Does Ky use Medicaid managed care?
The state has since implemented a mandatory risk-based managed care program, referred to as Medicaid Managed Care, for most Medicaid beneficiaries. In January 2014, Kentucky expanded managed care through an Alternative Benefit Plan (ABP). The newly eligible populations are mandatorily enrolled in existing MCOs.
What is a prepaid ambulatory health plan?
• Prepaid Ambulatory Health Plan (PAHP): A PAHP is a non-comprehensive prepaid health plan. that provides only certain outpatient services, such as dental services or outpatient behavioral health. care, and does not cover any inpatient services.5.
What is a Medicaid managed care organization?
Medicaid managed care organizations (MCOs) provide comprehensive acute care and in some cases long-term services and supports to Medicaid beneficiaries. MCOs accept a set per member per month payment for these services and are at financial risk for the Medicaid services specified in their contracts.
What is the purpose of the Wellcare of Kentucky managed care contract?
As a company that provides managed care services targeted to government-sponsored health care programs, our primary mission is to enhance our members’ health and quality of life, and to partner with our government customers and providers to develop and deliver quality, cost-effective health care.
What are MCOs in healthcare?
What is WellCare global choices?
Global Choices is the benefit plan for most Kentucky Medicaid members. This plan covers basic medical services. This is not a complete list of services. If a service is not listed, there is no co-pay. Some service limits can be increased if the service is medically necessary (requires prior approval).
What is PAHP?
Prepaid ambulatory health plan (PAHP) means an entity that – (1) Provides services to enrollees under contract with the State, and on the basis of capitation payments, or other payment arrangements that do not use State plan payment rates.
What is Pihp?
PIHP is an acronym for Prepaid Inpatient Health Plan, a term contained in federal regulations from the Centers for Medicare & Medicaid Services.
What is the difference between Medicaid and managed care?
Under the FFS model, the state pays providers directly for each covered service received by a Medicaid beneficiary. Under managed care, the state pays a fee to a managed care plan for each person enrolled in the plan.