Idaho Admin. Code r. 16.03.17.010 - DEFINITIONS

01. Department. The Idaho Department of Health and Welfare or designee. (4-6-23)

02. Dual-Eligible. Individuals meeting eligibility requirements under Section 100 of these rules. (4-6-23)

03. Fully Integrated Dual-Eligible Special Needs Plan (FIDE-SNP). A health plan fully integrating care for dual-eligible participants under a single MAO. (4-6-23)

04. Idaho Medicaid Plus (IMPlus). A health plan option for certain dual-eligible participants where Medicaid covered services are provided under a managed care organization, under IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits," Sections 076 through 079. (4-6-23)

05. Evidence of Coverage. The Medicare Advantage Plan contract between the MAO and the participant that explains the covered services, including services under Medicare Parts A, B, and D. (4-6-23)

06. Medicare Advantage Organizations (MAOs). Insurance companies approved by the Centers for Medicare/Medicaid Services (CMS) to offer Medicare Advantage Plans. (4-6-23)

07. Medicare Advantage Plan. A private health plan approved by and contracted with CMS to provide Medicare Parts A, B, and D benefits as described in its "Evidence of Coverage." (4-6-23)

08. Medicare/Medicaid Coordinated Plan (MMCP). FIDE-SNP for certain dual-eligible participants integrating Medicare and Medicaid covered services under one (1) managed care organization. (4-6-23)

Notes

Idaho Admin. Code r. 16.03.17.010