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- Managed Care | Medicaid
Managed Care is 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
- Managed Care Entities | Medicaid
Federal Managed Care regulations at 42 CFR 438 recognize four types of managed care entities: Managed Care Organizations (MCOs) Comprehensive benefit package Payment is risk-based capitation Primary Care Case Management (PCCM)
- Managed Care in Pennsylvania - Medicaid. gov
available for beneficiaries who do not voluntarily choose a HealthChoices MCO in those counties The state also has two other managed care programs: (1) the Program for the All-Inclusive Care for the Elderly (PACE), which in Pennsylvania is known as Living Independence for the Elderly (LIFE), provides a full continuum of acute, primary and long
- Managed Care in Puerto Rico - Medicaid. gov
Care Organization (MCO) per region, to one of island-wide coverage and choice of four (4) MCOs, with the goal of improving access to care and choice of providers Plan Vital also implemented a model of stratified capitated payments to MCOs, with focused resources for High Cost High Need conditions which is expected to result
- Medicaid Managed Care State Guide
types (i e , MCO, PIHP, PAHP, NEMT PAHP, PCCM, PCCM entity, HIO) to which the requirement applies; 4) the governing statutory, regulatory, and or other policy citation(s); and 5) the date by which CMS will enforce the contract requirement Sections II and III of this guide provide additional resources to help states in their contract development
- Managed Care in Arizona - Medicaid. gov
MCO contracts coveredand by the Arizona Department of Health Services Division of Behavioral Health Services (ADHS DBHS) through subcontracts with community-based organizations, known as Regional Behavioral Health Authorities (RBHAs) or Tribal Regional Behavioral Health Authorities (TRBHAs) for members who live on a reservation
- Managed Care in New York - Medicaid. gov
primary, specialty, limited long term care and limited behavioral health through managed care organizations (MCO) and primary care case management (PCCM options) Low-income adults and childrenare enrolled on a mandatory basis, and foster care children may enroll on a voluntary basis In 2001, New York extended the Partnership Progam to create r
- Managed Care Authorities | Medicaid
States can implement a managed care delivery system using three basic types of federal authorities:State plan authority [Section 1932(a)]Waiver authority [Section 1915 (a) and (b)]Waiver authority [Section 1115]Regardless of the authority, states must comply with the federal regulations that govern managed care delivery systems
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