Medicaid Managed Care Program definition

Medicaid Managed Care Program means the Department’s system of coordinated care for individuals under HFS Medical Programs.
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Medicaid Managed Care Program means the Department’s system of coordinated care for individuals under HFS Medical Programs.‌
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Medicaid Managed Care Program means a program under sections 1903(m), 1905(t), and 1932 and includes a man- aged care program operating under a waiver under section 1915(b) or 1115 or otherwise.’’.
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Examples of Medicaid Managed Care Program in a sentence

  • The South Carolina Healthy Connections Program (a.k.a. the South Carolina Medicaid Managed Care Program) is administered by the South Carolina Department of Health and Human Services (SCDHHS) under the 1932(a) State Plan Authority (SSA Sec.

  • Ancillary medical services are included in the Medicaid Managed Care Program coverage array.

  • The Provider agrees that if it claims, orders, or is paid $500,000 or more per year from the Medical Assistance Program, including, in the aggregate, claims submitted to or paid directly by the Medical Assistance Program and/or claims submitted to or paid by any MCO under the Medicaid Managed Care Program, that it shall adopt and implement a compliance program which meets the requirements of New York State Social Services Law § 363-d(2) and 18 NYCRR § 521.3.

  • For initial and renewal waiver requests, please describe the efforts the State has made to ensure Federally recognized tribes in the State are aware of and have had the opportunity to comment on this waiver proposal.The quarterly Tribal Health Directors meeting offers Tribal chairs and the health directors an opportunity to be updated on the activities, operations, and changes of the Medicaid Managed Care Program.

  • Being coherent, the BW and SPP interfere and illuminate the detector sensitive element with the intensity 𝐼 described by the expression: 𝐼(𝑥) = 𝐼1 + 𝐼𝑜 · exp(−𝛼 · 𝑥) + 2 · 𝐼1 · 𝐼𝑜 · 𝑒𝑥𝑝 (−𝛼 · 𝑥) · cos (Δ𝜑) , (1)here 𝐼1 is the BW intensity, independent on the distance 𝑥 (supposing that air does not absorb the radiation); 𝐼𝑜 is the SPP intensity right under screen 5 when 𝑥 = 0.The interference pattern (interferogram) registered by mobile detector 7 is charac- terized by a constant period Λ.

  • The quarterly Tribal Health Directors meeting offers Tribal chairs and the health directors an opportunity to be updated on the activities, operations, and changes of the Medicaid Managed Care Program.

  • Managed Care Programs If you enroll in a Medicaid Managed Care Program you will not be subject to the Utilization Threshold Program except for pharmacy.

  • HHSC has authority to contract with MCOs to carry out the duties and functions of the Medicaid Managed Care Program under Title XIX of the Social Security Act; Texas Health and Safety Code §§ 12.011, 12.017, and 12.021; and Texas Government Code, Chapter 533.

  • To find out if there is a Medicaid Managed Care Program available to you, please call your local department of social services.

  • The report to the Department must include the following: (1) An explanation of how the case was resolved; (2) Details relating to the case, including any pertinent materials; (3) Any determination that the MCO has failed to meet the requirements of the Maryland Medicaid Managed Care Program; and (4) Any other information required by the Department.


More Definitions of Medicaid Managed Care Program

Medicaid Managed Care Program means a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per-member, per-month (capitation) payment for these services pursuant to 42 U.S.C. § 438.
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Related to Medicaid Managed Care Program

  • 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 plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Child Care Program means a person or business that offers child care.

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

  • Medicaid program means the medical assistance

  • Managed health care system means: (a) Any health care

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Federal Health Care Program has the meaning set forth in 42 U.S.C. 1320a-7b(f).

  • Licensed health care practitioner means a physician, as defined in Section 1861(r)(1) of the Social Security Act, a registered professional nurse, licensed social worker or other individual who meets requirements prescribed by the Secretary of the Treasury.

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • Medicaid Regulations means, collectively, (i) all federal statutes (whether set forth in Title XIX of the Social Security Act or elsewhere) affecting the medical assistance program established by Title XIX of the Social Security Act and any statutes succeeding thereto; (ii) all applicable provisions of all federal rules, regulations, manuals and orders of all Governmental Authorities promulgated pursuant to or in connection with the statutes described in clause (i) above and all federal administrative, reimbursement and other guidelines of all Governmental Authorities having the force of law promulgated pursuant to or in connection with the statutes described in clause (i) above; (iii) all state statutes and plans for medical assistance enacted in connection with the statutes and provisions described in clauses (i) and (ii) above; and (iv) all applicable provisions of all rules, regulations, manuals and orders of all Governmental Authorities promulgated pursuant to or in connection with the statutes described in clause (iii) above and all state administrative, reimbursement and other guidelines of all Governmental Authorities having the force of law promulgated pursuant to or in connection with the statutes described in clause (ii) above, in each case as may be amended, supplemented or otherwise modified from time to time.

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Child care provider means a provider who receives compensation for providing child care services on a regular basis, including an ‘eligible child care provider’ (as defined in section 658P of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n)).

  • Licensed health care professional means a person who possesses a professional medical license that is valid in Oregon. Examples include, but are not limited to, a registered nurse (RN), nurse practitioner (NP), licensed practical nurse (LPN), medical doctor (MD), osteopathic physician (DO), respiratory therapist (RT), physical therapist (PT), physician assistant (PA), or occupational therapist (OT).

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

  • Medicare Advantage The Medicare managed care options that are authorized under Title XVIII as specified at Part C and 42 C.F.R. § 422.

  • TRICARE means, collectively, a program of medical benefits covering former and active members of the uniformed services and certain of their dependents, financed and administered by the United States Departments of Defense, Health and Human Services and Transportation, and all laws applicable to such programs.

  • Health Care Operations shall have the meaning given to such term under the HIPAA 2 Privacy Rule in 45 CFR § 164.501.

  • Medicare Advantage plan means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:

  • Health care system means any public or private entity whose function or purpose is the management of, processing of, enrollment of individuals for or payment for, in full or in part, health care services or health care data or health care information for its participants;

  • Medicare Provider Agreement means an agreement entered into between CMS (or other such entity administering the Medicare program on behalf of the CMS) and a health care provider or supplier, under which such health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • Health care practitioner means an individual licensed