Glossary of Terms

Managed Care Organization (MCO)
For the purposes of this request for qualifications, the term Plan refers to the managed care organization and Health and Recovery Plan (HARP) collectively. Any requirement under the request for qualifications that references the Plan shall apply to both the HARP and the managed care organization. Requirements that reference only the HARPs shall apply only to the HARPs. Used interchangeably with the Plan and Managed Care Plans.
Managed Care Plans
For the purposes of this request for qualifications, the term Plan refers to the managed care organization and Health and Recovery Plan (HARP) collectively. Any requirement under the request for qualifications that references the Plan shall apply to both the HARP and the managed care organization. Requirements that reference only the HARPs shall apply only to the HARPs. Used interchangeably with Managed Care Organizations (MCO) and the Plan.
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 system that streamlines the delivery of long–term services to people who are chronically ill or disabled and who wish to stay in their homes and communities.
Managed Long Term Services and Supports (MLTSS)
Delivery of long-term services and supports through managed care.
Medicaid Management Information System (MMIS)
A NYS system for providers to enroll in Medicaid, sometimes referred to as eMedNY. 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.
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, § 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.