Idaho Administrative Code
Title IDAPA 16 - Health and Welfare, Department of
Rule 16.03.17 - MEDICARE/MEDICAID COORDINATED PLAN BENEFITS
COVERED SERVICES
Section 16.03.17.300 - MMCP: COVERAGE AND LIMITATIONS
Universal Citation: ID Admin Code 16.03.17.300
Current through August 31, 2023
An MMCP is subject to applicable federal managed care requirements. (4-6-23)
01. MMCP-Covered Services. Include: (4-6-23)
a. MAO-Covered Services. Under the "Evidence
of Coverage," the MAO may limit or expand the scope of services as defined in
the "Evidence of Coverage." MAO-covered services, including Medicare Parts A,
B, and D benefits, are detailed in the MMCP contract. (4-6-23)
b. Medicaid-Only Services. Under IDAPA
16.03.09, "Medicaid Basic Plan Benefits," or IDAPA 16.03.10, "Medicaid Enhanced
Plan Benefits," provided by Medicaid providers that are not MAOs. Medicaid may
cover additional services that are not included in the MAO's "Evidence of
Coverage." (4-6-23)
c. Supplemental
services unavailable on Medicare or Medicaid. (4-6-23)
02. Services Excluded from the MMCP. Services not included in the MAO's "Evidence of Coverage" or listed under Subsection 300.01 of this rule are not covered under the MMCP. (4-6-23)
03. Premiums and Cost-Sharing. Participants will not pay any premiums or cost-sharing when covered under the MMCP, except as described in an approved MMCP contract. (4-6-23)
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