. Enrollee – a Member enrolled in the Contractor’s Plan, either by choice, or assignment by EOHHS. A Member shall be considered an Enrollee beginning on the Effective Date of Enrollment in the Contractor’s Plan, including retroactive enrollment periods. A Member shall not be considered an Enrollee during any period following the Effective Date of Disenrollment from the Contractor’s Plan, including retroactive disenrollment periods. Enrollee Days – the sum of the number of days each Enrollee is enrolled in the Contractor’s Plan. Enrollee Incentive – any compensation in cash or cash equivalent, or in-kind gifts, granted to an Enrollee as a result of engagement, or lack of engagement, in a targeted behavior, such as guideline-guideline- recommended clinical screenings, Primary Care Provider (PCP) visits, or Wellness Initiatives. Enrollee Information – information about a Managed Care Organization (MCO) for Enrollees that includes, but is not limited to, a Provider directory that meets the requirements of Section 2.7.E., and an Enrollee handbook that contains all of the information in Section 2.4.B.2.f. Enrollees with Special Health Care Needs – Enrollees who meet the following characteristics:.

Early Intervention Services. a comprehensive program for children between the ages of birth and three years whose developmental patterns are atypical, or are at serious risk to become atypical through the influence of certain biological or environmental factors. Early Intervention Services include a set of integrated community- based developmental services which use a family centered approach to facilitate developmental progress. Early Intervention Program regulations are found at 130 CMR 440.000. Effective Date of Enrollment – as of 12:01 a.m. on the first day, as determined by EOHHS, on which the Contractor is responsible for providing MCO Covered Services to an Enrollee and as reflected in the HIPAA 834 Outbound Enrollment File. Effective Date of Disenrollment – up to 11:59 p.m. on the last day, as determined by EOHHS, on which the Contractor is responsible for providing MCO Covered Services to an Enrollee and as reflected in the HIPAA 834 Outbound Enrollment File. Eligibility Verification System (EVS) [formerly known as the Recipient Eligibility Verification System (REVS)] – the online and telephonic system Providers must access to verify eligibility, managed care enrollment, and available third party liability information about Members. Emergency Aid to the Elderly, Disabled, and Children (EAEDC) – a cash assistance program administered by the Massachusetts Department of Transitional Assistance. Individuals receiving EAEDC cash assistance are eligible for MassHealth Basic coverage upon Managed Care enrollment in accordance with the requirements of 130 CMR 508.000. Families receiving EAEDC are eligible for MassHealth Standard coverage. Emergency Medical Condition – a medical condition, whether physical or mental, manifesting itself by symptoms of sufficient severity, including severe pain, that, in the absence of prompt medical attention, could reasonably be expected by a prudent layperson who possesses an average knowledge of health and medicine to result in placing the health of an Enrollee or another person or, in the case of a pregnant individual, the health of the individual or their unborn child, in serious jeopardy, serious impairment to bodily function, or serious dysfunction of any body organ or part; or, with respect to a pregnant individual, as further defined in Section 1867(e)(1)(B) of the Social Xxxxxxxx XxxSecurity Act, 00 X.X.X. 42 U.S.C. § 0000xx(x)(0)(X1395dd(e)(1)(B). Emergency Services – covered inpatient and outpatient services, including Behavioral Health Services, which are furnished to an Enrollee by a Provider that is qualified to furnish such services under Title XIX of the Social Security Act, and are needed to evaluate or stabilize an Enrollee’s Emergency Medical Condition. Emergency Services Programs (ESPs) – Medically necessary services provided through designated, contracted providers, and which are available seven (7) days per week, twenty-four (24) hours per day to provide treatment of any individual who is experiencing a mental health or substance use disorder crisis, or both. An ESP encounter includes, at a minimum, crisis assessment, intervention and stabilization, as described in Appendix C. In addition to contracted ESPs, ESP Encounter services (not Youth Mobile Crisis Intervention services) may also be provided by outpatient hospital emergency departments as further directed by EOHHS. Encounter Data – a dataset provided by the Contractor that records every service provided to an Enrollee. This dataset shall be developed in the format specified by EOHHS and shall be updated electronically according to protocols and timetables established by EOHHS in accordance with Appendix E. Enrollee – a Member enrolled in the Contractor’s Plan, either by choice, or assignment by EOHHS. A Member shall be considered an Enrollee beginning on the Effective Date of Enrollment in the Contractor’s Plan, including retroactive enrollment periods. A Member shall not be considered an Enrollee during any period following the Effective Date of Disenrollment from the Contractor’s Plan, including retroactive disenrollment periods. Enrollee Days – the sum of the number of days each Enrollee is enrolled in the Contractor’s Plan. Enrollee Incentive – any compensation in cash or cash equivalent, or in-kind gifts, granted to an Enrollee as a result of engagement, or lack of engagement, in a targeted behavior, such as guideline-recommended clinical screenings, Primary Care Provider (PCP) visits, or Wellness Initiatives. Enrollee Information – information about a Managed Care Organization (MCO) for Enrollees that includes, but is not limited to, a Provider directory that meets the requirements of Section 2.7.E., and an Enrollee handbook that contains all of the information in Section 2.4.B.2.f. Enrollees with Special Health Care Needs – Enrollees who meet the following characteristics: