Common use of Annual Health-Plan Selection Clause in Contracts

Annual Health-Plan Selection. The MCO shall accept enrollment of any eligible Beneficiaries during any annual health-plan selection period required by the STATE or CMS. Period of Enrollment. Each MSC+ Enrollee shall be enrolled for twelve (12) months following the effective date of coverage, subject to the exceptions in this section. For MSHO, each Enrollee may choose to disenroll at the end of any month consistent with paragraph (J) below. The MCO agrees to retain Medicare eligible Enrollees for up to three months after losing their Medicaid eligibility in the MCO, including Enrollees who no longer meet the requirements for managed care enrollment as part of the MCO’s Medicare Special Needs Plan enrollment. Voluntary Enrollment for MSHO. Enrollment in the MCO for the MSHO program shall be voluntary. Single MCO Entity Provider. For MSC+, if the MCO is a single entity provider in a Rural Area, the MCO must allow Beneficiaries: 1) to choose from at least two Network Providers; and 2) to obtain services from any other Provider when the circumstances allow pursuant to 42 CFR § 438.52. Enrollee Change of MCO. Enrollees may change to a different MSHO MCO every thirty (30) days, and for MSC+ and MSHO upon request to the MCO during the open enrollment period, or as allowed under Minnesota Rules, part 9500.1453, subparts 5, 7, and 8, and 42 CFR Part 438. Enrollee Change of Primary Care Provider. The Enrollee may change to a different Primary Care Provider within the MCO’s network or Care System every thirty (30) days upon request to the MCO. This section does not apply to Enrollees who are under restriction pursuant to section 9.17. No Random Assignment of Provider. In no circumstance shall the MCO randomly assign an Enrollee to a Primary Care Provider upon reenrollment. Choice of Network Provider. The MCO must allow an Enrollee to choose his or her Network Provider to the extent possible and appropriate.

Annual Health-Plan Selection. The MCO shall accept enrollment of any eligible Beneficiaries during any annual health-plan selection period required by the STATE or CMS. Period of Enrollment. Enrollment.‌ Each MSC+ Enrollee shall be enrolled for twelve (12) months following the effective date of coverage, subject to the exceptions in this section. For MSHO, each Enrollee may choose to disenroll at the end of any month consistent with paragraph (J) below. The MCO agrees to retain Medicare eligible Enrollees for up to three months after losing their Medicaid eligibility in the MCO, including Enrollees who no longer meet the requirements for managed care enrollment as part of the MCO’s Medicare Special Needs Plan enrollment. Voluntary Enrollment for MSHO. Enrollment in the MCO for the MSHO program shall be voluntary. Single MCO Entity Provider. For MSC+, if the MCO is a single entity provider in a Rural Area, the MCO must allow Beneficiaries: 1) to choose from at least two Network Providers; and 2) to obtain services from any other Provider when the circumstances allow pursuant to 42 CFR § 438.52. Enrollee Change of MCO. Enrollees may change to a different MSHO MCO every thirty (30) days, and for MSC+ and MSHO upon request to the MCO during the open open‌ enrollment period, or as allowed under Minnesota Rules, part 9500.1453, subparts 5, 7, and 8, and 42 CFR Part 438. Enrollee Change of Primary Care Provider. The Enrollee may change to a different Primary Care Provider within the MCO’s network or Care System every thirty (30) days upon request to the MCO. This section does not apply to Enrollees who are under restriction pursuant to section 9.17. No Random Assignment of Provider. In no circumstance shall the MCO randomly assign an Enrollee to a Primary Care Provider upon reenrollment. Choice of Network Provider. The MCO must allow an Enrollee to choose his or her Network Provider to the extent possible and appropriate.appropriate.‌