Type of publicly or privately held administrative group that gives strategic, financial, and operational plans needed by physicians, clinics, and ancillary service providers for a successful managed care business enterprise. The MSO contracts with payers, hospitals, and physicians to provide services such as negotiating fee schedules, handling administrative functions, billing, and collections. An MSO may own the facilities and employ nonphysician staff to deliver care or may be a direct subsidiary of a hospital or owned by investors. Sometimes referred to as medical services organization (MSO) or physician management corporation (PMC) .

1. Medical services required by state or federal statutes but not necessarily covered as an insurance benefit (e.g., medical services for child abuse or rape or mandated 48-hour maternity stays following delivery of a baby). Also referred to as mandated services . 2. Minimum insurance benefits specified under federal or state regulations (e.g., specific smallest amount of benefits that must be paid for alcoholism under all insurance contracts sold in the state). Also called state legislated benefits .

1. Health care professionals who must be state or federal licensed providers to render services under a managed care plan (e.g., chiropractors, optometrists, podiatrists, psychologists). 2. Health care suppliers whose medical services must be included in insurance coverage offered by a health plan as required by state or federal regulations.

Under Medicaid programs, medical services required by state statutes for needy individuals such as inpatient and outpatient hospital services, laboratory tests, x-rays, home health care, family planning, nurse midwives, nursing facility care, dental services, renal dialysis services, and medical transportation. Also referred to as mandated benefits .

Required membership in a program (e.g., Medicaid managed care, Medicare Part D).

List of surgical procedures that should be performed as an outpatient to reduce unnecessary inpatient hospital admission.

Liability account designed to absorb, within specified limits, realized and unrealized gains and losses that result from an insurance company’s investments.

Outlay of funds for entitlement programs such as Medicare and Medicaid that are not subject to the federal appropriations process.

Medical services not covered by Medicare that enrollees must purchase as a condition of enrollment in a Medicare Advantage Plan. Usually those services are paid for by premiums and/or cost sharing. Mandatory supplemental benefits can be different for each Medicare Advantage Plan. Medicare Advantage Plans must ensure that any particular group of Medicare beneficiaries does not use mandatory supplemental benefits to discourage enrollment.

Characteristic signs or symptoms associated with an illness.