Medicare+Choice definition

Medicare+Choice plan means a plan of coverage for health benefits under Medicare Part C as defined in Section 1859 in Title IV, Subtitle A, Chapter 1 of P.L. 105−33, and includes:
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Medicare+Choice plan means a plan of coverage for health benefits under Medicare Part C, including coordinated care plans, provider-sponsored organizations and preferred provider organization plans, medical savings accounts coupled with a contribution into a Medicare+Choice medical savings account, and Medicare+Choice private fee-for-service plans.
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Medicare+Choice means the managed care option that is offered to retirees through a health maintenance organization or other legally licensed organization and that is approved through the Centers forMedicare and Medicaid Services for Medicare enrolled retirees. (2-16-00) (2-13-02) (4-10-02)
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Examples of Medicare+Choice in a sentence

  • The school recognises the following statement from Keeping Children Safe in Education (2022), paragraph 119: The Data Protection Act 2018 and GDPR do not prevent the sharing of information for the purposes of keeping children safe.

  • Code 58 in the Condition Codes block in CMS 1450 UB-04 will be the indication that patient is a terminated enrollee in a Medicare+Choice Organization plan whose three day inpatient hospital stay was waived.

  • It also established the Medicare+Choice program, which expanded private plan options for beneficiaries and changed the way most of these plans were paid.

  • For portions of cost re- porting periods occurring on or after January 1, 1998, the product derived in step one is multiplied by the propor- tion of the hospital’s inpatient days at- tributable to individuals who are en- rolled under a risk-sharing contract with an eligible organization under sec- tion 1876 of the Act and who are enti- tled to Medicare Part A or with a Medicare+Choice organization under Title XVIII, Part C of the Act.

  • If block 36 of CMS 1450 UB-04 is blank, the SNF claim will be denied unless the patient was involuntarily disenrolled from Medicare+Choice plan (see paragraph 4.3.4).

  • Effective for portions of cost reporting periods occurring on or after January 1, 2000, the product de- rived from step three is reduced by a percentage equal to the ratio of the Medicare+Choice nursing and allied health payment ‘‘pool’’ for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hos- pitals for the current calendar year.

  • Such a contract with an organization may cover more than 1 Medicare+Choice plan.

  • The Medicare+Choice program under Part C of title XVIII of the Act, 42 U.S.C. 1395w-21 through 1395w-28.

  • The term post-hospital SNF care in- cludes SNF care that does not follow a hospital stay when the beneficiary is enrolled in a plan, as defined in § 422.4 of this chapter, offered by a Medicare+Choice (M+C) organization, that includes the benefits described in§ 422.101(c) of this chapter.[48 FR 12541, Mar.

  • TRICARE will follow CMS policy and waive the three day prior hospitalization requirement for those TRICARE dual eligible beneficiaries involuntarily disenrolling from Medicare+Choice plans.


More Definitions of Medicare+Choice

Medicare+Choice means the managed care Option that is offered to Retirees through an HMO or other legally licensed organization and that is approved through the Centers for Medicare and Medicaid Services for Medicare enrolled Retirees.
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Medicare+Choice means the Medicare health benefits program created by Section 4001 of the Balanced Budget Act of 1997 (Pub.L. 105-33) as defined in 42 USC 1395w-21-28.
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Medicare+Choice means the comprehensive managed care program for Medicare created under the Balanced Budget Act of 1997 and contained in Title XVIII, Part C of the Social Security Act (§§ 1851-1859; 42 U.S.C.A. §§ 1395w-21 to -28 (West Supp. 1999)) and the rules and regulations promulgated thereunder.
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Related to Medicare+Choice

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • 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.

  • 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.

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

  • 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.

  • 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.

  • Medicare benefit means the Medicare benefit payable within the meaning of Part II of the Health Insurance Act 1973 with respect to a professional service.

  • Centers for Medicare and Medicaid Services or “CMS” means the federal office under the Secretary of the United States Department of Health and Human Services, responsible for the Medicare and Medicaid programs.

  • Health care practitioner means an individual licensed

  • 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;

  • 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).

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

  • 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.

  • Respiratory care practitioner means a person who is

  • Medicaid Certification means a certification by a state agency or other entity responsible for certifying Medicaid providers and suppliers that a health care provider or supplier is in compliance with all the conditions of participation set forth in the Medicaid Regulations.

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

  • Indian Health Care Provider means a health care program operated by the Indian Health Service (IHS) or by an Indian Tribe, Tribal Organization, or Urban Indian Organization (otherwise known as an I/T/U) as those terms are defined in § 4 of the Indian Health Care Improvement Act (25 USC § 1603). Indian Health Care Provider includes a 638 Facility and provision of Indian Health Service Contract Health Services (IHS CHS).

  • Medicaid program means the medical assistance

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

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other such entity administering the Medicaid program and a health care provider or supplier under which the health care provider or supplier agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

  • Health Care Law means any Applicable Law regulating the acquisition, construction, operation, maintenance or management of a healthcare practice, facility, provider or payor.

  • Health practitioner means a registered health practitioner registered or licensed as a health practitioner under an appropriate law of the State of Tasmania.

  • Health means physical or mental health; and

  • Home health aide means an individual employed by a home health agency to provide home health services under the direction of a registered nurse or therapist.

  • Medicare Regulations means, collectively, all federal statutes (whether set forth in Title XVIII of the Social Security Act or elsewhere) affecting the health insurance program for the aged and disabled established by Title XVIII of the Social Security Act and any statutes succeeding thereto; together with all applicable provisions of all rules, regulations, manuals and orders and administrative, reimbursement and other guidelines having the force of law of all Governmental Authorities (including without limitation, Health and Human Services ("HHS"), HCFA, the Office of the Inspector General for HHS, or any Person succeeding to the functions of any of the foregoing) promulgated pursuant to or in connection with any of the foregoing having the force of law, as each may be amended, supplemented or otherwise modified from time to time.

  • Home health care services means medical and nonmedical services, provided to ill, disabled or infirm persons in their residences. Such services may include homemaker services, assistance with activities of daily living and respite care services.