MCO. On an ongoing basis, if a Recipient was previously enrolled with a MCO and loses eligibility for a period of six (6) months or less, the Recipient will be re- enrolled with that MCO;
MCO. If the Recipient’s MCO is not a Centennial Care 2.0 MCO, then he/she will be auto assigned to a Centennial Care 2.0
MCO. ETO benefits may be used, but will not be considered 5 mandatory, for scheduled work days missed when a nurse is called 6 off, mandated to unschedule his/her shift or part thereof, or given 7 the option to go off the schedule any time within the nurse’s shift 8 due to low census, nursing unit closures (for example, on a holiday) 9 or low acuity. This includes nurses who may also receive stand-by 10 pay.
MCO. 3. If the Member’s Current MCO is not a Centennial Care 2.0 MCO and the Member fails to select a Centennial Care 2.0 MCO, the Member will be auto-assigned to a Centennial Care 2.0 MCO in the first auto-assignment cycle that begins December 1, 2018.
MCO. Not covered. Only available as an optional supplemental benefit under Medicare Advantage plans. (Medicare Managed Care Manual, 30.3)
MCO. Covers (for all persons 20 and older) annual tests to determine blood hemoglobin, blood pressure, blood glucose level, and blood cholesterol levels (low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels). (N.J.S.A.§26:2J- 4.6(a)1) (SSA §1905(a)13) For all persons 20 years of age and older, annual cardiovascular screenings are covered. More frequent testing is covered when determined to be medically necessary. Covered for services rendered beyond Medicare Part B limits. Covered. Part B. Covers screenings for cholesterol, lipid, and triglyceride levels once every 5 years. No copay or coinsurance. Part B deductible does not apply. Members generally pay 20% of the Medicare-approved amount for the doctor’s visit itself. (42 CFR §410.17) Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability. Chiropractic Services Covered. MCO. Categorically Needy. Covers manipulation of the spine which the chiropractor is legally authorized by the State to perform. The chiropractor may prescribe certain services as outlined in N.J.A.C. Covers manipulation of the spine, as well as certain services as outlined in N.J.A.C. 10:68-2, such as clinical laboratory services; certain medical supplies; durable medical equipment; pre- fabricated orthoses; *Covered. Part B. *Limited services provided to correct subluxation when deemed medically necessary. --Does not cover x-rays or any other diagnostic or therapeutic services furnished or ordered by a chiropractor. Member pays 20% of Medicare-approved amount. The Part B deductible applies. (42 CFR §410.21(b)) Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability. §10:68-2. physical therapy (N.J.A.C. §10:49- services; and
MCO. (Except for ABD population. FFS for the Aged, Blind, and Disabled). Covers a minimum of 60 home care visits during any contract year. (N.J.A.C. §10:49- 5.2(a)8) FFS for the ABD population. (N.J.A.C. §10:49- 5.2(b)14). Coverage includes nursing services by a registered nurse and/or licensed practical nurse; home health aide service; medical supplies and equipment, and appliances suitable for use in the home; audiology services; physical therapy; speech- *Covered. Parts A & B. *Limited to medically necessary part-time or intermittent skilled nursing care, physical therapy, speech-language pathology, or a continuing need for occupational therapy. May include medical social services, home health aide services, durable medical equipment, and certain medical supplies. Members must meet a specific set of criteria to be eligible. Members pay 20% of the Medicare- approved amount for covered medical equipment. Any applicable cost sharing is covered by Categorically Needy. (N.J.A.C. §11:24- 5.2(a)19) language pathology; and occupational therapy. Home Health Agency Services must be provided by a home health agency that is licensed through the Department of Health as a home health agency and meets Medicare participation requirements. Covered for services rendered beyond Medicare Parts A & B limits. the Medicaid benefit. Members have $0 cost sharing liability.
MCO. Covers semi- private room accommodations; Covers stays in critical access hospitals; inpatient rehabilitation facilities; inpatient mental health care; semi-private Covered. Part A. Includes stay in critical access hospitals, inpatient rehabilitation facilities, inpatient mental health care, and long-term care hospitals other than State- or County- operated psychiatric facilities. Does not cover private duty nursing. Includes a semi-private room (private rooms are only covered when deemed
MCO. A Medicaid managed care organization contracted with HHSC to provide health care services to Medicaid recipients.
