Idaho Administrative Code
Title IDAPA 16 - Health and Welfare, Department of
Rule 16.03.17 - MEDICARE/MEDICAID COORDINATED PLAN BENEFITS
COVERED SERVICES
Section 16.03.17.301 - MMCP BENEFITS: PROVIDER REIMBURSEMENT

01. Medicaid-Only Service Providers. Providers who only offer Medicaid services must be approved for the MMCP before receiving reimbursement and are subject to the General Provider Provisions under IDAPA 16.03.09, "Medicaid Basic Plan Benefits." Approved providers are reimbursed under the methodology in IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits," related to the Medicaid-only service. (4-6-23)

02. Medicare Service Providers. Medicare service providers are reimbursed under the methodologies established by the MAO and approved by CMS. MAOs are responsible for participant Medicare cost-sharing as described in the approved MMCP contract. (4-6-23)