MA organization definition

MA organization means a public or private entity organized and licensed by a State as a risk-bearing entity (with the exception of provider-sponsored organizations receiving waivers) that is certified by CMS as meeting the MA contract requirements. MA plan means health benefits coverage offered under a policy or contract by an MA organization that includes a specific set of health benefits offered at a uniform premium and uniform level of cost-sharing to all Medicare beneficiaries residing in the service area of the MA plan (or in individual segments of a service area, under § 422.304(b)(2)). MA plan enrollee is an MA eligible individual who has elected an MA plan offered by an MA organization. Mandatory supplemental benefits means health care services not covered by Medicare that an MA enrollee must accept or purchase as part of an MA plan. The benefits may include reductions in cost sharing for benefits under the original Medicare fee for service program and are paid for in the form of premiums and cost sharing, or by an application of the beneficiary rebate rule in section 1854(b)(1)(C)(ii)(I) of the Act, or both. MSA stands for medical savings account. MSA trustee means a person or business with which an enrollee establishes an MA MSA. A trustee may be a bank, an insurance company, or any other entity that—
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MA organization means an entity that has entered into a contract with CMS to operate an MA Plan.
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Examples of MA organization in a sentence

  • The file and use process set out at §422.80(a)(2) must be used, unless the MA organization notifies CMS that it will not use this process.

  • Failure to reference a regulatory requirement in this contract does not affect the applicability of such requirements to the MA organization and CMS.

  • The MA organization also provides CMS with updated ▇▇▇▇▇- cial information and a discussion of the financial and solvency impact of the change of ownership on the surviving organization.

  • The MA organization submits to CMS, at least 30 days before the proposed change of ownership date, three signed copies of the novation agreement con- taining the provisions specified in paragraph (b) of this section, and one copy of other relevant documents re- quired by CMS.

  • The MA Organization maintains ultimate responsibility for adhering to and otherwise fully complying with all terms and conditions of its contract with CMS, notwithstanding any relationship(s) that the MA organization may have with related entities, contractors, or subcontractors.

  • If an MA organization leases all or part of its fa- cilities to another entity, the other en- tity does not acquire MA organization status under section 1876 of the Act.

  • The MA organization must comply with all applicable requirements as described in CMS regulations and guidance implementing the Medicare Improvements for Patients and Providers Act of 2008.

  • Enrollees will not be held liable for payment of any fees that are the legal obligation of the MA organization.

  • Aligned Medicaid Managed Care Organization (Aligned Medicaid MCO) means a Medicaid MCO under the ownership and control of the same MA organization, parent organization, or another entity owned and controlled by the parent organization as the MA Dual SNP covered under this Agreement and that operates in the same region(s) as the MA Dual SNP covered under this Agreement.

  • OhioHealthy and Provider acknowledge that, as a condition of participating as a provider with an MA organization, CMS requires MA organizations and providers to agree in writing to abide by certain contracting provisions set forth in 42 C.F.R. Part 422, as may be amended from time to time.