Habilitative (neurodevelopmental) services Habilitative (neurodevelopmental) services are health care services that help you keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who isn't walking or talking at the expected age. These services may include physical and occupational therapy, speech- language pathology, and other services for people with disabilities in a variety of inpatient and/or outpatient settings. Health Care Authority (HCA) The Health Care Authority (HCA) is the Washington State agency that administers the Uniform Medical Plan (UMP Classic, UMP Select, UMP CDHP, and the UMP Plus plans: UMP Plus–Puget Sound High Value Network and UMP Plus–UW Medicine Accountable Care Network), in addition to the following health care programs: Washington Prescription Drug Program, PEBB Program, SEBB Program, Behavioral Health and Recovery, and Apple Health (also known as Medicaid). Health intervention Health intervention is a prescription drug, service, or supply provided to prevent, diagnose, detect, treat, or palliate the following: disease, illness, injury, genetic or congenital anomaly, pregnancy, or biological or psychological condition that lies outside the range of normal, age-appropriate human variation. A health intervention may also maintain or restore functional ability. A health intervention is defined not only by the intervention itself, but also by the medical condition and patient indications for which it is being applied. A health intervention is new if it is not yet in widespread use for the medical condition and the patient indications being considered. Health outcomes Health outcomes are results that affect health status as measured by the length or quality (primarily as perceived by the member) of a person’s life. High-cost generic drug High-cost generic drug is a generic prescription drug (see the definition of “Generic drug”) that the plan covers under Tier 2 (see the “What you pay for prescription drugs” section). Home health agency A home health agency is an agency or organization that: • Provides a program of home health care; • Practices within the scope of its license as a provider of home health services; and • Is Medicare-certified, accredited by the Joint Commission on Accreditation of Healthcare Organizations, or a network provider. Hospice Hospice is services provided by a state-licensed hospice program in the member’s home or in a hospice facility to terminally ill members. Hospice care includes services such as pain care relief for terminally ill members without the intent to cure, and support services for their families. 176 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage