MCO Programs and Service Areas Clause Samples
The "MCO Programs and Service Areas" clause defines the specific programs managed by a Managed Care Organization (MCO) and the geographic regions where these programs are offered. It typically outlines which healthcare services are included under the MCO’s administration and identifies the counties, cities, or regions covered. For example, it may specify that certain Medicaid or Medicare plans are available only in designated service areas. This clause ensures clarity for both the MCO and contracting parties regarding the scope of services and locations, helping to prevent misunderstandings about coverage and responsibilities.
MCO Programs and Service Areas. This Contract applies to the following HHSC MCO Programs and Service Areas (check all that apply). All references in the Contract Attachments to MCO Programs or Service Areas that are not checked are superfluous and do not apply to the MCO. þ Medicaid STAR MCO Program Service Areas: þ Bexar o Medicaid RSA - Central o Dallas o Medicaid RSA - Northeast þ El Paso o Medicaid RSA - West ▇ ▇▇▇▇▇▇ þ Nueces ▇ ▇▇▇▇▇▇▇ ▇ ▇▇▇▇▇▇▇ o Jefferson þ ▇▇▇▇▇▇ þ Lubbock See Attachment B-4, “Map of Counties with MCO Program Service Areas,” for listing of counties included within the STAR Service Areas. þ Medicaid STAR+PLUS MCO Program Service Areas: þ Bexar o Jefferson o El Paso þ Lubbock ▇ ▇▇▇▇▇▇ þ Nueces ▇ ▇▇▇▇▇▇▇ o Travis See Attachment B-4.2, “Map of Counties with STAR+PLUS MCO Program Service Areas,” for listing of counties included within the STAR+PLUS Service Areas. þ CHIP MCO Program Service Areas: þ Bexar þ Lubbock o Dallas þ Nueces þ El Paso o Tarrant ▇ ▇▇▇▇▇▇ þ ▇▇▇▇▇▇ ▇ ▇▇▇▇▇▇▇▇▇ See Attachment B-4.1, “Map of Counties with MCO Program Service Areas,” for listing of counties included within the CHIP Service Areas. þ Medicaid STAR MCO Program Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the STAR Program. The following Rate Cells and Capitation Rates will apply to Rate Period 1: 1 TANF Child > 12 months *** 2 TANF child ≤ 12 months *** 3 TANF Adult *** 4 Pregnant Woman *** 5 Newborn ≤ 12 months *** 6 Expansion Child > 12 months *** 7 Expansion child ≤ 12 months *** 8 Federal Mandate child *** 9 Delivery Supplemental Payment *** 1 TANF Child > 12 months *** 2 TANF child ≤ 12 months *** 3 TANF Adult *** 4 Pregnant Woman *** 5 Newborn ≤ 12 months *** 6 Expansion Child > 12 months *** 7 Expansion child ≤ 12 months *** 8 Federal Mandate child *** 9 Delivery Supplemental Payment *** 1 TANF Child > 12 months *** 2 TANF child ≤ 12 months *** 3 TANF Adult *** 4 Pregnant Woman *** 5 Newborn ≤ 12 months *** 6 Expansion Child > 12 months *** 7 Expansion child ≤ 12 months *** 8 Federal Mandate child *** 9 Delivery Supplemental Payment *** 1 TANF Child > 12 months *** 2 TANF child ≤ 12 months *** 3 TANF Adult *** 4 Pregnant Woman *** 5 Newborn ≤ 12 months *** 6 Expansion Child > 12 months *** 7 Expansion child ≤ 12 months *** 8 Federal Mandate child *** 9 Delivery Supplemental Payment *** 1 TANF Child > 12 months *** 2 TANF c...
MCO Programs and Service Areas. This Contract applies to the following HHSC MCO Programs and Service Areas (check all that apply). All references in the Contract Attachments to MCO Programs or Service Areas that are not checked are superfluous and do not apply to the MCO. þ Medicaid STAR MCO Program Service Areas: þ Bexar o Medicaid RSA - Central o Dallas o Medicaid RSA - Northeast þ El Paso o Medicaid RSA - West ▇ ▇▇▇▇▇▇ þ Nueces ▇ ▇▇▇▇▇▇▇ ▇ ▇▇▇▇▇▇▇ o Jefferson þ ▇▇▇▇▇▇ þ Lubbock See Attachment B-4, “Map of Counties with MCO Program Service Areas,” for listing of counties included within the STAR Service Areas. þ Medicaid STAR+PLUS MCO Program Service Areas: þ Bexar o Jefferson o El Paso þ Lubbock ▇ ▇▇▇▇▇▇ þ Nueces ▇ ▇▇▇▇▇▇▇ o Travis See Attachment B-4.2, “Map of Counties with STAR+PLUS MCO Program Service Areas,” for listing of counties included within the STAR+PLUS Service Areas. þ CHIP MCO Program Service Areas: þ Bexar þ Lubbock o Dallas þ Nueces þ El Paso o Tarrant ▇ ▇▇▇▇▇▇ þ ▇▇▇▇▇▇ ▇ ▇▇▇▇▇▇▇▇▇ See Attachment B-4.1, “Map of Counties with MCO Program Service Areas,” for listing of counties included within the CHIP Service Areas.