Medicaid Managed Care definition

Medicaid Managed Care. Orthopedic Footwear means shoes, shoe modifications, or shoe additions which are used to correct, accommodate or prevent a physical deformity or range of motion malfunction in a diseased or injured part of the ankle or foot; to support a weak or deformed structure of the ankle or foot, or to form an integral part of a brace.
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Medicaid Managed Care refers to one or all of the following health care plans authorized and contracted by New York to manage a specified benefit package of Medicaid benefits for a defined group of eligible enrollees: Mainstream Managed Care Plan (MMCP), Health and Recovery Plan (HARP), Medicaid Advantage Plus (MAP), or Managed Long Term Care Partial Capitation (MLTCP).
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Medicaid Managed Care. North Carolina’s program under which contracted Managed Care Organizations arrange for integrated medical, physical, pharmacy, behavioral, and other services to be delivered to Medicaid and NC Health Choice Beneficiaries. Medicaid Managed Care will include four types of plans: (1) Standard Plans, (2) BH I/DD Tailored Plans, and (3) Children and Families Specialty Plan. The use of Medicaid Managed Care is also inclusive of) EBCI Tribal Option, operating as a primary care case management entity (PCCMe).
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Examples of Medicaid Managed Care in a sentence

  • Providers will use a single, electronic application to submit information to be verified and screened to become a Medicaid enrolled provider, with the application serving for enrollment as a Medicaid Fee-for-Serviceprovider as well as a Medicaid Managed Care Provider.

  • In June 2018, the North Carolina General Assembly enacted North Carolina Session Law 2018-48, which amended Session Law 2015-245, directing the Department to provide a plan to the General Assembly about the future of serving children and youth currently and formerly in the child welfare system under Medicaid Managed Care.

  • The Children and Families Specialty Plan (CFSP) is an integrated Medicaid Managed Care plan that covers services specified to address a spectrum of Member needs, including those related to physical health, behavioral Health, I/DD, LTSS, and pharmacy services and unmet health-related resource needs.

  • The Department will ensure that Medicaid Beneficiaries and their families and caregivers are supported in the transition to Medicaid Managed Care and the CFSP throughout the Enrollment process, including enrolling in the CFSP and selecting a Primary Care Provider (PCP).

  • The Department shall not mandate Medicaid Managed Care providers enrolled with the State participate in the State Medicaid Fee-for-Service program.

  • The CFSP must notify the Department with an attestation of any Member still enrolled in Medicaid Managed Care prior to the first day of the next month following the 90th day of stay, if there is a delay in the Department’s disenrollment notification.

  • The North Carolina Medicaid Managed Care and CFSP Enrollment Policy outlines the expectations of the Department, the Enrollment Broker, and the CFSP in the Enrollment of Beneficiaries into the CFSP.

  • The Department reserves the right to amend this Policy based on an increase or decrease in covered populations in Medicaid Managed Care, changes in North Carolina or federal law or regulation, federally approved Medicaid waivers for North Carolina, or a change in the Enrollment processes.


More Definitions of Medicaid Managed Care

Medicaid Managed Care. A NC Medicaid Managed Care plan that will serve members as described in Section 9E.22 of Session Law 2023-134. d. Section III.
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Medicaid Managed Care. The name of the North Carolina managed care program for North Carolina Medicaid and NC Health Choice benefits; does not include LME/MCOs.
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Medicaid Managed Care means Medicaid provided under section three hundred sixty-four-j of this chapter.
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Medicaid Managed Care means a program of health services provided to eligible clients by a managed care organization under a contract with a department.
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Related to Medicaid Managed Care

  • 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.

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

  • Health care facility or "facility" means hospices licensed

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

  • Child care means continuous care and supervision of five or more qualifying children that is:

  • Managed care entity means an insurer that:

  • PREVENTIVE CARE SERVICES means covered healthcare services performed to prevent the occurrence of disease as defined by the Affordable Care Act (ACA). See Preventive Care and Early Detection Services in Section 3. PRIMARY CARE PROVIDER (PCP) means, for the purpose of this plan, professional providers that are family practitioners, internists, and pediatricians. For the purpose of this plan, gynecologists, obstetricians, nurse practitioners, and physician assistants may be credentialed as PCPs. To find a PCP or check that your provider is a PCP, please use the “Find a Doctor” tool on our website or call Customer Service.