Definitions

Section 143 Section 143.100  Definitions For purposes of this Part, the terms below shall be defined as follows: "Contract" means a document containing certain terms and conditions that meet the requirements of this Part and is entered into by a Managed Care Community Network (MCCN) and the Department. "County MCCN" means a county with a population of over three million that has a contract with the Department to provide primary, secondary, or tertiary managed health care services as an MCCN. "Department" means the Illinois Department of Public Aid and any successor agencies. "Eligible enrollee" means anyone who is eligible to receive medical services through programs administered by the Department and is eligible to receive services through an MCCN. "Enrollee" means a person who receives medical services through an MCCN. "Managed Care Community Network (MCCN)" means an entity, other than a health maintenance organization, that is owned, operated, or governed by providers of health care services within Illinois and that provides or arranges primary, secondary and tertiary managed health care services under contract with the Department exclusively to persons participating in programs administered by the Department.    An MCCN may choose to contract with the Department to provide only pediatric health care services. "Person" means any individual, corporation, proprietorship, firm, partnership, limited partnership, trust, association, governmental authority or other entity, whether acting in an individual, fiduciary or other capacity. "Provider" means a person who is approved by the Department to furnish medical, educational or rehabilitative services to enrollees.