In this chapter:
(1) Notwithstanding § 521.0001(2), “commission” means the Health and Human Services Commission or an agency operating part of the Medicaid managed care program, as appropriate.
(2) “Health care service region” or “region” means a Medicaid managed care service area the commission delineates.
(3) “Managed care organization” means a person that is authorized or otherwise permitted by law to arrange for or provide a managed care plan.
(4) “Managed care plan” means a plan under which a person undertakes to provide, arrange for, pay for, or reimburse any part of the cost of any health care service. A part of the plan must consist of arranging for or providing health care services as distinguished from indemnification against the cost of those services on a prepaid basis through insurance or otherwise. The term includes a primary care case management provider network. The term does not include a plan that indemnifies a person for the cost of health care services through insurance.
(5) “Potentially preventable event” has the meaning assigned by Section 543A.0001.
(6) “Recipient” means a Medicaid recipient.

Text of section effective on April 01, 2025