Thursday, May 16, 2013

What is Interdisciplinary Care Team, Medical Group, participating physician

“Interdisciplinary Care Team” or “ICT” refers to interdisciplinary services provided by a
treatment team in which all of its members participate in a coordinated effort to benefit the patient
and the patient’s significant others and caregivers. Interdisciplinary services, by definition, cannot
be provided by only one discipline. Though individual members of the interdisciplinary team work
within their own scopes of practice, each professional is also expected to coordinate his or her
efforts with team members of other specialties, as well as with the patient and the patient’s
significant others and caregivers. The purpose of the interdisciplinary team is to foster frequent,
structured, and documented communication among disciplines to establish, prioritize, and achieve
treatment goals

“MA Organization” means a public or private entity organized and licensed by a State as a riskbearing entity (with the exception of provider-sponsored organization receiving waivers) that is
certified by CMS as meeting the MA contract.

“Medicaid” is a joint Federal and State program that provides health coverage for selected
categories of people with low incomes. Its purpose is to improve the health of people who might
otherwise go without medical care for themselves. Medicaid is different in every state. In Florida,
the AHCA develops and carries out policies related to the Medicaid program.

“Medicaid Fiscal Agent” refers to the State Medicaid Program’s vendor contracted to serve as the
state’s fiscal agent. Some of the fiscal agent functions include: enroll non-institutional providers,
process Medicaid claims, serve as the enrollment broker for Medicaid recipients, and distribute
Medicaid forms and publications.

“Medical Director” means a physician contracted by the organization to provide consultation
regarding member policies and services.

“Medical Group” means a group of PCP and/or Specialist Physicians who:
(1) are formally organized as a partnership or professional corporation;
(2) provide for the diagnosis or direct care and treatment of a medical condition; and
(3) divide their income based on a specified, fixed formula.

“Medically Necessary” shall be determined by CarePlus’ Medical Director and shall include
consideration of whether services:
(1) are appropriate and necessary for the symptoms, diagnosis or treatment of a medical
(2) provide for the diagnosis or direct care and treatment of a medical condition; and
(3) are not primarily for the convenience of the Enrollee, the Enrollee’s attending or
consulting physician, or another healthcare provider.

“Participating Physician” means any physician licensed to practice in the State of Florida who
satisfies the participation criteria established by CAREPLUS and who has entered into a contractual
arrangement with, or is otherwise engaged by, CAREPLUS to provide physician services to

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