Medicare+Choice organization definition

Medicare+Choice organization means a public or private entity that is certified under section 1856 as meeting the requirements and standards of this part for such an organization.
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Medicare+Choice organization means a public or private entity organized and licensed by a State as a risk-bearing entity (with the exception of provider-sponsored organizations receiving waivers) that is certified by HCFA as meeting the Medicare+Choice contract requirements.
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Examples of Medicare+Choice organization in a sentence

  • For portions of cost re- porting periods occurring on or after January 1, 1998, the product derived in step one is multiplied by the propor- tion of the hospital’s inpatient days at- tributable to individuals who are en- rolled under a risk-sharing contract with an eligible organization under sec- tion 1876 of the Act and who are enti- tled to Medicare Part A or with a Medicare+Choice organization under Title XVIII, Part C of the Act.

  • In applying paragraph (1) in the case of a Medicare+Choice organization that is offering an MSA plan, paragraph (1) shall be applied by substituting covered lives for individuals.

  • The Secretary shall not permit the election under section 1395w–21 of this title of a Medicare+Choice plan offered by a Medicare+Choice organization under this part, and no payment shall be made under section 1395w–23 of this title to an organization, unless the Secretary has entered into a contract under this section with the organization with respect to the offering of such plan.

  • Subject to paragraphs (2) and (3), a Medicare+Choice organization shall be orga- nized and licensed under State law as a risk- bearing entity eligible to offer health insur- ance or health benefits coverage in each State in which it offers a Medicare+Choice plan.

  • The Secretary may not enter into a con- tract with a Medicare+Choice organization if a previous contract with that organization under this section was terminated at the re- quest of the organization within the preced- ing 2-year period, except as provided in sub- paragraph (B) and except in such other cir- cumstances which warrant special consider- ation, as determined by the Secretary.

  • If the Medicare+Choice organization fails to establish and enforce procedures required under clause (ii), the organization is subject to intermediate sanctions under section 1395w–27(g) of this title.

  • A Medicare+Choice organization shall con- sult with physicians who have entered into participation agreements with the organiza- tion regarding the organization’s medical pol- icy, quality, and medical management proce- dures.

  • The Secretary is authorized to charge a fee to each Medicare+Choice organization with a contract under this part and each PDP sponsor with a contract under part D of this subchapter that is equal to the organiza- tion’s or sponsor’s pro rata share (as deter- mined by the Secretary) of the aggregate amount of fees which the Secretary is di- rected to collect in a fiscal year.

  • The Medicare+Choice organization that offers such a plan shall establish proce- dures, similar to the procedures described in section 1395w–4(g)(1)(A) of this title, in order to carry out the previous sentence.

  • The facility has a contract with the Medicare+Choice organization for the pro- vision of such services, or the facility agrees to accept substantially similar pay- ment under the same terms and conditions that apply to similarly situated skilled nursing facilities that are under contract with the Medicare+Choice organization for the provision of such services and through which the enrollee would otherwise receive such services.

Related to Medicare+Choice organization

  • 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.

  • Health care organization ’ means any person or en-

  • 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).

  • Provider Organization means a group practice, facility, or organization that is:

  • Health maintenance organization means a person licensed pursuant to Chapter 43 (§ 38.2-4300 et

  • Employee organization means any organization, union, or

  • Credit union service organization means an organization, corporation, or association whose membership or ownership is primarily confined or restricted to credit unions or organizations of credit unions and whose purpose is primarily designed to provide services to credit unions, organizations of credit unions, or credit union members.

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

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other such entity administering the Medicaid program and a health care provider or supplier under which the health care provider or supplier agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

  • Procurement organization means an eye bank, organ procurement organization, or tissue bank.

  • Medicare Provider Agreement means an agreement entered into between CMS or other such entity administering the Medicare program on behalf of CMS, and a health care provider or supplier under which the health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • Preferred Provider Organization (PPO) means a health insurance issuer's or carrier's insurance policy that offers covered health care services provided by a network of providers who are contracted with the issuer or carrier (“in-network”) and providers who are not part of the provider network (“out-of-network”).

  • Religious organization means a church, ecclesiastical corporation, or group, not organized for pecuniary profit, that gathers for mutual support and edification in piety or worship of a supreme deity.

  • Eligible organization means a veterans, charitable, educational, religious, fraternal,

  • ADR Organization means The American Arbitration Association or, if The American Arbitration Association no longer exists or if its ADR Rules would no longer permit mediation or arbitration, as applicable, of the dispute, another nationally recognized mediation or arbitration organization selected by the Sponsor.

  • Labor organization means any organization of any kind, or any agency or employee representation committee or plan, in which employees participate and that exists for the purpose, in whole or in part, of dealing with employers concerning grievances, labor disputes, wages, rates of pay, hours of employment, or conditions of work.

  • Review organization means a disability insurer regulated

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

  • 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.

  • Medicaid Certification means certification by CMS or a state agency or entity under contract with CMS that health care operations are in compliance with all the conditions of participation set forth in the Medicaid Regulations.

  • Accountable care organization or “ACO” means an organization of health care providers that has a formal legal structure, is identified by a federal Taxpayer Identification Number, and agrees to be accountable for the quality, cost, and overall care of the patients assigned to it.

  • Provider agreement means the signed, written, contractual agreement between the department and the provider of services or goods.

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

  • Subscriber organization means any for-profit or nonprofit entity that owns or operates one or more

  • Electric Reliability Organization or “ERO” means the organization that is certified by the Commission under Section 39.3 of its regulations, the purpose of which is to establish and enforce Reliability Standards for the Bulk Power System in the United States, subject to Commission review. The organization may also have received recognition by Applicable Governmental Authorities in Canada and Mexico to establish and enforce Reliability Standards for the Bulk Power Systems of the respective countries.

  • 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.

Most Referenced Clauses

Most Referenced Definitions