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Medicaid Update: Transmittal #10-06 MCO Reimbursement Information for Out-of-Pocket Medical Expenditures for Managed Care (Alliance) Medicaid Beneficiaries

Friday, January 29, 2010

Pursuant to the terms of the contract entered into by the Managed Care Organizations (MCO's) and the District of Columbia, each DC Medicaid MCO is required to comply with the terms of the Salazar Settlement Order, including any subsequent Orders entered by the Court.

On September 2, 2005, in the Salazar case, Judge Gladys Kessler approved and entered the Order Setting Reimbursement Procedures for Medicaid Beneficiaries Enrolled with a DC Medicaid Managed Care Organization. The Order sets the procedure for the MCO's to make and communicate to their enrollees, determinations on reimbursement claims that are submitted by an MCO enrollee to the MCO directly or to the Recipient Claims Research Team at the Department of Health Care Finance (DHCF).