Managed care arrangement definition
Managed care arrangement or "MCA” means a system that may use capitated financing to deliver high quality services and promote and optimize health outcomes through a medical home. Such an arrangement also includes services and supports that optimize the health and independence of beneficiaries who are determined to need or be at risk for Medicaid funded LTSS. An MCA includes any arrangement under which an MCO or contracted entity is granted some or all of the responsibility for providing and/or paying for long-term care services and supports through a contractual agreement with the Medicaid program.
Managed care arrangement means an agreement offered by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services through the covered person’s use of health care providers managed by, owned by, under contract with, or employed by the insurer because the insurer creates incentives, including financial incentives, for the covered person’s use of those providers. A managed care arrangement includes, but is not limited to, and HMO or PPO arrangement.
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