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.

  • Allowable graduate medical edu- cation costs are non-reimbursable if payment for these costs are received from a hospital or a Medicare+Choice organization.

  • 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.

  • This would allow the Medicare+Choice organization to address specific examples of problems the company encountered during its ongoing audits and risk analysis, while reinforcing the company’s firm commitment to the general principles of compliance and ethical conduct.

  • The OIG suggests all relevant levels of personnel be made part of various educational and training programs of the Medicare+Choice organization.

  • The Medicare+Choice organization should maintain its newsletters in a central location to document the guidance offered and provide new employees with access to guidance previously provided.

  • Each Medicare+Choice organization shall permit the payment of Medicare+Choice monthly basic, prescription drug, and supple- mental beneficiary premiums on a monthly basis, may terminate election of individuals for a Medicare+Choice plan for failure to make premium payments only in accordance with section 1395w–21(g)(3)(B)(i) of this title, and may not provide for cash or other monetary rebates as an inducement for enrollment or otherwise.

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.

  • 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 that term as defined in section 3501 of the insurance code of 1956, 1956 PA 218, MCL 500.3501.

  • Employee organization means any organization, union, or

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

  • 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.

  • 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.

  • 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.

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