9399

For the purposes of this chapter, the following terms shall have the meanings ascribed:

Audit – A systematic process where an entity reviews Medicaid claims, obtains evidence, evaluates findings, and determines compliance with applicable laws, regulations, and policies.

Beneficiary – An individual who is eligible for Medical Assistance (Medicaid) under Titles XIX or XXI of the Social Security Act.

Demonstration – A project approved by CMS and authorized under Section 1115 of the Social Security Act.

Managed Care – The program authorized under Section 1915(b) of the Social Security Act in which Medicaid beneficiaries are enrolled into managed care organizations to receive services.

Waiver – A program operated by a state or by the District of Columbia pursuant to a CMS-approved application to waive standard Medicaid provisions to deliver long term care in community-based settings.

SOURCE: Final Rulemaking published at 63 DCR 1915 (February 19, 2016).