SubPart 98-1 - Managed Care Organizations

Effective Date

07/01/2025

SubPart 98-1 - Managed Care Organizations
Section 98-1.1 - Applicability

Section 98-1.2 - Managed Care Organizations

Section 98-1.3 - RESERVED

Section 98-1.4 - Certificate of incorporation or articles of organization

Section 98-1.5 - Application for a certificate of authority

Section 98-1.6 - Issuance of a certificate of authority

Section 98-1.7 - Limitations of a certificate of authority

Section 98-1.8 - Continuance of a certificate of authority

Section 98-1.9 - Acquisition or retention of control of HMO's

Section 98-1.10 - Transactions within a holding company system affecting controlled HMO's

Section 98-1.11 - Operational and financial requirements for MCOs

Section 98-1.12 - Quality management program

Section 98-1.13 - Assurance of access to care

Section 98-1.14 - Enrollee services and grievance procedures

Section 98-1.15 - Employer requirements

Section 98-1.16 - Audited Financial Statements for Managed Care Organizations

Section 98-1.17 - Audits and examinations

Section 98-1.18 - Relationship between an MCO and an IPA

Section 98-1.19 - Marketing by MLTCPs

Section 98-1.20 - Waived requirements for MLTCPs

Section 98-1.21 - Fraud and abuse prevention plans and special investigation units

Section 98-1.22 - Warning Statements