Medicaid Managed Care Program definition

Medicaid Managed Care Program means the Department’s system of coordinated care for individuals under HFS Medical Programs.
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Medicaid Managed Care Program means a program under sections 1903(m), 1905(t), and 1932 and includes a man- aged care program operating under a waiver under section 1915(b) or 1115 or otherwise.’’.
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Medicaid Managed Care Program means a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per-member, per-month (capitation) payment for these services pursuant to 42 U.S.C. § 438.
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Examples of Medicaid Managed Care Program in a sentence

  • The South Carolina Healthy Connections Program (a.k.a. the South Carolina Medicaid Managed Care Program) is administered by the South Carolina Department of Health and Human Services (SCDHHS) under the 1932(a) State Plan Authority (SSA Sec.

  • Ancillary medical services are included in the Medicaid Managed Care Program coverage array.

  • HHSC has authority to contract with MCOs to carry out the duties and functions of the Medicaid Managed Care Program under Title XIX of the Social Security Act; §12.011 and §12.02, Texas Health and Safety Code; and Chapter 533, Texas Government Code.

  • The Provider agrees that if it claims, orders, or is paid $500,000 or more per year from the Medical Assistance Program, including, in the aggregate, claims submitted to or paid directly by the Medical Assistance Program and/or claims submitted to or paid by any MCO under the Medicaid Managed Care Program, that it shall adopt and implement a compliance program which meets the requirements of New York State Social Services Law § 363-d(2) and 18 NYCRR § 521.3.

  • The state uses Plan Qualification Standards to qualify MCOs for participation in the Medicaid Managed Care Program.

  • The Contractor may conduct marketing campaigns for members subject to the restrictions noted in RI EOHHS Guidelines for Marketing and Member Communications for Medicaid Managed Care Program, Rite Smiles, Non-Emergency Medical Transportation and Medicare-Medicaid Program (ad hoc materials).

  • The contract must define those technical managed care terms used in the contract, and whether those definitions reference other documents distributed to providers and are consistent with definitions included in Medicaid Member materials issued in conjunction with the Medicaid Managed Care Program.

  • For a comprehensive description of the access performance measures below, see ODJFS Methods for the ABD Medicaid Managed Care Program Access Performance Measures.

  • If a Medi-Cal and Medicaid Managed Care Program Provisions require additional scope change, the Parties shall amend the applicable Statement of Work to revise the fees/charges in an amount bearing a reasonable relationship to the impact of the change in the scope.

  • Plans are required to comply with the information requirements and marketing guidelines under 42 § C.F.R. 438.10 and 42 C.F.R. 438.104; RI EOHHS Guidelines for Marketing and Member Communications for Medicaid Managed Care Program as set forth in the CMS Medicaid and CHIP Final Rule.