Capitated Managed Care Plan definition

Capitated Managed Care Plan. A managed care plan that is licensed or certified as a fully risk-bearing entity, or qualified pursuant to s. 409.912(4)(d), F.S., in the state, and is paid a prospective per-member, per-month payment by the Agency. Capitation Rate — The per-member, per-month amount, including any adjustments, that is paid by the Agency to a capitated managed care plan for each Medicaid recipient enrolled under a Contract for the provision of Medicaid services during the payment period.
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Capitated Managed Care Plan. A managed care plan that is licensed or certified as a fully risk-bearing entity, or qualified pursuant to s. 409.912(4)(d), F.S., in the state, and is paid a prospective per-member, per-month payment by the Agency. Capitation Rate — The per-member, per-month amount, including any adjustments, that is paid by the Agency to a capitated managed care plan for each Medicaid recipient enrolled under a Contract for the provision of Medicaid services during the payment period. Care Coordination/Case Management — A process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an enrollee's health needs using communication and all available resources to promote quality outcomes. Proper care coordination/case management occurs across a continuum of care, addressing the ongoing individual needs of an enrollee rather than being restricted to a single practice setting. Case Record — A record that includes information regarding the management of services for an enrollee including the plan of care and documentation of care coordination/case management activities.
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Related to Capitated Managed Care Plan

  • Managed care plan means a health benefit plan that either requires a covered person to use, or

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Managed Care Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.

  • Managed care entity means either a managed care organization licensed by the department of insurance (e.g., HMO or PHP) or a primary care case management program (i.e., MediPASS).

  • Managed care means a system that provides the coordinated delivery of services and supports that are necessary and appropriate, delivered in the least restrictive settings and in the least intrusive manner. Managed care seeks to balance three factors: