Aligned Community HealthChoices Managed Care Organization (Aligned A CHC-MCO operated by the same organization that also operates a Companion D-SNP for purposes of integrating services for members who are enrolled in both. Centers for Medicare & Medicaid Services (CMS). The federal agency within the Department of Health and Services responsible for oversight of both the Medicare and Medicaid Programs. Chronic Condition Improvement Program (CCIP). Initiative focused on clinical areas with the aim of improving health outcomes and beneficiary satisfaction, especially for those members with chronic conditions. The CCIP is part of the required QI Program. Coinsurance. A percentage of costs normally paid by a D-SNP member for medical services provided by a D-SNP. Coinsurance amounts must comply with the terms of the D-SNP. Community HealthChoices (CHC). The state’s mandatory managed care program through which participants will receive Medicaid physical health services and LTSS. Community HealthChoices Managed Care Organization (CHC-MCO). A Managed Care Organization (MCO) chosen through the competitive bid process and who has been awarded a contract by the Department and entered into such a contract with the Department to purchase and provide services through the CHC program. Companion D-SNP. A D-SNP that is a plan of an that also operates an Aligned CHC-MCO for purposes of integrating services for members who are enrolled in both. Copayments. Fixed dollar amounts that a member of a D-SNP normally must pay for a medical service provided by a D-SNP. Copayment amounts must comply with the terms of the D-SNP plan. Cost Sharing Obligations. Those financial payment obligations incurred by the state for dual eligible members in satisfaction of the coinsurance, copayments, deductibles, and premiums for the Medicare Part A and Part B programs. Deductible. Fixed dollar amounts that a D-SNP member normally must pay before the costs of services are covered by a D-SNP. Deductibles must comply with the terms of the D-SNP plan. Department. The Pennsylvania Department of Human Services (DHS). Dual Eligible. A Medicare beneficiary entitled to Medicare Part A and/or Part B who is also a Medicaid beneficiary, and for whom the Department has a responsibility for
Aligned Community HealthChoices Managed Care Organization (Aligned A CHC-MCO operated by the same organization that also operates a Companion D-SNP for purposes of integrating services for members who are enrolled in both. Centers for Medicare & Medicaid Services (CMS). The federal agency within the Department of Health and Services responsible for oversight of both the Medicare and Medicaid Programs. Chronic Condition Improvement Program (CCIP). Initiative focused on clinical areas with the aim of improving health outcomes and beneficiary satisfaction, especially for those members with chronic conditions. The CCIP is part of the required QI Program. Coinsurance. A percentage of costs normally paid by a D-SNP member for medical services provided by a D-SNP. Coinsurance amounts must comply with the terms of the D-SNP. Community HealthChoices (CHC). The state’s mandatory managed care program through which participants will receive Medicaid physical health services and LTSS. Community HealthChoices Managed Care Organization (CHC-MCO). A Managed Care Organization (MCO) chosen through the competitive bid process and who has been awarded a contract by the Department and entered into such a contract with the Department to purchase and provide services through the CHC program. Companion D-SNP. A D-SNP that is a plan of an that also operates an Aligned CHC-MCO for purposes of integrating services for members who are enrolled in both. Copayments. Fixed dollar amounts that a member of a D-SNP normally must pay for a medical service provided by a D-SNP. Copayment amounts must comply with the terms of the D-SNP plan. Cost Sharing Obligations. Those financial payment obligations incurred by the state for dual eligible members in satisfaction of the coinsurance, copayments, deductibles, and premiums for the Medicare Part A and Part B programs. Deductible. Fixed dollar amounts that a D-SNP member normally must pay before the costs of services are covered by a D-SNP. Deductibles must comply with the terms of the D-SNP plan. Department. The Pennsylvania Department of Human Services (DHS). Dual Eligible. A Medicare beneficiary entitled to Medicare Part A and/or Part B who is also a Medicaid beneficiary, and for whom the Department has a responsibility for
c_226421.docx