Medicaid Managed Care definition

Medicaid Managed Care. Orthopedic Footwear means shoes, shoe modifications, or shoe additions which are used to correct, accommodate or prevent a physical deformity or range of motion malfunction in a diseased or injured part of the ankle or foot; to support a weak or deformed structure of the ankle or foot, or to form an integral part of a brace.

Medicaid Managed Care refers to one or all of the following health care plans authorized and contracted by New York to manage a specified benefit package of Medicaid benefits for a defined group of eligible enrollees: Mainstream Managed Care Plan (MMCP), Health and Recovery Plan (HARP), Medicaid Advantage Plus (MAP), or Managed Long Term Care Partial Capitation (MLTCP).

Medicaid Managed Care. North Carolina’s program under which contracted Managed Care Organizations arrange for integrated medical, physical, pharmacy, behavioral and other services to be delivered to Medicaid enrollees. Medicaid Managed Care will include three types of plans: (1) Standard Plans, (2) BH I/DD Tailored Plans, and (3) Statewide Xxxxxx Care Plan. The use of Medicaid Managed Care is also inclusive of EBCI Tribal Option, operating as a primary care case management entity (PCCMe).

Examples of Medicaid Managed Care in a sentence

• Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

• Control Name Provided by CMS (List each actuarial rate certification separately) Please note, states and actuaries should consult the most recent Medicaid Managed Care Rate Development Guide for how to document state directed payments in actuarial rate certification(s).

• A list of all carve-out services is available in section 8, “Carve-Out Services” in the Medicaid Managed Care Handbook (Vol.

• The Medicaid Managed Care regulations in 42 CFR 438 require the state to establish certain access and quality standards for PAHP programs, including plan assurances on network adequacy.

• EQR Protocol 1: Assessment of Compliance with Medicaid Managed Care Regulations: A Mandatory Protocol for External Quality Review (EQR), Protocol 1, Version 2.0, September 1, 2012.

• The Medicaid Managed Care regulations in 42 CFR Part 438 establishes certain beneficiary protections for PCCM programs that correspond to the waiver areas under “Program Impact.” However, generally the regulations do not stipulate access or quality standards for PCCM programs.

• The Medicaid Managed Care Regulations in 42 CFR Part 438 put forth clear expectations on how access and quality must be assured in capitated programs.

• The Contractor shall utilize and refer Members to the Ombudsman for Medicaid Managed Care to assist with problem-solving, Grievance resolution, in-plan and administrative law judge hearing level Appeals, and referrals to Community resources, as appropriate.

• If the Department is contacted by a Member, family members or caregivers of a Member, advocates, the Ombudsman for Medicaid Managed Care, or other individuals/entities with a Grievance regarding concerns about the care or lack of care a Member is receiving, the Contractor shall address all issues as soon as possible after the Department has informed the Contractor of the concerns.

• In accordance with the Affordable Care Act, manufacturers that participate in the Medicaid drug rebate program are required to pay rebates for drugs dispensed to individuals enrolled with a Medicaid Managed Care Organization.

More Definitions of Medicaid Managed Care

Medicaid Managed Care means a program of health services provided to eligible clients by a managed care organization under a contract with a department.

Medicaid Managed Care means Medicaid provided under section three hundred sixty-four-j of this chapter.

Medicaid Managed Care. The name of the North Carolina managed care program for North Carolina Medicaid and NC Health Choice benefits; does not include LME/MCOs.