Indian Managed Care Entities definition

Indian Managed Care Entities. (IMCE) means a CCO, MCO, PIHP, PAHP, PCCM, or PCCM entity that is controlled (section 1903(m)(1)(C) of the Act) by the Indian Health Service, a Tribe, Tribal Organization, or Urban Indian Organization, or a consortium, which may be composed of one or more Tribes, Tribal Organizations, or Urban Indian Organizations, and which also may include the Service.
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Examples of Indian Managed Care Entities in a sentence

  • The MCO must follow the requirements related to Indians, Indian Health Care Providers, and Indian Managed Care Entities in accordance with the terms of 42 CFR 438.14.

  • The MCO must follow the requirements related to Indians, Indian Health Care Providers, and Indian Managed Care Entities in accordance with the terms of 42 CFR §438.14.

  • OHA and Tribes have engaged in discussions about one or more Tribes becoming Indian Managed Care Entities under federal law.

  • AAG Ted Falk advised the OHA in assisting tribes to form Indian Managed Care Entities (IMCE) for tribal members in urban areas who are on Medicaid.

  • CareOregon reports high rates of member satisfaction with the program, which has been renewed for a second year.OHA has been working with tribal health representatives from Oregon’s nine Federally-recognized Tribes to support efforts to establish one or more Indian Managed Care Entities.

  • In the future OHA may contract with Indian Managed Care Entities or other similar Tribal-related organizations to provide health care services to Tribal members and potentially other OHP members as allowed by law.2.3 Scope of WorkWork to be performed under the Contracts awarded through this RFA is to provide Coordinated Care Services for the CCO’s Members, in accordance with the objectives of Health System Transformation, as described in this RFA.

  • In the future OHA may contract with Indian Managed Care Entities or other similar Tribal-related organizations to provide health care services to Tribal members and potentially other OHP members as allowed by law.2.3 Scope of Work‌Work to be performed under the Contracts awarded through this RFA is to provide Coordinated Care Services for the CCO’s Members, in accordance with the objectives of Health System Transformation, as described in this RFA.

  • Pules Applicable Under Medicaid and CHIP to Managed Care Entities witL Pespect to Indian Enrollees and Indian HealtL Care Providers and Indian Managed Care Entities.

  • AAG Ted Falk assisted OHA in its work to create Indian Managed Care Entities with four tribes and NARA NW.

Related to Indian Managed Care Entities

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

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

  • Managed care plan means a health benefit plan that either requires a covered person to use, or

  • Health care entity means any health care provider, health plan or health care clearinghouse.

  • 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.

  • CMS means the Centers for Medicare and Medicaid Services.

  • 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 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.

  • Managed Care Organization (MCO) means a contracted health delivery system providing capitated or prepaid health services, also known as a Prepaid Health Plan (PHP). An MCO is responsible for providing, arranging, and making reimbursement arrangements for covered services as governed by state and federal law. An MCO may be a Chemical Dependency Organization (CDO), Dental Care Organization (DCO), Mental Health Organization (MHO), or Physician Care Organization (PCO).

  • Managed care means a system that provides the coordinated delivery of services and supports that are necessary and appropriate, delivered in the least restrictive settings and in the least intrusive manner. Managed care seeks to balance three factors: achieving high-quality outcomes for participants, coordinating access, and containing costs.

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

  • 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.

  • 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).

  • 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.

  • 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.

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

  • Foster care services means the provision of a full range of casework, treatment and community

  • Home care agency means any sole proprietorship,

  • Child care services means the range of activities and programs provided by a certificate holder to an enrolled child, including personal care, supervision, education, guidance, and transportation.

  • 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.

  • Coordinated care organization means an organization meeting criteria adopted by the

  • Primary care services means the services in respect of which NHS England has a duty or power to make arrangements pursuant to the Primary Care Functions;

  • Environmental Management System means an environmental management system or plan of management to address all environmental risks and to ensure compliance with all Environmental Laws and licences;

  • 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)).