Introducing MIIA's Custom Network
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Emergency Behavioral Health Services
ALERT #24 ___________________ October 5, 2007 EMERGENCY BEHAVIORAL HEALTH SERVICES POLICIES AND PROCEDURES FOR EMERGENCY SERVICES PROGRAMS AND HOSPITAL EMERGENCY DEPARTMENTS FOR MBHP MEMBERS AND UNINSURED CONSUMERS The following information should be communicated immediately to other appropriate staff in your organization. The Massachusetts Behavioral Health Partnership (MBHP) is the company that manages behavioral health (mental health and substance abuse) services for MassHealth’s Primary Care Clinician (PCC) Plan Members*. Additionally, MBHP is contracted with the Department of Mental Health to manage most of the Emergency Services Programs (ESPs) across the Commonwealth. In that role, MBHP is issuing this Alert to hospital Emergency Departments (EDs), MBHP network providers, and other interested stakeholders in order to provide clarification and guidance relative to the management of behavioral health emergencies in the ED setting. More specifically, this Alert delineates the roles and responsibilities of the Emergency Services Programs (ESPs) and describes an individual’s progression through this system, with a goal of expediting his or her movement through the hospital ED and into acute behavioral health services, as medically necessary. ESPs function as a “safety net” for all citizens of the Commonwealth regardless of age, payer, or ability to pay. It is important to note that the policies and procedures in this Alert applies to those populations for whom the ESPs are contracted with MBHP to serve, which includes MBHP members, MassHealth (non-MCO enrolled) Members, uninsured consumers, and DMH consumers. However, it is also important to note that MassHealth also requires the four Managed Care Organizations (MCOs) contracted with MassHealth to utilize the ESP system for emergency behavioral health services for MassHealth MCO enrolled Members. -
Community Choice Acute Care Hospital Listing Effective July 1, 2017 When You Use a Community Choice Hospital, You Pay a $275 Inpatient Copay Per Calendar Quarter
UNICARE STATE INDEMNITY PLAN Community Choice Acute Care Hospital Listing Effective July 1, 2017 When you use a Community Choice hospital, you pay a $275 inpatient copay per calendar quarter. Community Choice members can also use additional hospitals for the same $275 copay for certain complex procedures and neonatal ICUs. To look for hospitals, go to unicarestateplan.com and, under the Quick Links tab on the Members page, select Look for health care providers. When you use non-Community Choice hospitals, your out-of-pocket costs are higher. Addison Gilbert Hospital Lawrence Memorial Hospital Anna Jaques Hospital Leominster Hospital (UMass Memorial) Athol Memorial Hospital Leonard Morse Hospital Baystate Franklin Medical Center Lowell General Hospital Baystate Medical Center Mary Lane Hospital (Baystate) Berkshire Medical Center Massachusetts Eye and Ear Beth Israel Deaconess Medical Center – Boston Melrose-Wakefield Hospital Beverly Hospital Mercy Medical Center Brockton Hospital Merrimack Valley Hospital Burbank Hospital (UMass Memorial) Milford Regional Medical Center Cambridge Hospital Milton Hospital (Beth Israel Deaconess) Cape Cod Hospital Morton Hospital Carney Hospital Mount Auburn Hospital Charlton Memorial Hospital Nashoba Valley Medical Center Children’s Hospital Boston Needham Hospital (Beth Israel Deaconess) Cooley Dickinson Hospital New England Baptist Hospital *Dana-Farber Cancer Institute (Boston location only) Noble Hospital (Baystate) Emerson Hospital Norwood Hospital Everett Hospital (formerly Whidden Hospital) Plymouth -
Health Care in Massachusetts: Key Indicators
DHCFP Health Care in Massachusetts: Key Indicators November 2008 Deval L. Patrick, Governor JudyAnn Bigby, Secretary Commonwealth of Massachusetts Executive Office of Health and Human Services Timothy P. Murray Sarah Iselin, Commissioner Lieutenant Governor Division of Health Care Finance and Policy Introduction About this Report Table of Contents Health Care in Massachusetts: Key Indicators is a quarterly report from the Division of Health Care Finance and Policy. Key Indicators provides an overview of the Massachusetts health care landscape through data reported by providers, health plans, government, and surveys of Massachusetts residents and employers. The Division received positive feedback from readers of prior editions of this report and has incorporated suggestions for improvement where possible. We continue Health Insurance Coverage 2 to strive to make this report as useful as possible and welcome your feedback. In this edition of Health Care in Massachusetts: Key Indicators, the Division found that since the implementation of Employer Survey 4 health reform over 442,000 additional people have obtained health insurance. Nearly half of that growth (187,000) has been in private group coverage (i.e., through employers) or individual purchase. In the first six months of the Health Uncompensated Care Pool/ Safety Net, volume in hospitals and community health centers decreased by 36% compared to the same period in the prior year. Payments decreased by 38% over the same period. This edition also includes updates of the following: Health Safety Net 7 cost trends in health insurance premiums compared to the Commonwealth Health Insurance Connector Authority’s affordability schedule for 2008, health plan financial performance, hospital financial performance, and other indica- Health Insurance Premiums 11 tors of health care in Massachusetts. -
Lawrence General Hospital
Massachusetts Hospital Payment Variation 2015 2016 Share of # Hospital Relative Relative Commercial MA Acute Hospital Commercial Relative Price (Weighted Average 2016) Price Price Payments Statewide Results Published By CHIA February 2018 1 Baystate Noble 0.681 0.682 0.2% Baystate Noble Hospital 2 Holyoke Medical Center 0.722 0.728 0.2% Holyoke Medical Center 3 Lawrence General 0.754 0.736 0.4% Lawrence General Hospital 4 Anna Jaques 0.756 0.743 0.5% Anna Jaques Hospital 5 Baystate Wing 0.749 0.752 0.2% Baystate Wing Hospital 6 Cambridge Health Alliance 0.797 0.754 0.6% Cambridge Health Alliance 7 BIDH - Milton 0.760 0.757 0.4% Beth Israel Deaconess- Milton 8 Massachusetts Eye & Ear 0.833 0.760 Massachusetts Eye & Ear 9 Heywood Hospital 0.752 0.763 0.4% Heywood Hospital 10 Signature Brockton 0.785 0.787 0.7% Signature Brockton Hospital 11 Mercy Medical Center 0.806 0.796 0.6% Mercy Medical Center 12 HealthAlliance 0.781 0.804 0.4% HealthAlliance Hospital 80% of Average 13 Emerson 0.846 0.824 1.1% Emerson Hospital 14 Steward Morton 0.855 0.837 0.4% Steward Morton Hospital 15 Milford Regional 0.840 0.840 1.1% Milford Regional Medical Center 16 Lowell General 0.822 0.850 1.6% Lowell General Hospital 85% of Average 17 Northeast Beverly 0.867 0.851 1.3% Northeast Hospital 18 MetroWest 0.856 0.853 1.0% MetroWest Medical Center 19 Steward Holy Family 0.859 0.857 0.7% Steward Holy Family Hospital 20 Winchester Hospital 0.892 0.865 1.6% Beth Israel Deaconess - Plymouth 21 BIDH - Plymouth 0.861 0.865 0.8% Winchester Hospital Underpaid Hospitals -
Masshealth Enrollment Guide Your Choices Starting JULY 2021
MassHealth Enrollment Guide Your Choices Starting JULY 2021 LEARN about health plans COMPARE health plans ENROLL in a health plan COMMONWEALTH OF MASSACHUSETTS | Executive Office of Health and Human Services We are here to help We speak your language If you need an interpreter or translation help, please call the MassHealth Customer Service Center. Questions? www.mass.gov/masshealth MassHealth Customer Service Center (800) 841-2900 TTY: (800) 497-4648 for people who are deaf, hard of hearing, or speech disabled. Monday–Friday 8:00 a.m.–5:00 p.m. Hello and welcome MassHealth is the Medicaid program in Massachusetts. We have health plans to choose from so you can get the health care you need. Please read this guide to learn about the plans and choose the one that’s best for you. This guide will help you... Learn Learn about the health plans available in your area and how to choose a provider. Compare Compare health plans in your area and choose the one that’s right for you. Enroll Enroll in a health plan or change to a different health plan. Let’s enroll in a health plan. i Is this guide for you? Certain members in the MassHealth program will need to enroll in a health plan. Use this guide if you ■ Are under 65 ■ Do not have other insurance (including Medicare) ■ Live in the community (for example, not in a nursing facility), and ■ Are in MassHealth Standard, CommonHealth, CarePlus, or Family Assistance. For information about MassHealth coverage, visit www.mass.gov/masshealth. Members described below are not eligible for the health plan options described in this guide. -
Fallonhealth.Org Find Your Doctor
Your Network Get more choice with Select Care NETW O O M R H K D H A O S E R L B E SC C T H C E A R What you get • Greater choice at a competitive price. • Access to an expansive network that includes physician practices, community-based hospitals and medical facilities across the Commonwealth and southern New Hampshire. • Plus, worldwide emergency coverage! Please see the back of this insert for a full listing of participating Massachusetts, New Hampshire and Vermont hospitals in Select Care. Participating hospitals Select Care service area fallonhealth.org Find your doctor Just visit fallonhealth.org and follow these simple steps: • Click on “Find a doctor” in the members section, or on the home page. • Click on “Search our regional networks.” If you are looking for a specific provider, type his/her last name. Once you start typing, you will be given a list of providers to choose from. Within the search results, you will see if the provider accepts Select Care. • If you don’t have a particular provider in mind, you can use the advanced search option to search by ZIP code to find a provider convenient to you. You can use this advanced search option for specialists as well as for primary care providers. We update the provider listing on fallonhealth.org every day, so you can trust that you are seeing the most up-to-date information. You can also call our Customer Service Department to have a representative help you find the doctor you’re looking for. -
Inpatient Hospital Discharge Database Documentation Manual
Division of Health Care Finance and Policy Fiscal Year 2005 Inpatient Hospital Discharge Database Documentation Manual DATA ISSUED MAY 2006 Division of Health Care Finance and Policy Two Boylston Street Boston, Massachusetts 02116-4704 http://www.mass.gov/dhcfp General Documentation FY2005 Inpatient Hospital Discharge Database Table of Contents Page Introduction 1 Compact Disk (CD) File Specification 2 SECTION I. GENERAL DOCUMENTATION 3 PART A. BACKGROUND INFORMATION 4 1. General Documentation Overview 4 2. Quarterly Reporting Periods 5 3. Development of the FY05 HDD Database 6 4. DRG Grouper Methodology 7 PART B. DATA 10 1. Data Quality Standards 11 2. General Definitions 13 3. General Data Caveats 14 4. Specific Data Elements 16 a. Existing Data Elements 16 b. New Data Elements 19 c. Important Note Regarding Use of Race Code 21 d. DHCFP Calculated Fields 22 PART C. HOSPITAL RESPONSES 23 1. Summary of Hospitals’ FY05 Verification Report Responses 24 2. List of Error Categories 30 3. Summary of Reported Discrepancies by Category 31 4. Index of Hospitals Reporting Data Discrepancies 34 5. Individual Hospital Discrepancy Documentation 35 PART D. CAUTIONARY USE HOSPITALS 46 PART E. HOSPITALS SUBMITTING DATA FOR FY05 48 1. List of Hospitals Submitting Data for FY2005 49 2. Hospitals with No Data Submissions for FY2005 51 3. Discharge Totals and Charges by Quarter 52 MA DIVISION OF HEALTH CARE FINANCE & POLICY – MAY, 2006 i General Documentation FY2005 Inpatient Hospital Discharge Database Table of Contents Page PART F. SUPPLEMENTARY INFORMATION 61 Supplement I – List of Type A and Type B Errors 62 Supplement II – Content of Hospital Verification Report Package 64 Supplement III – Hospital Addresses, DPH ID, ORG ID 65 & Service Site Numbers Supplement IV – Mergers, Name Changes, Closures, Conversions, 71 and Non-Acute Care Hospitals Supplement V – Alphabetical Source of Payment List 78 Supplement VI – Numerical Source of Payment List 86 SECTION II. -
Wayfair Preferred (Narrow) Network Plan Hospitals
Wayfair Preferred (Narrow) Network Hospitals Hospital Name City State Addison Gilbert Hospital Gloucester MA Anna Jaques Hospital Newburyport MA BayRidge Hospital (acute psychiatric hospital) Lynn MA Beth Israel Deaconess Medical Center—Boston Boston MA Beth Israel Deaconess Hospital—Milton Milton MA Beth Israel Deaconess Hospital—Needham Campus Needham MA Beth Israel Deaconess Hospital—Plymouth Plymouth MA Beverly Hospital Beverly MA Boston Children’s Hospital Boston MA Boston Medical Center Boston MA Brigham and Women’s/Mass General Health Care Center at Patriot Place Foxborough MA Cambridge Health Alliance—Cambridge Campus Cambridge MA Cambridge Health Alliance—Somerville Campus Somerville MA Cambridge Health Alliance—Whidden Campus Everett MA Carney Hospital Dorchester MA Clinton Hospital Clinton MA Cooley Dickinson Hospital Northampton MA Emerson Hospital Concord MA Faulkner Hospital Jamaica Plain MA Good Samaritan Medical Center Brockton MA HealthAlliance Hospitals—Burbank Campus Fitchburg MA HealthAlliance Hospitals—Leominster Campus Leominster MA Heywood Hospital Gardner MA Holyoke Medical Center Holyoke MA Lahey Hospital and Medical Center Burlington MA Hospital Name City State Lahey Medical Center Peabody MA Lawrence General Hospital Lawrence MA Lawrence Memorial Hospital Medford MA Lowell General Hospital (includes the campus Lowell MA formerly known as Saints Medical Center) Massachusetts Eye and Ear®´ Infirmary Boston MA Mass General/North Shore Center for Outpatient Care Danvers MA Melrose-Wakefield Hospital Melrose MA Mercy -
Health Care System ACUTE INPATIENT HOSPITALS
A B C D E 1 ACUTE INPATIENT HOSPITALS PARTICIPATING IN MASSHEALTH (June 2021) Has Inpatient 2 Health Care System Acute Inpatient Hospital Town Psychiatric Unit? 3 Beth Israel Lahey Health Anna Jaques Hospital Newburyport X 4 Heywood Healthcare Athol Hospital Athol 5 Baystate Health Baystate Franklin Medical Center Greenfield X 6 Baystate Health Baystate Medical Center Springfield X 7 Baystate Health Baystate Noble Hospital Westfield X 8 Baystate Health Baystate Wing Hospital Palmer X 9 Berkshire Health Systems Berkshire Fairview Hospital Great Barrington 10 Berkshire Health Systems Berkshire Medical Center Pittsfield X 11 Beth Israel Lahey Health Beth Israel Deaconess Hospital - Milton Milton 12 Beth Israel Lahey Health Beth Israel Deaconess Hospital - Needham Needham 13 Beth Israel Lahey Health Beth Israel Deaconess Hospital - Plymouth Plymouth X 14 Beth Israel Lahey Health Beth Israel Deaconess Medical Center Boston X 15 Beth Israel Lahey Health Beverly Hospital (aka Northeast Health) Beverly X 16 Boston Children's Hospital Boston X 17 Boston Medical Center Boston 18 MassGeneralBrigham Brigham & Women's Hospital Boston 19 MassGeneralBrigham Brigham and Women's Faulkner Hospital Boston X 20 Cambridge Health Alliance Cambridge Hospital Cambridge X 21 Cape Cod Healthcare Cape Cod Hospital Hyannis X 22 Steward Health Care Carney Hospital Boston X 23 MassGeneralBrigham Cooley Dickinson Hospital Northampton X 24 Dana Farber Cancer Institute Boston 25 Emerson Hospital Concord X 26 Cambridge Health Alliance Everett Hospital Everett X 27 Cape -
CHA Fact Sheet FY20.Indd
CHA FY20 Fact Sheet About Cambridge Health Alliance Cambridge Health Alliance (CHA) is a vibrant, innovative health system dedicated to providing essential services to all members of the community. With 140,000 patients in Cambridge, Somerville, and Boston’s Metro North region, CHA is a local provider of choice for primary care, specialty care, emergency services, hospital care, maternity care and behavioral health. CHA patients receive high quality care in convenient neighborhood locations and have seamless access to advanced care through CHA’s affiliations with Beth Israel Deaconess Medical Center (BIDMC) and Mass. General Hospital for Children (MGHfC). CHA’s community commitment extends beyond serving its patients. CHA operates the Cambridge Public Health Department and collaborates with many local agencies and organizations to improve the health of local residents. It also provides a vital safety net for underserved populations facing barriers to care. As a Harvard Medical School, Harvard School of Public Health, Harvard School of Dental Medicine and Tufts University School of Medicine teaching hospital, CHA trains the health care providers of tomorrow. Fiscal Year 2020 CHA Components Key Statistics • 2 hospitals – Cambridge and Everett – Discharges ………………………………………… 9,853 each with 24-hour emergency services Patient Days ……………………………………… 56,184 • Urgent Care at Somerville Campus Avg. LOS (in days) ……………………………… 5.40 ED Visits ……………………………………………85,052 • 13 primary care practices and 3 Teen Ambulatory Visits ………………………… 772,184 Health Centers Births ……………………………………………………… 1,130 • Cambridge Public Health Department Research • CHA Physicians Organization (CHAPO) # of research grant applications • CHA Foundation submitted ……………………………………………………38 Active/funded research grants …………… 50 Delivery System Primary Service Area Research expenditures …………… $6,014,315 Cambridge, Somerville, Malden, Medford, Chelsea, Revere, Everett and Winthrop, MA. -
Table of Contents
Fallon Medicare Plus™ Central HMO Plan Provider Directory This directory is current as of September 2, 2021. This directory provides a list of Fallon Medicare Plus Central’s current network providers. This directory is for the Fallon Medicare Plus Central service area which includes all of Worcester County. To access Fallon Medicare Plus Central’s online provider directory, you can visit fallonhealth.org/medicare. For any questions about the information contained in this directory, please call our Customer Service Department at 1-800-325-5669, 8 a.m.–8 p.m., Monday–Friday (Oct. 1–March 31, seven days a week). TTY users should call TRS 711. This document may be available in an alternate format such as braille, larger print, or audio. For more information call our Customer Service Department at 1-800-325-5669. Issued: September 8, 2021 Table of contents Notice of nondiscrimination ................................................................................................................... ii Multi-language interpreter services ....................................................................................................... iii Section 1: Introduction What is the service area for Fallon Medicare Plus Central? ................................................................... v How do you find Fallon Medicare Plus Central providers that serve your area? .................................... v Section 2: List of Network Providers Primary care (PCPs) ............................................................................................................................. -
THC Massachusetts
THC Massachusetts TENET HEALTHCARE CORPORATION (THC) Key/Legend Organizational Chart Effective 1/1/17 * These three entities have general payer contracting responsibilities for the healthcare providers affiliated with for purposes of HPC RPO Program THC, and may, therefore depending on the nature of a Vanguard Health Systems, Inc. particular payer contract, undertake contracting activities Health Services Network on behalf of the Massachusetts entities. Hospitals, Inc. * ** NEQCA contracts for the MetroWest PO physicians and Vanguard Health Holding the MWPS, who are part of the AHO. Company I, LLC (Holdco I) *** CMIPA contracts with certain physicians of SVPS National ASC, Inc.* Tenet Florida, Inc. Non-Clinical Non THC Entity Vanguard Health Holding Company II, LLC (Holdco II) Clinical 3rd-party Contracting Entity National Urgent Care, Inc. * Vanguard Health Management, Inc. New England Quality Care CMIPA, Inc. (non-THC Alliance, Inc. (non-THC Vanguard Health Financial Entity/Contracting) Entity/Contracting) Company, LLC (CMIPA) *** (NEQCA) ** VHS Acquisition Subsidiary Number 7, Inc. MetroWest Healthcare VHS Acquisition Subsidiary Number 9, Inc. d/b/a Saint Vincent Hospital Alliance, Inc. (non-THC d/b/a MetroWest Medical Center (SVH) Entity/PO) (MWMC) 24% 50% 50% Ownership Ownership Ownership MetroWest Accountable Healthcare Saint Vincent Physician Total Accountable Care VHM Services, Inc. d/b/a Organization, LLC Services, Inc. d/b/a Saint Organization, LLC d/b/a 76% Ownership MetroWest Physician (AHO) Vincent Medical Company Collaborative Health ACO Services (MWPS) (SVPS) (ACO) Additional subsidiary detail continued on slide 2 Note: The Hospitals and Physician Services entities consolidate their reporting to CHIA and the HPC for purposes of the annual cost hearings and submit the information under the name of Tenet Healthcare Northeast Region (TNR).