Glossary of Terms

Managed Care Organization (MCO)
Qualified Mainstream Managed Care Organization that meets the qualifications established by this RFQ to manage behavioral health services for Medicaid beneficiaries.
Managed Care Plans
Includes the Mainstream MCO, Managed Care Organizations, and Health and Recovery Plans.
Managed Care Technical Assistance Center (MCTAC)
Provides trainings and resources to support BH providers in New York State with the successful transition to Medicaid managed care.
Managed Long Term Care (MLTC)
A care management program for individuals in the community as an alternative to a nursing home or health-related facility.
Medicaid Management Information System (MMIS)
The 21st Century Cures Act requires that enrollable providers in Medicaid Managed Care networks be Medicaid Enrolled. Programs must enroll for a provider number such as the MMIS.
Medicaid Redesign Team (MRT)
The Medicaid Redesign Team was established by Governor Cuomo in January 2011 as a means of finding new ways to lower Medicaid spending in New York State (CHC NYS).
Medical Loss Ratio (MLR)
The percent of premium an insurer spends on claims and expenses that improve health care quality. New York State has imposed an MLR of 89%. This means that for every dollar spent in the transition to managed care, 89 cents must be used to pay for services.
Medical Necessity
New York law defines "medically necessary medical, dental, and remedial care, services, and supplies" in the Medicaid program as those "necessary to prevent, diagnose, correct, or cure conditions in the person that cause acute suffering, endanger life, result in illness or infirmity, interfere with such person's capacity for normal activity, or threaten some significant handicap and which are furnished an eligible person in accordance with state law" (N.Y. Soc. Serv. Law, ยง 365-a).
Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
A federal law that prohibits group health plans and health insurance issuers from imposing less favorable benefit limitations on mental health or substance use disorder benefits than on medical/surgical benefits.
Multipayer Advanced Primary Care Practice Demonstration Program (MAPCP)
A CMS Innovations program where Medicare will take part in existing state multi-payer health reform initiatives. The program will pay a monthy care management fee, designed to cover care coordination; improved access; patient education; and other services to support chronically ill patients, to beneficiaries receiving primary care from APC practices. The goal of the program is to make advanced primary care practices more widely available.