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http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1265
"Health care plan" means a plan, including, but not limited to, a health maintenance organization, a managed care community network as defined in the Illinois Public Aid Code, or an accountable care entity as defined in the Illinois Public Aid Code that receives capitated payments to cover medical services from the Department of Healthcare and ...
https://www.dfs.ny.gov/insurance/circltr/1997/cl97_07.htm
The Managed Care Reform Act (the Act), in part, amends the Insurance Law to address disclosure requirements, provider due process requirements, provider contract limitations, grievance procedure requirements and provider access and continuity of care requirements.
https://www.healthaffairs.org/do/10.1377/hblog20180430.387981/full/
May 03, 2018 · Editor’s note: Part 1 of this post, which appears below, provides background on Medicaid managed care and outlines the pressing questions and challenges facing …
https://www.dfs.ny.gov/insurance/circltr/1998/cl98_09.htm
Specifically, the Managed Care Reform Act added §4802(a) to the New York State Insurance Law to require insurers that offer a "managed care product" to establish and maintain a grievance procedure with regard to such a product. A "managed care product" is defined under §4801(c) of the Insurance Law. (See page three for definition.)
https://www.medicaid.gov/medicaid/quality-of-care/index.html
The Center for Medicaid and CHIP Services (CMCS) partners with states to share best practices and provide technical assistance to improve the quality of care. CMCS’s efforts are guided by the overarching aims of the Centers for Medicare & Medicaid Services (CMS) Quality Strategy : better health, better care, lower cost through improvement.
http://www.ag.state.il.us/consumers/healthcare.html
HEALTH CARE COMPLAINT FORMS. Fill out our Health Care Complaint Form (English) Large Print Fill out our Health Care Complaint Form (Español) Fill out our Health Care Complaint Form (Polish). Call our Health Care Hotline at 1-877-305-5145 (TTY 1-800-964-3013). The Attorney General’s Health Care Bureau was created to assist consumers with difficulties they encounter in obtaining health care ...
https://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights.aspx
9. Your New Rights Under Health Care Reform. To purchase health insurance or determine Medi-Cal eligibility through the California Health Benefit Exchange, Covered California. To stay on a parent’s health plan until age 26. To get many preventive care services without a co-pay, co-insurance or deductible.
Today, the California Department of Managed Health Care (DMHC) announced enforcement action against a dozen health plans, including fines totaling $1.9 million, for lack of oversight of a contracted medical group which led to improper denials and delays of enrollees’ care.
https://www.illinois.gov/hfs/MedicalClients/ManagedCare/Pages/default.aspx
Welcome to the Managed Care section of the Illinois Department of Healthcare and Family Services (HFS) website. In 2018, HealthCare and Family Services expanded their Managed Care program to cover all counties in Illinois. This program is a member-focused program called HealthChoice Illinois. Special Needs for Children - Latest News
https://flmedicaidmanagedcare.com/
Statewide Medicaid Managed Care. Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services. There are three different programs that makeup the Statewide Medicaid Managed Care. Managed Medical Assistance (MMA) Program, Long-term Care (LTC) Program, and Dental Program. Learn More About ...
https://content.naic.org/cmte_b.htm
American Health Benefit Exchange Model Act (Document adopted by Health Insurance and Managed Care (B) Committee 11/22/10) NAIC Comment Letter on OPM's Multi-State Plan Application. SPECIAL SECTION: Health Care Reform (PPACA) Implementation: NAIC Activities FAQ. Guidance Discussion Papers Adopted by Committee, June 27, 2013
https://www.hhs.gov/answers/health-care/how-can-i-complain-about-poor-medical-care/index.html
If you get an infection while you are in the hospital or have problems getting the right medication, you can file a complaint with the Joint Commission. This group certifies many U.S. hospitals' safety and security practices and looks into complaints about patients' rights. It does not oversee medical care or how the hospital may bill you.
https://nyhpa.org/resources/consumer-protection-laws/ny-managed-care-act/
NY Managed Care Act New York’s Managed Care Reform Act, enacted in 1997, is the most far-reaching legislation to regulate health plans in the country. The law established utilization review standards for all managed care plans, standardized grievance and appeals procedures, and requirements for providing all enrollees and potential enrollees with detailed descriptions of a
https://www.mass.gov/how-to/file-a-health-care-complaint
The Health Care Division offers a free mediation service, and if your complaint is appropriate for mediation, a staff member will contact you. If we determine that your complaint is not appropriate for mediation, a staff member will offer you information about other courses of action available to you.
http://insurance.illinois.gov/HealthInsurance/OCHIFactSheet.pdf
• Assist you when you have a problem or complaint. What is the Managed Care Reform and Patient Rights Act? The . Managed Care Reform and Patient Rights Act, 215 ILCS 134, gives Illinois consumers more control of their health care through tighter requirements on health maintenance organizations, insurance companies, doctors and
https://www.kff.org/report-section/medicaid-managed-care-plans-and-access-to-care-provider-networks-and-access-to-care/
Medicaid Managed Care Plans and Access to Care: Results from the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans. Rachel Garfield Follow @RachelLGarfield on …
https://www.health.ny.gov/health_care/managed_care/
Managed Care is a term that is used to describe a health insurance plan or health care system that coordinates the provision, quality and cost of care for its enrolled members. In general, when you enroll in a managed care plan, you select a regular doctor, called a primary care practitioner (PCP ...
https://ahca.myflorida.com/consumers.shtml
General Consumer Information. File a Complaint; FloridaHealthFinder.gov; Health Care Advance Directives-En español: Directivas por anticipado de cuidado médico ... Information about Medicaid Managed Care and the Medicaid Reform Pilot. Choose a Health Plan (Reform) Choose a Medicaid Health Plan (Non-Reform) Quality in Managed Care;
https://opwdd.ny.gov/opwdd_services_supports/managed_care/faqs
Managed care is a payment system in which a Managed Care Organization (MCO) receives money that will be paid to a group or network of providers to plan and deliver all of a person’s medical, behavioral and developmental disabilities services and supports.
https://hhs.texas.gov/services/health/medicaid-chip/provider-information/contracts-manuals/texas-medicaid-chip-uniform-managed-care-manual
Texas Medicaid and CHIP - Uniform Managed Care Manual The manual below defines procedures that Managed Care Organizations (MCOs) must follow in order to meet certain requirements in the HHSC managed care contracts, and to provide interpretation on contractual provisions that need clarification.
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