Medicare+Choice Organization Law and Legal Definition
A Medicare+Choice organization is defined as a risk-bearing public or private entity organized and licensed by a state, and certified by the Health Care Financing Administration (HCFA) as an entity satisfying all the medicare+choice contract requirements. Medicare+Choice organization demonstrates the operational effectiveness of a compliance program. They also inform their enrollees in writing about the rights and options available to a medicare beneficiary with regard to disenrolling from a medicare+choice plan and enrolling to another plan.
According to 42 USCS § 1395w-28(a)(1), the term "Medicare + Choice organization" means a public or private entity that is certified under section 1856 [42 USCS § 1395w-26] as meeting the requirements and standards of this part [42 USCS §§ 1395w-21 et seq.] for such an organization.
