Subsection 144-101-VI-0302 - DEFINITIONS3.02-1Accountable Community (AC) is an entity participating in a MaineCare program established through a contract between the Department and an AC Lead Entity that establishes a financial relationship between the Department and the AC Lead Entity to both provide a financial incentive and hold the AC accountable for the provision of efficient, coordinated, and high-quality care. AC Lead Entities that achieve savings relative to a benchmark Total Cost of Care (TCOC) amount are eligible to receive a portion of these savings dependent on and proportional to their performance on a number of quality measures.3.02-2Attribution Assessment Period is the twenty-four- (24) month "lookback" period used for member attribution.3.02-3Behavioral and Physical Health Integration is the care a member experiences as a result of a team of primary care and behavioral health providers, working together with members and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population (based on the definition of "Integrated Behavioral Health Care" from the Agency for Healthcare Research and Quality).3.02-4Care Plans are developed and updated by the PCP in collaboration with the Member and their families and contain a problem list, expected outcome/prognosis, treatment goals, and medication management.3.02-5Certified Electronic Health Record Technology (CEHRT) is Electronic Health Record (EHR) technology (which could include multiple technologies) certified under the Office of National Coordinator for Health IT Certification Program that meets the criteria listed in 42 CFR § 414.1305.3.02-6Community Health Worker (CHW) is a trained health worker who applies their unique understanding of the community's experience, socio-economic needs, language and/or culture to advocate for individual and community needs and acts as a bridge between providers and individuals to promote health, reduce disparities, and improve service delivery. CHWs are distinguished from other health professionals in that they are hired primarily for their understanding of the populations and communities they serve, conduct outreach a significant portion of the time, and have experience providing services in community settings (adapted from the Maine State Innovation Model). CHW training shall include CHW core competencies defined by The Community Health Worker Core Consensus Project (see https://www.c3project.org/roles-competencies) or be evidenced by a Maine CHW certification or registration (effective the date such a designation becomes active in the State of Maine).
3.02-7Joint Care Management and Population Health Strategy is a written three-year plan, updated annually, which describes operational and financial coordination across the PCPlus practice, the AC, and any Community Care Team (as described in Section 91 of the MaineCare Benefits Manual) that is contracted with the AC and/or the PCPlus practice.3.02-8MaineCare Peer Group is a group of PCPs, determined by the Department, based on Risk Scores and influenced by Tier level, practice size, practice type, and rurality, as needed. MaineCare Peer Group assignment will be determined upon acceptance into PC Plus and reassessed at least annually or when a PCP undergoes a significant change, which may include a relocation or inclusion of new populations.3.02-9Medication for Addiction Treatment (MAT) is the use of medications for the treatment of substance use disorders.3.02-10Members are MaineCare members attributed to a PCP for the purposes of reimbursement.3.02-11Performance-Based Adjustments (PBA) are quarterly adjustments made to participating PCPs' PBPs based on PCP performance on PCPlus performance measures.3.02-12Performance-Based Adjustment Assessment Period is the twelve (12)-month "lookback" period used for assessing PBAs.3.02-13Population-Based Payments (PBP) are monthly payments that the Department calculates quarterly by adding the Tier per member per month (PMPM) rate and the population group and risk category PMPM rate and multiplying the sum by the PCP's total number of Members. These payments are for a flexible array of care delivery approaches, including those that are not dependent on office-based, face-to-face care, such as care management, access to additional care team members, and targeted patient supports that best meet the needs of the Members.3.02-14Primary Care Services are evaluation and management, preventive, and wellness services.3.02-15Risk Score is a metric from a patient classification model that evaluates and forecasts individual healthcare utilization and costs for each individual Member using demographic and heath care data from a rolling twelve-(12) month period with a two-month claims run out period. C.M.R. 10, 144, ch. 101, ch. VI, 144-101-VI-03, subsec. 144-101-VI-0302