Prevalent Languages. those languages spoken by a significant percentage of Enrollees. EOHHS has determined the current Prevalent Languages spoken by MassHealth Enrollees are Spanish and English. EOHHS may identify additional or different languages as Prevalent Languages at any time during the term of the Contract. Primary Care – the provision of coordinated, comprehensive medical services, on both a first contact and a continuous basis, to an Enrollee. The provision of Primary Care incorporates an initial medical history intake, medical diagnosis and treatment, communication of information about illness prevention, health maintenance, and referral services. Primary Care Accountable Care Organization (Primary Care ACO) – an entity contracted with EOHHS to be a Primary Care ACO consisting of a network of primary care providers who contract directly with MassHealth, using MassHealth’s provider network, to provide integrated and coordinated care for members. MassHealth members enrolled in Primary Care ACOs receive behavioral health services through MassHealth’s behavioral health vendor. Primary Care Clinician (PCC) Plan – a managed care option administered by EOHHS through which enrolled MassHealth Members receive Primary Care and certain other medical services. See 130 CMR 450.118. Primary Care Entity – An entity that may be made up of one or more unique Practice PID/SLs. For the purposes of Primary Care Sub-Capitation Program, this entity is the Tax ID for Contract Year 2023. Primary Care Provider (PCP) – an EOHHS-contracted primary care practitioner participating in the managed care program pursuant to 130 CMR 450.119. PCPs provide comprehensive Primary Care and certain other medical services to Primary Care ACO Enrollees and function as the referral source for most other MassHealth services. Primary Care Sub-Capitation Included Services – the service codes that are included in calculating the Primary Primary Care Sub-Capitation Payment – a per Member per Month payment from EOHHS to the Contractor based on a defined set of Primary Care Sub-Capitation Included Services, in accordance with the provisions of this Contract. Primary Care Sub-Capitation Program – an EOHHS-specified primary care initiative, as described in Section Privacy and Security Rules – the privacy, security and related regulations promulgated under the Health Insurance Portability and Accountability Act of 1996, as amended (HIPAA) (found at 45 CFR Parts 160 and 164). Progress Reports – information provided by the Contractor on the Contractor’s activities under this Contract, Protected Information (PI) – shall mean any Protected Health Information, any “personal data” as defined in Providers – an individual, group, facility, agency, institution, organization, or business that furnishes or has furnished medical services to Members. Quality Committee – a committee reporting directly to the Contractor’s Governing Board, which regularly reviews and sets goals to improve the Contractor’s performance on clinical quality or health outcomes, Enrollee experience measures, other Quality Measures, and disparities. Quality Improvement Goals – standardized quality areas in which EOHHS measures Primary Care ACOs’ performance against, and implements interventions to achieve, established objectives on a two-year cycle. EOHHS selects which quality improvement goals and topics shall constitute the Quality Improvement Goals for the measurement period. Quality Measures – Measures used to evaluate the quality of the Contractor’s Enrollee care as described in Appendix B. Quality Score – a score calculated by EOHHS based on the Contractor’s performance on Quality Measures, as Query and Retrieve – Or, query-based exchange, refers to the ability for providers to find and/or request information on a patient from other providers, often used for unplanned care. Referral Circle – a subset of Affiliated Providers for whom Participating PCP referral requirements are modified
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Sources: Standard Contract, Standard Contract
Prevalent Languages. those languages spoken by a significant percentage of Enrollees. EOHHS has determined the current Prevalent Languages spoken by MassHealth Enrollees are Spanish and English. EOHHS may identify additional or different languages as Prevalent Languages at any time during the term of the Contract. Primary Care – the provision of coordinated, comprehensive medical services, on both a first contact and a continuous basis, to an Enrollee. The provision of Primary Care incorporates an initial medical history intake, medical diagnosis and treatment, communication of information about illness prevention, health maintenance, and referral services. Primary Care Accountable Care Organization (Primary Care ACO) – an entity contracted with EOHHS to be a Primary Care ACO consisting of a network of primary care providers who contract directly with MassHealth, using MassHealth’s provider network, to provide integrated and coordinated care for members. MassHealth members enrolled in Primary Care ACOs receive behavioral health services through MassHealth’s behavioral health vendor. Primary Care Clinician (PCC) Plan – a managed care option administered by EOHHS through which enrolled MassHealth Members receive Primary Care and certain other medical services. See 130 CMR 450.118. Primary Care Entity – An entity that may be made up of one or more unique Practice PID/SLs. For the purposes of Primary Care Sub-Capitation Program, this entity is the Tax ID for Contract Year 2023. Primary Care Provider (PCP) – an EOHHS-contracted primary care practitioner participating in the managed care program pursuant to 130 CMR 450.119. PCPs provide comprehensive Primary Care and certain other medical services to Primary Care ACO Enrollees and function as the referral source for most other MassHealth services. Primary Care Sub-Capitation Included Services – the service codes that are included in calculating the Primary Care Sub-Capitation Payment, as further specified by EOHHS. Primary Care Sub-Capitation Payment – a per Member per Month payment from EOHHS to the Contractor fixed fee for each Enrollee based on a defined set of Primary Care Sub-Capitation Included Services, in accordance with the provisions of this Contract. Primary Care Sub-Capitation Program – an EOHHS-specified primary care initiative, as described in Section Privacy and Security Rules – the privacy, security and related regulations promulgated under the Health Insurance Portability and Accountability Act of 1996, as amended (HIPAA) (found at 45 CFR Parts 160 and 164). Progress Reports – information provided by the Contractor on the Contractor’s activities under this Contract, Protected Information (PI) – shall mean any Protected Health Information, any “personal data” as defined in Providers – an individual, group, facility, agency, institution, organization, or business that furnishes or has furnished medical services to Members. Quality Committee – a committee reporting directly to the Contractor’s Governing Board, which regularly reviews and sets goals to improve the Contractor’s performance on clinical quality or health outcomes, Enrollee experience measures, other Quality Measures, and disparities. Quality Improvement Goals – standardized quality areas in which EOHHS measures Primary Care ACOs’ performance against, and implements interventions to achieve, established objectives on a two-year cycle. EOHHS selects which quality improvement goals and topics shall constitute the Quality Improvement Goals for the measurement period. Quality Measures – Measures used to evaluate the quality of the Contractor’s Enrollee care as described in Appendix B. Quality Score – a score calculated by EOHHS based on the Contractor’s performance on Quality Measures, as Query and Retrieve – Or, query-based exchange, refers to the ability for providers to find and/or request information on a patient from other providers, often used for unplanned care. Referral Circle – a subset of Affiliated Providers for whom Participating PCP referral requirements are modified.
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