Managed care entity definition

Managed care entity means either a managed care organization licensed by the department of insurance (e.g., HMO or PHP) or a primary care case management program (i.e., MediPASS).

Managed care entity means an insurer that:

Managed care entity means an entity that enters into a contract to provide services in the statewide managed care system pursuant to articles 4, 5, and 6 of title 25.5.

Examples of Managed care entity in a sentence

• Managed care entity (MCE) means managed care organizations (MCOs), PIHPs, PAHPs, PCCMs, and HIOs. Managing employee means a general manager, business manager, administrator, director, or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of an institution, organization, or agency.

• Managed care entity (MCE) means managed care organizations (MCOs), pre-paid inpatient health plans (PIHPs), pre-paid ambulatory health plans (PAHPs), primary case care management (PCCMs), and health improvement organizations (HIOs).

• Managed care entity has the same meaning as set forth in 42 CFR Section 455.101 (2011).

• Managed care" means a health care delivery system operated by the state in accordance with 42 C.F.R. part 438 (October 1, 20192021).(X) (W) "Managed care entity" means a managed care organization, the single pharmacy benefit manager, a MyCare Ohio plan as defined in rule 5160-58-01 of the Administrative Code, and the OhioRISE plan as defined in rule 5160-59-01 of the Administrative Code.

• Section 438.2 is amended by adding the definition of ‘‘Managed care entities (MCEs) in alphabetical order to read as follows:§ 438.2 Definitions.* * * * *Managed care entity (MCE) means a Medicaid managed care organization, asdefined in section 1903(m)(1)(A) of the Act, that provides or arranges for services for enrollees under a contract pursuant to section 1903(m) of the Act or a primary care case manager, as defined in section 1905(t)(2) of the Act.* * * * *■ 5.

More Definitions of Managed care entity

Managed care entity means any entity including

Managed care entity means any entity which delivers, administers, or indemnifies health care services with systems or techniques to control or influence the quality, accessibility, utilization, or costs and prices of such services to a defined enrollee population, but does not include an employer purchasing coverage or action on behalf of its employees or the employees of one or more subsidiaries or affiliated corporations of the employer or a pharmacy licensed by this state;

Managed care entity. (MCE) means:

Managed care entity means an entity licensed as a health maintenance organization under Title 56, Chapter 32, and certified by the state as a risk-bearing entity, that meets the federal requirements of 42 U.S.C. § 1396 u-2(a) and regulations promulgated thereto.

Managed care entity or "MCE" means any entity permitted under 42 C.F.R. Part 438 to contract with a state for services provided under a risk contract or a nonrisk contract within the state's Medicaid managed care program, including but not limited to managed care organization (MCO), primary care case management (PCCM), primary care case management entity (PCCM entity), prepaid ambulatory health plan (PAHP), and prepaid inpatient health plan (PIHP).

Managed care entity means any entity that delivers,

Managed care entity means a Managed Care Organization (MCO), Prepaid Ambulatory Health Plan (PAHP), Prepaid Inpatient Health Plan (PIHP), Primary Care Case Management (PCCM) or Primary Case Managed Care Entity (PCCM entity) as defined in 42 C.F.R. § 438.2.