managed care entity

(1) Use of medicaid managed care organizations and primary care case managers (A) In general Subject to the succeeding provisions of this section, and notwithstanding paragraph (1), (10)(B), or (23)(A) of section 1396a(a) of this title , a State— (i) may require an individual who is eligible for medical assistance under the State plan under this subchapter to enroll with a managed care entity as a condition of receiving such assistance (and, with respect to assistance furnished by or under arrangements with such entity, to receive such assistance through the entity), if— (I) the entity and the contract with the State meet the applicable requirements of this section and section 1396b(m) of this title or section 1396d(t) of this title , and (II) the requirements described in the succeeding paragraphs of this subsection are met; and (ii) may restrict the number of provider agreements with managed care entities under the State plan if such restriction does not substantially impair access to services. (B) “Managed care entity” defined In this section, the term “managed care entity” means— (i) a medicaid managed care organization, as defined in section 1396b(m)(1)(A) of this title , that provides or arranges for services for enrollees under a contract pursuant to section 1396b(m) of this title ; and (ii) a primary care case manager, as defined in section 1396d(t)(2) of this title .


42 USC § 1396u-2(a)(1)

Scoping language

In this section
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