Sentences with phrase «health plan operations»

Quality Management Officer for quality planning, quality assurance, quality control, and continuous quality improvement for all health plan operations.

Not exact matches

Such risks and uncertainties include, but are not limited to: our ability to achieve our financial, strategic and operational plans or initiatives; our ability to predict and manage medical costs and price effectively and develop and maintain good relationships with physicians, hospitals and other health care providers; the impact of modifications to our operations and processes; our ability to identify potential strategic acquisitions or transactions and realize the expected benefits of such transactions, including with respect to the Merger; the substantial level of government regulation over our business and the potential effects of new laws or regulations or changes in existing laws or regulations; the outcome of litigation, regulatory audits, investigations, actions and / or guaranty fund assessments; uncertainties surrounding participation in government - sponsored programs such as Medicare; the effectiveness and security of our information technology and other business systems; unfavorable industry, economic or political conditions, including foreign currency movements; acts of war, terrorism, natural disasters or pandemics; our ability to obtain shareholder or regulatory approvals required for the Merger or the requirement to accept conditions that could reduce the anticipated benefits of the Merger as a condition to obtaining regulatory approvals; a longer time than anticipated to consummate the proposed Merger; problems regarding the successful integration of the businesses of Express Scripts and Cigna; unexpected costs regarding the proposed Merger; diversion of management's attention from ongoing business operations and opportunities during the pendency of the Merger; potential litigation associated with the proposed Merger; the ability to retain key personnel; the availability of financing, including relating to the proposed Merger; effects on the businesses as a result of uncertainty surrounding the proposed Merger; as well as more specific risks and uncertainties discussed in our most recent report on Form 10 - K and subsequent reports on Forms 10 - Q and 8 - K available on the Investor Relations section of www.cigna.com as well as on Express Scripts» most recent report on Form 10 - K and subsequent reports on Forms 10 - Q and 8 - K available on the Investor Relations section of www.express-scripts.com.

In particular, the information provided in this press release may contain certain forward - looking statements with respect to the financial condition, results of operations and business of Centene and certain plans and objectives of Centene with respect thereto, including but not limited to the expected benefits of the acquisition of Health Net, Inc. («Health Net Acquisition»), New York State Catholic Health Plan, Inc., d / b / a Fidelis Care New York («Fidelis Care»)(«Proposed Fidelis Acquisition») or MHM Services, Inc. (the «Proposed MHM Acquisition»).

These risks and uncertainties include food safety and food - borne illness concerns; litigation; unfavorable publicity; federal, state and local regulation of our business including health care reform, labor and insurance costs; technology failures; failure to execute a business continuity plan following a disaster; health concerns including virus outbreaks; the intensely competitive nature of the restaurant industry; factors impacting our ability to drive sales growth; the impact of indebtedness we incurred in the RARE acquisition; our plans to expand our newer brands like Bahama Breeze and Seasons 52; our ability to successfully integrate Eddie V's restaurant operations; a lack of suitable new restaurant locations; higher - than - anticipated costs to open, close or remodel restaurants; increased advertising and marketing costs; a failure to develop and recruit effective leaders; the price and availability of key food products and utilities; shortages or interruptions in the delivery of food and other products; volatility in the market value of derivatives; general macroeconomic factors, including unemployment and interest rates; disruptions in the financial markets; risk of doing business with franchisees and vendors in foreign markets; failure to protect our service marks or other intellectual property; a possible impairment in the carrying value of our goodwill or other intangible assets; a failure of our internal controls over financial reporting or changes in accounting standards; and other factors and uncertainties discussed from time to time in reports filed by Darden with the Securities and Exchange Commission.

Mr. Chabot is fluent in French and English and has a wealth of experience in developing advanced - stage projects, including permitting, environmental management, project evaluation, operation start - up, reserve evaluation, mine planning, health and safety, and budget control.

Beginning in April 2018, Americares emergency planning specialists will be working with health care providers in Texas serving vulnerable populations to complete detailed after - action reports on the impact of Hurricane Harvey on their clinical operations and make recommendations for future performance.

There are health issues that result from the operation, significantly more so than a planned vaginal delivery.»

As of Feb. 1, the Essential Plan had signed up 379,559 members for its first year of operation, according to a report released Friday by New York State of Health, the state's Affordable Care Act exchange.

The Ulster County planning board's response to the application reflected a similar uncertainty, requesting verification of the proposed use and stating that a permit for operation as a campground may be required from the county's health department.

Spending reductions are split roughly even between state operations ($ 474 million) and local assistance ($ 412 million, which includes freezing planned increases in payments to health and social service providers.)

Connie then goes on to tell the e-mail recipients, who identified themselves to Obama's political operation as «seniors,» that «President Obama's plan for health insurance is good for seniors» and lists five major reasons to justify her claim.

State operations, local governments, schools, and health care facilities will be hard hit in the Governor's latest plan.

It provides support to school districts on facilities planning, finance, operations, maintenance, and health issues through its website, technical assistance, and training.

Rhonda's most recent role was leading Human Resources operations for 13 years at CareOregon, a nonprofit involved in Medicaid / Medicare health plan services, reforms and innovations.

The U.S. Department of Agriculture's Animal Plant Health Inspection Service (APHIS) plans to outsource to private parties the inspections required for operations regulated by the Animal Welfare Act, including puppy mills, animal exhibitions, and animal research labs.

Overseer Beryl R. Benacerraf, M.D., who has great expertise in developing efficient operations in health care settings, is working with the staff to develop a new operating plan based on best practices.

My estate planning practice includes drafting documents including wills, revocable trusts, powers of attorney, health care directives, pre - and post-marital agreements, irrevocable life insurance trusts (ILITs), intentional defective grantor trusts (IDGTs), grantor retained annuity trusts (GRATs), all types of partnership agreements and documents related to the formation and operation of limited liability companies (LLCs).

In response to the Commission for Social Care Inspection's recent review of the operation of eligibility criteria in England, the Department of Health says it intends to «rework» the Fair Access to Care Services (FACS) guidance, with public consultation planned for spring 2009.

Mr. Wasserman served as General Counsel & Vice President for four years at CarePlus Health Plan, a NYC - based health maintenance organization where he was responsible for the oversight of all internal and external legal operations, including, without limitation, the general corporate affairs and regulatory complHealth Plan, a NYC - based health maintenance organization where he was responsible for the oversight of all internal and external legal operations, including, without limitation, the general corporate affairs and regulatory complhealth maintenance organization where he was responsible for the oversight of all internal and external legal operations, including, without limitation, the general corporate affairs and regulatory compliance.

Accreditation organizations are performing health care operations functions on behalf of health plans and covered health care providers.

Under the NPRM and the final rule, plans, providers and clearinghouses are only required to account for disclosures that are not for treatment, payment, and health care operations, a small minority of all disclosures.

Instead, in the final rule, health care operations are the enumerated activities to the extent that the activities are related to the covered entity's functions as a health care provider, health plan or health care clearinghouse, i.e., the entity's «covered functions.»

Most operations of the group health plan are contracted out to other entities or are carried out by employees of the employer who sponsors the plan.

For larger health care entities such as hospitals and health plans, the Department assumed that the complexity of their operations would require them to seek more customized assistance from outside council or consultants.

Because employees of the plan sponsor often perform health care operations and payment (e.g. plan administration) functions, such as claims payment, quality review, and auditing, they may have legitimate need for such information.

If a covered health care provider with an indirect treatment relationship, a health plan, or a health care clearinghouse does not seek consent, the covered entity may use or disclose protected health information to carry out treatment, payment, and health care operations as otherwise permitted under the rule and consistent with its notice of privacy practices (see § 164.520 regarding notice requirements and § 164.502 (i) regarding requirements to adhere to the notice).

We note that when a plan sponsor has several different group health plans, or when such plans provide insurance or coverage through more than one health insurance issuer or HMO, the covered entities may jointly engage in this type of analysis as a health care operation of the organized health care arrangement.

We expect that in most cases, government agencies that run health plans or provide health care services would typically meet the definition of a «hybrid entity» under § 164.504 (a), so that such an agency would be required to designate the health care component or components that run the program or programs in question under § 164.504 (c)(3), and the rules would not apply to the remainder of the agency's operations, under § 164.504 (b).

In the final rule we have not required that health plans or health care clearinghouses obtain consent for their uses and disclosures of protected health information for treatment, payment, or health care operations.

We revise the final rule to clarify that health plans may conduct population based care management programs as a health care operation activity.

Response: As explained above, under § 164.506 (a)(4), health plans and other covered entities may seek the individual's consent for the covered entity's use and disclosure of protected health information to carry out treatment, payment, or health care operations.

For example, a health plan's application for enrollment may include a consent for the health plan to use or disclose protected health information to carry out treatment, payment, and / or health care operations.

They expressed the concern that limiting health care operations to the underwriting and rating of existing members places a health plan in the position of not being able to evaluate prudently and underwrite a consumer's health care risk.

If the employer sponsors more than one group health plan, or if its group health plan provides coverage through more than one health insurance issuer or HMO, the different covered entities may be an organized health care arrangement and be able to jointly participate in such an analysis as part of the health care operations of such organized health care arrangement.

We limit the employees of the plan sponsor who may receive protected health information to those employees performing plan administration functions, as that term is understood with respect to ERISA compliance, and as limited by this rule's definitions of payment and health care operation.

Comment: Several commenters argued that many activities that are integral to the day - to - day operations of a health plan have not been included in the definition.

The component of the plan sponsor would have been able to use protected health information for treatment, payment, and health care operations, but not for other purposes, such as discipline, hiring and firing, placement and promotions.

Instead, we describe the activities that constitute health care operations in broad terms and categories, such as «quality assessment» and «business planning and development.»

One commenter offered the position that disease management services are more closely aligned with treatment because they involve the coordination of treatment whereas health care operations are more akin to financial and ministerial functions of plans.

Any employee of the plan sponsor who receives protected health information for payment, health care operations or other matters related to the group health plan must be identified in the plan documents either by name or function.

Many activities included in the definitions of health care operations and payment are commonly referred to as plan administration functions in the ERISA group health plan context.

In the final rule, we do not change the general approach of defining health care operations: health care operations are the listed activities undertaken by the covered entity that maintains the protected health information (i.e., one covered entity may not disclose protected health information for the operations of a second covered entity); a covered entity may use any protected health information it maintains for its operations (e.g., a plan may use protected health information about former enrollees as well as current enrollees); we expand the proposed list to reflect many changes requested by commenters.

The rule grants individuals the right to receive an accounting of disclosures made by a health care provider or plan for purposes other than treatment, payment, or health care operations, with certain exceptions such as disclosures to the individual.

Because the definition of «health plan» excludes many types of insurance products (in the exclusion under paragraph (2)(i) of the definition), we would consider an entity that has one or more of these lines of insurance in addition to its health insurance lines to come within the definition of «hybrid entity,» because the other lines of business constitute substantial parts of the total business operation and are required to be separate from the health plan (s) part of the business.

In their comments on our proposed rule, numerous organizations representing health plans, health providers, employers, and others acknowledged the value of a set of national privacy standards to the efficient operation of their practices and businesses.

Although not addressed in the proposed rule, this final rule also recognizes that a covered entity may as a single legal entity, affiliated entity, or other arrangement combine the functions or operations of health care providers, health plans and health care clearinghouses (for example, integrated health plans and health care delivery systems may function as both health plans and health care providers).

Many services, such as a refill reminder communication or nursing assistance provided through a telephone service, are considered treatment activities if performed by or on behalf of a health care provider, such as a pharmacist, but are regarded as health care operations if done on behalf of a different type of entity, such as a health plan.

Again, coordinating health care operations among these entities may be necessary to serve the participants and beneficiaries in the group health plans.

Under § 164.506 (a)(4), covered health care providers that have an indirect treatment relationship with an individual, as well as health plans and health care clearinghouses, may elect to seek consent for their own uses and disclosures to carry out treatment, payment, and health care operations.

The same activity performed by a nurse working for a health plan would be a health care operation.