10 Colo. Code Regs. § 2505-10-8.7402
Current through Register Vol. 47, No. 24, December 25, 2024
Section 10 CCR 2505-10-8.7402 - DefinitionsUnless otherwise specified, the following definitions apply throughout Sections 8.7000-7500.
A. Case Manager is as defined in Section 8.7100.A.8.B. Case Management Agency is as defined in Section 8.7100.A.8.C. Certification means a determination made by the Department, after considering a recommendation from the state survey Agency, that a Provider Agency is compliant with applicable Department statutes, rules, and program requirements for specific Home and Community-Based Services.D. Contractor is as defined at 8.7001.A.1-B.E. Department is as defined in Section 8.7200.B.14F. Direct Care Worker means a non-administrative employee or independent Contractor of a Provider Agency or Consumer Directed Attendant Support Services employer who provides hands-on care, services, and support to older adults and individuals with disabilities across the Long-Term Services and Supports continuum within Home and Community-Based settings.G. Discrimination is defined at Section 8.7001.A.3.H. Guardian is as defined at Section 8.7001.A.3-B.I. Health First Colorado means the state Medicaid program providing public health insurance for qualifying Coloradans.J. Home and Community-Based Services Waivers are as defined at Section 8.7100.A.35.K. An Incident means an event or occurrence that may endanger or negatively impact the mental and/or physical well-being of a Member.L. Intellectual and Developmental Disability is as defined at Section 8.7100.A.40.M. Legally Authorized Representative is as defined at Section 8.7001.A.7.N. Member is as defined at Section 8.7001.A.8-B.O. Medicaid means Health First Colorado, the Colorado state Medicaid program.P. Organized Health Care Delivery System (OHCDS) means a Case Management Agency that contracts with other qualified providers to furnish services authorized in any of the Home and Community-Based Services waivers. The OHCDS is the Medicaid provider of record for a Member whose services are delivered through the OHCDS.Q. Prior Authorization Request (PAR) is as defined at 8.7202.B.R. Protected Health Information (PHI) means individually identifiable health information, including, without limitation any information, whether oral or recorded in any form or medium that relates to the past, present or future physical or mental condition of an individual; the provision of healthcare to an individual; or the past, present or future payment for the provision of health care to an individual; and that identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual. Protected Health Information (PHI) includes, but is not limited to, any information defined as Individually Identifiable Health Information pursuant to 42 C.F.R. § 160.103.S. Provider Agency is as defined at Section 8.7001.A.12-B.T. Provider Care Plan means the documented approach the Provider Agency plans to take in the provision of services. The purpose of the Provider Care Plan is to outline the service(s) that will/is provided with corresponding functional goals and objectives that describes the need for the service and the anticipated benefit to the Member. The Provider Care Plan determines the focus of the services, while also documenting the scope, duration and frequency to which each service will be provided.U. Provider Participation Agreement is as defined at Section 8.7001.A.14-BV. Provider Specialty means a service that an HCBS Provider Agency may deliver and be reimbursed for upon meeting the service-specific qualifications and enrolling through the Department's Fiscal Agent.W. Telehealth means the provision of health care remotely using telecommunications technologies to provide approved services and supports through HCBS waivers when the Member is in a different location from the provider.47 CR 03, February 10, 2024, effective 3/16/202447 CR 21, November 10, 2024, effective 11/30/2024