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Full Medicaid definition

Full Medicaid is defined as members that have full Medicaid State Plan benefits. This excludes members receiving benefits from programs like IowaCare, Family Planning, Qualified Medicare Beneficiary (QMB)/Special Low Income Medicare Beneficiary (SLMB).
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Examples of Full Medicaid in a sentence

  • CMS strictly prohibits Balance Billing QMB Plus (Qualified Medicare Beneficiary plus Full Medicaid) – Medicaid Status Code 02 Required – must bill Medicaid, no exceptions.

  • Most Medicaid agencies will cover all or a portion of the Medicare cost-share for Full Medicaid individuals as well, even if they do not have QMB.

  • Full Medicaid Benefits for Presumptively Eligible Pregnant Women.

  • Be aware that when dispensing Part B covered drugs or supplies to Medicare Advantage Plan Members who have Full Medicaid, also known as Traditional Medicaid (including SLMB+), but where the Member is not located in the same state as the Pharmacy, that the Part B copay cannot be collected from the Member if they have qualifying Medicaid coverage for the service.

  • As of January 1, 2012, section 1860D-14 of the Act also eliminates Part D cost sharing for Full Medicaid individuals who are receiving home and community-based services (HCBS) either through: • A home and community-based waiver authorized for a state under section 1115 or subsection (c) or (d) of section 1915 of the Act; • A Medicaid State Plan Amendment under section 1915(i) of the Act; or • A Medicaid managed care organization with a contract under section 1903(m) or section 1932 of the Act.

  • Full Medicaid coverage is only available to United States Citizens and legal residents.

  • This documentation should be made available to the Administrator or Medicare Part D Sponsor upon request.Be aware that when dispensing Part B covered drugs or supplies to Medicare Advantage Plan Members who have Full Medicaid, also known as Traditional Medicaid (including SLMB+), but where the Member is not located in the same state as the Pharmacy, that the Part B copay cannot be collected from the Member if they have qualifying Medicaid coverage for the service.

  • Full Medicaid Pricing (FMP)Beginning in April 2014, LDH implemented a series of program changes to ensure consistent pricing in the Medicaid program for hospital services, including inpatient hospital, outpatient hospital, hospital-based physician, and ambulance services.

  • CMS strictly prohibits Balance Billing.• CMS 02 Full Dual – QMB+ (Qualified Medicare Beneficiary plus Full Medicaid): Must bill Medicaid for Medicare copay – no exceptions.

  • This contractual element requires that D-SNPs not impose cost sharing on specified dual eligibles (i.e., Full Medicaid individuals, QMBs, or any other population designated by the state) that exceed the amounts permitted under the State Medicaid plan if the individual were not enrolled in the D-SNP.

Related to Full Medicaid

  • Medicaid means that government-sponsored entitlement program under Title XIX, P.L. 89-97 of the Social Security Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set forth on Section 1396, et seq. of Title 42 of the United States Code.

  • 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.

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

  • 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.

  • Medicaid program means the Kansas program of medical

  • 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 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.

  • 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;

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

  • Iowa Medicaid enterprise means the entity comprised of department staff and contractors responsible for the management and reimbursement of Medicaid services.

  • Home Health Care Agency means an agency or organization which provides a program of home health care and which:

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

  • Health plan or "health benefit plan" means any policy,

  • 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.

  • Qualified medical provider means the same as that term is defined in Section 26-61a-102.

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

  • Nursing home-type patients means a patient who has been in hospital more than 35 days, no longer requires acute hospital care, cannot live independently at home or be looked after at home, and either cannot be placed in a nursing home or a nursing home place is not available.

  • Behavioral health provider means a person licensed under 34 chapter 18.57, 18.57A, 18.71, 18.71A, 18.83, 18.205, 18.225, or 18.79

  • Health history means the record of a person’s past health events obtained in writing, completed by the individual or their physician.

  • Family and Medical Leave means a leave of absence for the birth, adoption or foster care of a child, or for the care of your child, spouse or parent or for your own serious health condition as those terms are defined by the Federal Family and Medical Leave Act of 1993 (FMLA) and any amendments, or by applicable state law.

  • Emergency Medical Technician (EMT means: an individual licensed with cognitive knowledge and a scope of practice that corresponds to that level in the National EMS Education Standards and National EMS Scope of Practice Model.

  • Adult foster care facility means an adult foster care facility licensed under the adult foster care facility licensing act, 1979 PA 218, MCL 400.701 to 400.737.

  • Adult foster care means room and board, supervision, and special services to an adult who has a

  • State health plan means the employee and retiree insurance program provided for in Article 5, Chapter 11, Title 1.

  • Number of Students Who Began Program means the number of students who began the program who are scheduled to complete the program within the reporting calendar year.

  • Emergency medical service means [initial emergency medical

Most Referenced Clauses

Most Referenced Definitions