Source: https://www.govregs.com/regulations/42/422.2
Timestamp: 2020-07-04 16:15:26
Document Index: 290251331

Matched Legal Cases: ['§ 422', 'art 422', '§ 422', '§ 422', '§ 422', '§ 422', '§ 422', '§ 422', '§ 422', '§ 422', '§ 422', '§ 424', '§ 424', '§ 424', '§ 423', '§ 423', '§ 422', '§ 422', '§ 422', 'art 423']

42 CFR 422.2 - Definitions. § 422.2 - Definitions.
All TitlesTitle 42Chapter IVPart 422Subpart A - General Provisions
View all text of Subpart A [§ 422.1 - § 422.6]
§ 422.2 - Definitions.
Arrangement means a written agreement between an MA organization and a provider or provider network, under which -
Dual eligible special needs plan or D-SNP means a specialized MA plan for special needs individuals who are entitled to medical assistance under a State plan under title XIX of the Act that -
(3) Has a contract with the State Medicaid agency consistent with § 422.107 that meets the minimum requirements in paragraph (c) of such section; and
(i) Meets the additional requirement specified in § 422.107(d) in its contract with the State Medicaid agency.
Fully integrated dual eligible special needs plan means a dual eligible special needs plan -
Highly integrated dual eligible special needs plan means a dual eligible special needs plan offered by an MA organization that provides coverage, consistent with State policy, of long-term services and supports, behavioral health services, or both, under a capitated contract that meets one of the following arrangements -
Institutionalized-equivalent means for the purpose of defining a special needs individual, an MA eligible individual who is living in the community but requires an institutional level of care. The determination that the individual requires an institutional level of care (LOC) must be made by -
MA local area is defined in § 422.252.
MA eligible individual means an individual who meets the requirements of § 422.50.
MA plan means health benefits coverage offered under a policy or contract by an MA organization that includes a specific set of health benefits offered at a uniform premium and uniform level of cost-sharing to all Medicare beneficiaries residing in the service area of the MA plan (or in individual segments of a service area, under § 422.304(b)(2)).
MSA trustee means a person or business with which an enrollee establishes an MA MSA. A trustee may be a bank, an insurance company, or any other entity that -
(2) Meets the requirements of § 422.262(b).
Preclusion list means a CMS compiled list of individuals and entities that -
(i) The individual or entity is currently revoked from Medicare for a reason other than that stated in § 424.535(a)(3) of this chapter.
(ii) The individual or entity is currently under a reenrollment bar under § 424.535(c).
(i) The individual or entity has engaged in behavior, other than that described in § 424.535(a)(3) of this chapter, for which CMS could have revoked the individual or entity to the extent applicable had they been enrolled in Medicare.
(3) The individual or entity, regardless of whether they are or were enrolled in Medicare, has been convicted of a felony under Federal or State law within the previous 10 years that CMS deems detrimental to the best interests of the Medicare program. Factors that CMS considers in making such a determination under this paragraph (3) are -
Prescription drug plan (PDP). PDP has the definition set forth in § 423.4 of this chapter.
Prescription drug plan (PDP) sponsor. A prescription drug plan sponsor has the definition set forth in § 423.4 of this chapter.
Provider means -
Religious Fraternal benefit (RFB) society means an organization that -
Senior housing facility plan means an MA coordinated care plan that -
(1) Restricts enrollment to individuals who reside in a continuing care retirement community as defined in § 422.133(b)(2);
(2) Provides primary care services onsite and has a ratio of accessible physicians to beneficiaries that CMS determines is adequate consistent with prevailing patterns of community health care referenced at § 422.112(a)(10);
Specialized MA Plans for Special Needs Individuals means an MA coordinated care plan that exclusively enrolls special needs individuals as set forth in § 422.4(a)(1)(iv) and that provides Part D benefits under part 423 of this chapter to all enrollees; and which has been designated by CMS as meeting the requirements of an MA SNP as determined on a case-by-case basis using criteria that include the appropriateness of the target population, the existence of clinical programs or special expertise to serve the target population, and whether the proposal discriminates against sicker members of the target population.