St. Anthony"s Medicaid Managed Care and Capitation Manual (Mref)
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St. Anthony"s Medicaid Managed Care and Capitation Manual (Mref) by Michael Grambo

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Published by Ingenix .
Written in English


  • Medicaid & Medicare,
  • Medical / Nursing

Book details:

The Physical Object
Number of Pages400
ID Numbers
Open LibraryOL12134378M
ISBN 101563294923
ISBN 109781563294921

Download St. Anthony"s Medicaid Managed Care and Capitation Manual (Mref)


Information for All Providers – Managed Care Information Version J 4 of 4 County/District Codes Below is a listing of all the counties and their corresponding district codes. UPPER PAYMENT LIMITS AND MEDICAID CAPITATION RATES EDITION 4 An approach using Medicaid Long-Term Services and Supports (MLTSS) experience sets the PACE capitation rate based on the actual or expected cost of services provided to a comparable population through managed care . Capitation rates paid to Medicaid managed care programs must. M1 Office of Medicaid – Managed Care – payments for services covered by managed-care organizations. . MassHealth pays the MCO a fixed monthly fee, or capitated premium, Medicaid managed care regulations – U.S. Government Printing.   HMA Senior Consultant Ellen Breslin prepared this recently released primer for the Massachusetts Medicaid Policy Institute. It includes: An explanation of how state Medicaid programs generally pay their managed care organizations (MCOs) The overall process for setting Medicaid managed care capitation rates; and The various tools states use to mitigate the risks that MCOs face.

  For managed care contracts beginning on or after July 1, , states must ensure that capitation rates are adequate to meet MCO contractual requirements regarding availability of services, assurance of adequate capacity and services, and coordination and continuity of care. For managed care contracts beginning on or after July 1, , states. Medicaid Managed Longg Term Supports and Services (MLTSS) January 9 January 9, Maria Dominiak, FSA, MAAA The Integrated Care Resource Center is a joint technical assistance initiative of the Centers for Medicare & Medicaid Services’ Medicare-Medicaid Coordination Office and the Center for Medicaid and CHIP Services. Among the case-study states only Oklahoma pays PCPs using capitation. The capitation rates ($ for TANF and $ for ABD) cover primary, preventive, and case management services (including lab and X-ray services). Oklahoma Medicaid representatives reported taking this approach for two reasons. The purpose of this document is to assist participating managed care organizations in understanding and complying with the New York State Medicaid (NYS-Medicaid) requirements. The guide addresses Enrollee Rosters. This document is customized for managed care providers as File Size: KB.

DOH Medicaid Update Website Provides up-to-date changes that may affect your participation in the Medicaid Program.: MEVS and Supplemental Documentation This information is not part of your provider manual, however, it may be useful information and is placed here for your convenience.: Ordering Information Contact information you can use to order hard (paper-based) copies of eMedNY manuals. Medicaid Managed Care Capitation Rate Development Process and Considerations 4 Form of the Capitation Rates (Single Rate or Capitation Rate Ranges) 4 Structure of the Medicaid Managed Care Capitation Rates 4 Rebasing and Updating of Rates 4 Base Data 5 Covered Services 5. • The Medicaid baseline cost projection takes into account historical costs, and includes consideration of Medicaid managed care plan level payment (if the state currently serves Medicare-Medicaid enrollees through capitated managed care) as well as fee-for-service (FFS) costs. In capitated Medicaid managed care arrangements, State Medicaid programs pay managed care plans a fixed rate per Medicaid beneficiary in exchange for services included in the plan. 3 Except in limited circumstances specified by the State (e.g., the beneficiary receives services outside the managed care plan coverage area), MedicaidFile Size: KB.