{"component": "definition", "props": {"groups": [{"snippet_links": [{"key": "having-a", "type": "definition", "offset": [22, 30]}, {"key": "certificate-of-authority", "type": "definition", "offset": [31, 55]}, {"key": "certificate-of-registration", "type": "clause", "offset": [59, 86]}, {"key": "state-office", "type": "definition", "offset": [110, 122]}, {"key": "insurance-commissioner", "type": "definition", "offset": [126, 148]}, {"key": "contracts-with", "type": "clause", "offset": [154, 168]}, {"key": "risk-contract", "type": "definition", "offset": [198, 211]}, {"key": "to-provide", "type": "definition", "offset": [212, 222]}, {"key": "health-care-services", "type": "clause", "offset": [231, 251]}], "snippet": "means an organization having a certificate of authority or certificate of registration from the 11 Washington State Office of Insurance Commissioner that contracts with HCA under a comprehensive 12 risk contract to provide prepaid health care services to eligible HCA Enrollees under HCA managed 13 care programs.", "samples": [{"hash": "ezoSjUWf4Cm", "uri": "/contracts/ezoSjUWf4Cm#mco", "label": "Contract for Participation in the North Sound Integrated Care Network", "score": 29.7205467224, "published": true}, {"hash": "4JyNoi3Sylb", "uri": "/contracts/4JyNoi3Sylb#mco", "label": "Contract for Participation", "score": 29.1621246338, "published": true}, {"hash": "ltkXE7Dgujq", "uri": "/contracts/ltkXE7Dgujq#mco", "label": "Contract for Participation in the North Sound Integrated Care Network", "score": 28.54895401, "published": true}], "size": 36, "hash": "0f8cca22a63a5b9da7e3b8490818d759", "id": 1}, {"snippet_links": [{"key": "health-maintenance-organization", "type": "definition", "offset": [8, 39]}, {"key": "service-plan", "type": "clause", "offset": [66, 78]}, {"key": "under-article", "type": "definition", "offset": [98, 111]}, {"key": "new-york-state", "type": "definition", "offset": [122, 136]}], "snippet": "means a health maintenance 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"provision-of-health-services", "type": "clause", "offset": [448, 476]}, {"key": "practice-medicine", "type": "definition", "offset": [546, 563]}, {"key": "health-professions", "type": "definition", "offset": [574, 592]}, {"key": "medical-services-and-equipment", "type": "clause", "offset": [625, 655]}, {"key": "health-care-providers", "type": "definition", "offset": [688, 709]}, {"key": "will-provide", "type": "clause", "offset": [724, 736]}, {"key": "in-accordance-with", "type": "definition", "offset": [751, 769]}, {"key": "for-purposes-of-this-agreement", "type": "clause", "offset": [898, 928]}, {"key": "authority-to-contract", "type": "clause", "offset": [970, 991]}, {"key": "arrange-for", "type": "clause", "offset": [1033, 1044]}, {"key": "provide-services", "type": "definition", "offset": [1048, 1064]}, {"key": "new-york-state", "type": "definition", "offset": [1083, 1097]}], "snippet": "means the person, natural or corporate, or any groups of such persons, certified under Public Health Law Article 44, who enter into an arrangement, agreement or plan or any combination of arrangements or plans which provide or offer a comprehensive health services plan, or a health and long term care services plan. \u201cIndependent Practice Association\u201d or \u201cIPA\u201d shall mean an entity formed for the limited purpose of contracting for the delivery or provision of health services by individuals, entities and facilities licensed and/or certified to practice medicine and other health professions, and, as appropriate, ancillary medical services and equipment. Under these arrangements, such health care Providers and suppliers will provide their service in accordance with and for such compensation as may be established by a contract between such entity and one or more MCOs. \u201cIPA\u201d may also include, for purposes of this Agreement, a pharmacy or laboratory with the legal authority to contract with other pharmacies or laboratories to arrange for or provide services to enrollees of a New York State MCO.", "samples": [{"hash": "d4kJQetbBRu", "uri": "/contracts/d4kJQetbBRu#mco", "label": "Regulatory Requirements Appendix", "score": 33.9389762878, "published": true}, {"hash": "ly938wnfWQ0", "uri": "/contracts/ly938wnfWQ0#mco", "label": "Provider Agreement", "score": 31.8755607605, "published": true}, {"hash": "aanOlRxxGzw", "uri": "/contracts/aanOlRxxGzw#mco", "label": "Provider Participation Agreement", "score": 28.9421195984, "published": true}], "size": 14, "hash": "e11e9fd28c9a83d430f2db06a9f56d6d", "id": 4}, {"snippet_links": [{"key": "managed-care-organization", "type": "definition", "offset": [6, 31]}], "snippet": "means Managed Care Organization.", "samples": [{"hash": "2vVcWiCS44n", "uri": "/contracts/2vVcWiCS44n#mco", "label": "Supplemental Drug Rebate Agreement", "score": 29.3390369415, "published": true}, {"hash": "5UnsnQlcq5E", "uri": "/contracts/5UnsnQlcq5E#mco", "label": "Medicaid Care Management Services Model Contract", "score": 23.3299102783, "published": true}, {"hash": "c8VOZ4YMClu", "uri": "/contracts/c8VOZ4YMClu#mco", "label": "Standard Agreement", "score": 21.4526805878, "published": true}], "size": 12, "hash": "49566bea67a120872e9da2d30329f78f", "id": 5}, {"snippet_links": [{"key": "a-member", "type": "definition", "offset": [6, 14]}, {"key": "managed-care-organization", "type": "definition", "offset": [32, 57]}], "snippet": "means a member\u2019s HSD contracted managed care organization.", "samples": [{"hash": "ienuINzfEjl", "uri": "https://www.hca.nm.gov/wp-content/uploads/Rule-8_312_2-NMAC-1.pdf", "label": "www.hca.nm.gov", "score": 8.1891651154, "published": false}, {"hash": "8MPZWue7jaJ", "uri": "https://www.srca.nm.gov/parts/title08/08.312.0002.pdf", "label": "www.srca.nm.gov", "score": 7.151266098, "published": false}, {"hash": "43FJ9jdYSW6", "uri": "https://www.srca.nm.gov/wp-content/uploads/attachments/08.352.0002.pdf", "label": "www.srca.nm.gov", "score": 6.4387516975, "published": false}], "size": 10, "hash": "1fab61d6a3dbe6245999cb4802784aeb", "id": 6}, {"snippet_links": [{"key": "managed-care-organization", "type": "definition", "offset": [8, 33]}, {"key": "medicaid-only", "type": "definition", "offset": [34, 47]}, {"key": "an-individual", "type": "clause", "offset": [54, 67]}, {"key": "optional-coverage-groups", "type": "definition", "offset": [129, 153]}, {"key": "medically-needy", "type": "definition", "offset": [162, 177]}, {"key": "special-income", "type": "definition", "offset": [181, 195]}, {"key": "home-and-community", "type": "clause", "offset": [228, 246]}, {"key": "does-not-meet", "type": "definition", "offset": [270, 283]}, {"key": "for-purposes-of-this-agreement", "type": "clause", "offset": [341, 371]}, {"key": "medicare-advantage", "type": "clause", "offset": [459, 477]}, {"key": "dual-eligible-special-needs-plan", "type": "definition", "offset": [478, 510]}, {"key": "coordinated-care-plan", "type": "clause", "offset": [553, 574]}, {"key": "the-plan", "type": "clause", "offset": [648, 656]}, {"key": "designed-for", "type": "definition", "offset": [665, 677]}, {"key": "to-individuals", "type": "clause", "offset": [690, 704]}, {"key": "title-xviii", "type": "definition", "offset": [741, 752]}, {"key": "member-advisory-committee", "type": "clause", "offset": [760, 785]}, {"key": "same-meaning", "type": "clause", "offset": [794, 806]}, {"key": "enrollee-advisory-committee", "type": "clause", "offset": [810, 837]}], "snippet": "means a managed care organization Medicaid Only means an individual who is eligible for Medicaid either categorically or through optional coverage groups such as medically needy or special income levels for institutionalized or home and community-based waivers, but who does not meet the federal income or resource criteria for QMB or SLMB. For purposes of this Agreement, Medicaid Only does not include individuals required to recertify eligibility monthly. Medicare Advantage Dual Eligible Special Needs Plan or MA Dual SNP means a Medicare Advantage coordinated care plan that is filed and approved as a dual eligible special needs plan by CMS. The plan must be designed for and offered to individuals who are eligible for Medicare under Title XVIII of the Member Advisory Committee has the same meaning as enrollee advisory committee, as provided in 42 CFR Section 422.107(f).", "samples": [{"hash": "f8ys1XKCHIA", "uri": "/contracts/f8ys1XKCHIA#mco", "label": "Health and Human Services Commission Contract", "score": 35.069026947, "published": true}, {"hash": "lE92A3OaSnY", "uri": "/contracts/lE92A3OaSnY#mco", "label": "Health and Human Services Contract", "score": 28.2402458191, "published": true}, {"hash": "jVoKN10OkES", "uri": "/contracts/jVoKN10OkES#mco", "label": "Health and Human Services Commission Contract", "score": 28.2402458191, "published": true}], "size": 7, "hash": "9c7d8ccf415de871f717d20b8fcfcc4a", "id": 7}, {"snippet_links": [{"key": "managed-care-organization", "type": "definition", "offset": [6, 31]}, {"key": "a-party", "type": "clause", "offset": [73, 80]}, {"key": "this-contract", "type": "definition", "offset": [84, 97]}, {"key": "approved-by", "type": "definition", "offset": [128, 139]}, {"key": "in-compliance-with", "type": "definition", "offset": [167, 185]}, {"key": "insurance-code", "type": "definition", "offset": [211, 225]}, {"key": "exclusive-provider-benefit-plan", "type": "definition", "offset": [245, 276]}, {"key": "in-accordance-with", "type": "definition", "offset": [293, 311]}], "snippet": "means managed care organization. MCO or Contractor means the MCO that is a party to this Contract and is an insurer licensed or approved by TDI as an HMO, ANHC formed in compliance with Chapter 844 of the Texas Insurance Code, or an EPO with an Exclusive Provider Benefit Plan approved by TDI in accordance with 28 T.A.C. \u00a73.9201-3.9212.", "samples": [{"hash": "9Ct0e8TOLeU", "uri": "/contracts/9Ct0e8TOLeU#mco", "label": "Contract Amendment (Centene Corp)", "score": 25.1396312714, "published": true}, {"hash": "lSgjnkkNFzQ", "uri": "/contracts/lSgjnkkNFzQ#mco", "label": "Contract (Centene Corp)", "score": 24.8056125641, "published": true}, {"hash": "7OCCaSFeIWo", "uri": "/contracts/7OCCaSFeIWo#mco", "label": "Contract (Centene Corp)", "score": 24.8056125641, "published": true}], "size": 7, "hash": "40a0d5231f52defeae84bce663e9731b", "id": 8}, {"snippet_links": [{"key": "managed-care-organization", "type": "definition", "offset": [6, 31]}, {"key": "a-party", "type": "clause", "offset": [73, 80]}, {"key": "this-contract", "type": "definition", "offset": [84, 97]}, {"key": "approved-by", "type": "definition", "offset": [128, 139]}, {"key": "in-compliance-with", "type": "definition", "offset": [167, 185]}, {"key": "insurance-code", "type": "definition", "offset": [211, 225]}, {"key": "exclusive-provider-benefit-plan", "type": "definition", "offset": [245, 276]}, {"key": "in-accordance-with", "type": "definition", "offset": [293, 311]}, {"key": "mco-administrative-services", "type": "definition", "offset": [338, 365]}, {"key": "performance-of-services", "type": "definition", "offset": [376, 399]}, {"key": "delivery-of-covered-services", "type": "clause", "offset": [436, 464]}, {"key": "necessary-for", "type": "definition", "offset": [466, 479]}, {"key": "payment-for-covered-services", "type": "clause", "offset": [518, 546]}, {"key": "quality-management", "type": "definition", "offset": [592, 610]}, {"key": "service-authorization", "type": "definition", "offset": [612, 633]}, {"key": "claims-processing", "type": "clause", "offset": [635, 652]}, {"key": "systems-operation", "type": "clause", "offset": [677, 694]}, {"key": "infrastructure-development", "type": "clause", "offset": [739, 765]}, {"key": "preparation-of", "type": "clause", "offset": [771, 785]}, {"key": "and-delivery", "type": "clause", "offset": [787, 799]}, {"key": "required-deliverables", "type": "clause", "offset": [808, 829]}, {"key": "the-contract", "type": "definition", "offset": [836, 848]}], "snippet": "means managed care organization. MCO or Contractor means the MCO that is a party to this Contract and is an insurer licensed or approved by TDI as an HMO, ANHC formed in compliance with Chapter 844 of the Texas Insurance Code, or an EPO with an Exclusive Provider Benefit Plan approved by TDI in accordance with 28 T.A.C. \u00a73.9201-3.9212. MCO Administrative Services means the performance of services or functions, other than the direct delivery of Covered Services, necessary for the management of the delivery of and payment for Covered Services, including Network, utilization, clinical or quality management, service authorization, claims processing, management information systems operation, and reporting. This term also includes the infrastructure development for, preparation of, and delivery of, all required Deliverables under the Contract, outside of the Covered Services.", "samples": [{"hash": "4FJNnohiPic", "uri": "/contracts/4FJNnohiPic#mco", "label": "Contract (Centene Corp)", "score": 25.5530452728, "published": true}, {"hash": "af1fZYDcKWr", "uri": "/contracts/af1fZYDcKWr#mco", "label": "Contract Amendment (Centene Corp)", "score": 25.1396312714, "published": true}, {"hash": "gXibMVts8Vh", "uri": "/contracts/gXibMVts8Vh#mco", "label": "Contract No. 529 12 0002 00006 N (Centene Corp)", "score": 24.8213558197, "published": true}], "size": 7, "hash": "3709699f5c52770b530b5f7b28849247", "id": 9}, {"snippet_links": [{"key": "managed-care-organization", "type": "definition", "offset": [6, 31]}, {"key": "participates-in", "type": "definition", "offset": [57, 72]}, {"key": "centennial-care", "type": "definition", "offset": [73, 88]}, {"key": "under-contract", "type": "definition", "offset": [89, 103]}, {"key": "the-state", "type": "clause", "offset": [123, 132]}, {"key": "the-requirements", "type": "clause", "offset": [144, 160]}, {"key": "nmsa-1978", "type": "definition", "offset": [179, 188]}], "snippet": "means managed care organization, which is an entity that participates in Centennial Care under contract with HSD to assist the State in meeting the requirements established under NMSA 1978, \u00a7 27-2-12.", "samples": [{"hash": "2LPyaDFwKD2", "uri": "https://www.hca.nm.gov/wp-content/uploads/Facility-Rates-Payments-CMS-Compliance-Reporting-RFP-21-630-8000-0002.docx", "label": "www.hca.nm.gov", "score": 13.8272848129, "published": false}, {"hash": "LFPTzWEHf6", "uri": "https://www.hca.nm.gov/wp-content/uploads/files/17-630-8000-0006-MCO-Audit-Svcs-RFP-Final.pdf", "label": "www.hca.nm.gov", "score": 10.2028455734, "published": false}, {"hash": "1Xp57uldzBB", "uri": 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<strong>MCO</strong>, including information required by HHSC, will be in accordance with applicable law.", "The <strong>MCO</strong> must comply with Circular C-027 requirements in addition to other Fraud, Waste, and Abuse provisions in the contract and in state and federal law.", "Except as otherwise disclosed and approved by HHSC prior to the Effective Date of the Contract, <strong>MCO</strong> warrants that, as of the Effective Date and to the best of its knowledge and belief, there are no relevant facts or circumstances that could give rise to an organizational conflict of interest affecting this Contract.", "<strong>MCO</strong> certifies that it will comply with the Anti- Kickback Act of 1986 (41 U.S.C. \u00a7 51 58), 42 U.S.C. \u00a7 1320a-7b(b), and Federal Acquisition Regulation Subpart 52.203-7, to the extent applicable.", "The authority delegated to <strong>MCO</strong> by HHSC is limited to the terms of this Contract.", "<strong>MCO</strong> affirms that it has neither given, nor intends to give, at any time after Contract Execution, any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant or any employee or representative of same, at any time during the procurement process or in connection with the procurement process except as allowed under relevant state and federal law.", "The <strong>MCO</strong> may appeal the adjustment of capitation payments in the above circumstances using the HHSC dispute resolution process in Section 12.12, (Dispute Resolution).", "<strong>MCO</strong> must provide HHSC certificates evidencing this erasure or destruction.", "If the <strong>MCO</strong> receives a request for information deemed confidential under this Contract, the <strong>MCO</strong> will immediately notify HHSC of such request, and will make reasonable efforts to protect the information from public disclosure."], "related": [["hmo", "HMO", "HMO"], ["hhsc", "HHSC", "HHSC"], ["managed-care-plan", "Managed care plan", "Managed care plan"], ["mcp", "MCP", "MCP"], ["odjfs", "ODJFS", "ODJFS"]], "related_snippets": [], "updated": "2026-03-01T05:21:46+00:00"}, "json": true, "cursor": ""}}