MMC definition
Examples of MMC in a sentence
Regardless of whether the MCOPs and MMC program Managed Care Plans (MCPs) meet the COVID-19 vaccination incentive, MCPs/MCOPs are eligible to be reimbursed up to $55 million of the total $200 million incentive pool for their incurred expenses specifically related to member and provider COVID-19 vaccination incentives.
For example, if the MCPs/MCOPs spend (and are subsequently reimbursed by ODM for) $40 million on member and provider incentives, the MMC and MyCare incentive pools will be reduced to $140 million ($175M - $40M x 0.875) and $20 million ($25M - $40M x 0.125), respectively.
However, of the amount that is spent on member and provider incentives, 87.5% and 12.5% will be removed from the total MMC and MyCare incentive pools, respectively.
Program adjustments were applied in the rate development process to the extent a policy or reimbursement change is deemed to have a material cost impact to the MCOPs. We defined a program adjustment to be ‘material’ if the total benefit expense for any individual rate cell is impacted by more than 0.1%, or if the program adjustment was considered ‘material’ for the Medicaid Managed Care (MMC) program.