MCO Sample Clauses
MCO. On an ongoing basis, if a Recipient was previously enrolled with a MCO and loses eligibility for a period of six (6) months or less, the Recipient will be re- enrolled with that MCO;
MCO. If the Recipient’s MCO is not a Centennial Care 2.0 MCO, then he/she will be auto assigned to a Centennial Care 2.0
MCO. ETO benefits may be used, but will not be considered 5 mandatory, for scheduled work days missed when a nurse is called 6 off, mandated to unschedule his/her shift or part thereof, or given 7 the option to go off the schedule any time within the nurse’s shift 8 due to low census, nursing unit closures (for example, on a holiday) 9 or low acuity. This includes nurses who may also receive stand-by 10 pay.
MCO. A Medicaid managed care organization contracted with HHSC to provide health care services to Medicaid recipients.
MCO. If the Member’s Current MCO is not a Centennial Care 2.0 MCO and the Member fails to select a Centennial Care 2.0 MCO, the Member will be auto-assigned to a Centennial Care 2.0 MCO in the first auto-assignment cycle that begins December 1, 2018.
MCO. Covers (for all persons 20 and older) annual tests to determine blood hemoglobin, blood pressure, blood glucose level, and blood cholesterol levels (low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels). (N.J.S.A.§26:2J- 4.6(a)1) (SSA §1905(a)13) For all persons 20 years of age and older, annual cardiovascular screenings are covered. More frequent testing is covered when determined to be medically necessary. Covered for services rendered beyond Medicare Part B limits. Covered. Part B. Covers screenings for cholesterol, lipid, and triglyceride levels once every 5 years. No copay or coinsurance. Part B deductible does not apply. Members generally pay 20% of the Medicare-approved amount for the doctor’s visit itself. (42 CFR §410.17) Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability. Chiropractic Services Covered. MCO. Categorically Needy. Covers manipulation of the spine which the chiropractor is legally authorized by the State to perform. The chiropractor may prescribe certain services as outlined in N.J.A.C. Covers manipulation of the spine, as well as certain services as outlined in N.J.A.C. 10:68-2, such as clinical laboratory services; certain medical supplies; durable medical equipment; pre- fabricated orthoses; *Covered. Part B. *Limited services provided to correct subluxation when deemed medically necessary. --Does not cover x-rays or any other diagnostic or therapeutic services furnished or ordered by a chiropractor. Member pays 20% of Medicare-approved amount. The Part B deductible applies. (42 CFR §410.21(b)) Any applicable cost sharing is covered by the Medicaid benefit. Members have $0 cost sharing liability. §10:68-2. physical therapy (N.J.A.C. §10:49- services; and
MCO. MassHealth contracts with MCOs that provide comprehensive health coverage including behavioral health services to enrollees. MCO enrollees may receive family planning services from any provider without consulting their PCP or MCO and are not required to obtain prior approval from MassHealth. For family planning services provided by MassHealth providers not participating in the MCO network, MassHealth reimburses the provider on a FFS basis and recoups the funds from the MCO. MassHealth Standard/ABP 1, CommonHealth and Family Assistance members who either choose or are assigned to a health plan may transfer to another available health plan in their geographic service area at any time for any reason. Subject to approval of the Commonwealth’s ABP SPA entitled “CarePlus,” MassHealth CarePlus members may transfer to another available health plan in their geographic service area for any reason, effective on the first of the month following the request to transfer; provided, however, that transfers for cause are effective immediately.
MCO must notify the requesting Provider and Enrollee of any decision to deny a service authorization request, or to authorize a service in an amount, duration, or scope that is less than requested. The notice of adverse action to the Provider need not be in writing; however, the Enrollee notice must be in writing.
MCO. 1. Management; 2. Finance; 3. Information System; 4. Operations (Access, Network, Waiver Implementation); 5. Quality; and 6. Others to be identified if needed.