Common use of Assignment of Members Clause in Contracts

Assignment of Members. 2.1. Except as provided in Section 2.2, any Indian, as defined by 42 C.F.R. § 438.14(a), enrolled with AHCCCS to receive Medicaid-funded services through the Fee-For-Service American Indian Health Program may enroll with the Contractor to receive primary care case management services. 2.2. The following individuals are not eligible for enrollment in the Contractor’s AIMH:‌ 2.2.1. Persons enrolled in another managed care program; 2.2.2. Persons enrolled in the Tribal ALTCS program; 2.2.3. Persons enrolled through hospital presumptive eligibility; 2.2.4. Persons enrolled in Fee-For-Service Temporary, Fee-For-Service Regular, or Federal Emergency Services Only; 2.2.5. Persons residing in Nursing Facilities or Intermediate Care Facilities for the Mentally Retarded (also known as Intermediate Care Facilities for the Intellectually Disabled); and 2.2.6. Persons enrolled in prior quarter coverage or any other retroactive eligibility category (during the period of retroactive eligibility). 2.3. A Member’s enrollment and disenrollment with the Contractor is completely voluntarily and at the will of the Member. At any time and without cause, a Member may opt into or out of the AIMH program, or move to another AIMH that is not operated by the Contractor by notifying AHCCCS or the Contractor. [42 C.F.R. § 438.3(d) (2) & (q) (5); 42 C.F.R. § 438.54(c); 42 C.F.R. 438.56(c) & (d)]‌ 2.4. Upon enrollment in the Fee-For-Service American Indian Health Program, AHCCCS will provide the Member with the opportunity to enroll in an AIMH and will provide the information required by 42 C.F.R. § 438.10(e)(2). At any time after enrollment in the Fee-For-Service American Indian Health Program, a Member may contact AHCCCS and request placement into an AIMH. If the Member contacts AHCCCS to request assignment to a Contractor as his or her AIMH, AHCCCS will notify the Contractor. 2.5. The Contractor will maintain forms, in both electronic and paper formats, that an individual may complete to enroll or disenroll with the Contractor, or select a new AIMH. The Contractor must use the forms approved by AHCCCS that are available on AHCCCS’ website. 2.5.1. AHCCCS will ensure that the template enrollment and disenrollment forms comply with 42 C.F.R. § 438.10(e) (2) by including the following: information about enrolling and disenrolling at will; the basic features of managed care; the populations included and excluded from the AIMH program; the benefits of the AIMH program including the Contractor’s responsibility for coordinating care; and the lack of Member cost for the program. [42 C.F.R. § 438.10(e) (2)] 2.5.2. With AHCCCS’ approval, the Contractor may modify the enrollment and disenrollment forms to provide specific information about the Contractor. The Contractor will add to its enrollment and disenrollment forms information about the service area covered by the Contractor. [42 C.F.R. § 438.10(e) (2) (iv)] 2.5.3. Electronic enrollment and disenrollment forms must meet the following federal requirements:‌ 2.5.3.1. The format must be readily accessible, and placed in a prominent and readily accessible space on the Contractor’s website; [42 C.F.R. § 438.10(c) (6) (i) & (ii)] 2.5.3.2. The information is an electronic format that can be electronically retained and printed; 42 C.F.R. § 438.10(c) (6) (iii)] 2.5.3.3. The information meets the requirements of Section 4.4.1; [42 C.F.R. § 438.10(c) (6) (iv)] and‌ 2.5.3.4. The Contractor will make the electronic information available to Members and potential Members in paper form and without charge within five business days of a Member or potential Member’s request for the electronic information in paper form. [42 C.F.R. § 438.10(c) (6) (v)] 2.5.4. The Contractor will assist the Member in completing enrollment and disenrollment forms. The Contractor will manage assignment of members electronically through the AHCCCS Online web portal and will keep the signed enrollment forms on file. 2.6. AHCCCS may, unilaterally or at the request of the Contractor made pursuant to Section 2.10, restrict enrollment with the Contractor to individuals who reside sufficiently near the Contractor to reach the Contractor within a reasonable time using available and affordable modes of transportation. [42 C.F.R. § 438.3(q) (2)] 2.7. Upon a Member’s request, AHCCCS will assign, and notify the Contractor of the member’s request; individuals eligible for enrollment pursuant to Section 2.1 in the order in which they applied, without restriction. [42 C.F.R. § 438.3(d) (1)] 2.8. The Contractor will not, on the basis of health status or need for health care services, discriminate against individuals eligible to enroll pursuant to Section 2.1. [42 C.F.R. § 438.3(d) (3) & (q) (4)] 2.9. The Contractor will not discriminate against individuals eligible to enroll pursuant to Section 2.1 on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability and will not use any policy or practice that has the effect of discriminating on the basis of race, color, or national origin, sex, sexual orientation gender identity, or disability, except that the Contractor may restrict its enrollment and service delivery to “Indians” (as defined by 42 C.F.R. § 438.14(a)). [42 C.F.R. § 438.3(d) (4); 42 C.F.R. § 438.14(d)] 2.10. A Contractor may request, in writing, that AHCCCS discontinue assignment of a Member from the Contractor’s AIMH for good cause. The Contractor may not request disenrollment because of an adverse change in the Member’s health status, or because of the Member's utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs (except when his or her continued enrollment with the Contractor seriously impairs the Contractor's ability to furnish services to either this particular Member or other Members). [42 C.F.R. § 438.56(b)]‌ 2.11. If a Member assigned to the Contractor automatically discontinues assignment as a result of the loss of eligibility for AHCCCS’ Medicaid program, AHCCCS will automatically re-enroll the Member with the Contractor if the Member becomes eligible for the Fee-For-Service American Indian Health Program within two months of the date of the loss of AHCCCS eligibility.

Assignment of Members. 2.1. Except as provided in Section 2.2, any Indian, as defined by 42 C.F.R. § 438.14(a), enrolled with AHCCCS to receive Medicaid-funded services through the Fee-For-Service American Indian Health Program may enroll choose assignment with the Contractor to receive primary care case management services. 2.2. The following individuals are not eligible for enrollment assignment in the Contractor’s AIMH:‌AIMH: 2.2.1. Persons enrolled in another managed care program; 2.2.2. Persons enrolled in the Tribal ALTCS program; 2.2.3. Persons enrolled through hospital presumptive eligibility; 2.2.4. Persons enrolled in Fee-For-Service Temporary, Fee-For-Service Regular, or Federal Emergency Services Only;Only;‌ 2.2.5. Persons residing in Nursing Facilities or Intermediate Care Facilities for the Mentally Retarded (also known as Intermediate Care Facilities for the Intellectually Disabled); and 2.2.6. Persons enrolled in prior quarter coverage or any other retroactive eligibility category (during the period of retroactive eligibility).eligibility).‌ 2.3. A Member’s enrollment and disenrollment with assignment to the Contractor is completely voluntarily and at the will of the Member. At any time and without cause, a Member may opt into or out of the AIMH program, or move to another AIMH that is not operated by the Contractor by notifying AHCCCS or the Contractor. [42 C.F.R. § 438.3(d) (2438.3(d)(2) & (q) (5q)(5); 42 C.F.R. § 438.54(c); 42 C.F.R. 438.56(c) & (d)]‌d)] 2.4. Upon enrollment in the Fee-For-Service American Indian Health Program, AHCCCS will provide the Member with the opportunity to enroll in request assignment to an AIMH and will provide the information required by 42 C.F.R. § 438.10(e)(2). At any time after enrollment in the Fee-For-Service American Indian Health Program, a Member may contact AHCCCS and request placement into an AIMH. If the Member contacts AHCCCS to request assignment to a Contractor as his or her AIMH, AHCCCS XXXXXX will notify the Contractor. 2.5. The Contractor will maintain forms, in both electronic and paper formats, that an individual may complete to enroll or disenroll for assignment with the Contractor, or select a new AIMH. The Contractor must use the forms approved by AHCCCS that are available on AHCCCS’ website. 2.5.1. AHCCCS will ensure that the template enrollment and disenrollment forms comply with 42 C.F.R. § 438.10(e) (2438.10(e)(2) by including the following: information about enrolling and disenrolling choosing assignment at will; the basic features of managed care; the populations included and excluded from the AIMH program; the benefits of the AIMH program including the Contractor’s responsibility for coordinating care; and the lack of Member cost for the program. [42 C.F.R. § 438.10(e) (2438.10(e)(2)] 2.5.2. With AHCCCS’ approval, the Contractor may modify the enrollment and disenrollment assignment request forms to provide specific information about the Contractor. The Contractor will add to its enrollment and disenrollment forms assignment request form information about the service area covered by the Contractor. [42 C.F.R. § 438.10(e) (2) (iv)]438.10(e)(2)(iv)]‌ 2.5.3. Electronic enrollment and disenrollment assignment request forms must meet the following federal requirements:‌requirements: 2.5.3.1. The format must be readily accessible, and placed in a prominent and readily accessible space on the Contractor’s website; [42 C.F.R. § 438.10(c) (6) (i438.10(c)(6)(i) & (ii)] 2.5.3.2. The information is an electronic format that can be electronically retained and printed; 42 C.F.R. § 438.10(c) (6) (iii)]438.10(c)(6)(iii)]‌ 2.5.3.3. The information meets the requirements of Section 4.4.1; [42 C.F.R. § 438.10(c) (6) (iv438.10(c)(6)(iv)] and‌and 2.5.3.4. The Contractor will make the electronic information available to Members and potential Members in paper form and without charge within five business days of a Member or potential Member’s request for the electronic information in paper form. [42 C.F.R. § 438.10(c) (6) (v438.10(c)(6)(v)] 2.5.4. The Contractor will assist the Member in completing enrollment and disenrollment assignment request forms. The Contractor will manage assignment of members electronically through the AHCCCS Online web portal and will keep the signed enrollment assignment request forms on file.file.‌ 2.6. AHCCCS may, unilaterally or at the request of the Contractor made pursuant to Section 2.10, restrict enrollment assignment with the Contractor to individuals who reside sufficiently near the Contractor to reach the Contractor within a reasonable time using available and affordable modes of transportation. [42 C.F.R. § 438.3(q) (2438.3(q)(2)] 2.7. Upon a Member’s request, request AHCCCS will assign, and notify the Contractor of the member’s request; individuals are eligible for enrollment assignment pursuant to Section 2.1 in the order in which they applied, without restriction. [42 C.F.R. § 438.3(d) (1438.3(d)(1)] 2.8. The Contractor will not, on the basis of health status or need for health care services, discriminate against individuals eligible to enroll be assigned pursuant to Section 2.1. [42 C.F.R. § 438.3(d) (3438.3(d)(3) & (q) (4q)(4)] 2.9. The Contractor will not discriminate against individuals eligible to enroll be assigned pursuant to Section 2.1 on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability and will not use any policy or practice that has the effect of discriminating on the basis of race, color, or national origin, sex, sexual orientation gender identity, or disability, except that the Contractor may restrict its enrollment assignment and service delivery to “Indians” (as defined by 42 C.F.R. § 438.14(a)). [42 C.F.R. § 438.3(d) (4438.3(d)(4); 42 C.F.R. § 438.14(d)]438.14(d)]‌ 2.10. A Contractor may request, in writing, that AHCCCS discontinue assignment of a Member from the Contractor’s AIMH for good cause. The Contractor may not request disenrollment discontinuation of assignment because of an adverse change in the Member’s health status, or because of the Member's utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs (except when his or her continued enrollment assignment with the Contractor seriously impairs the Contractor's ability to furnish services to either this particular Member or other Members). [42 C.F.R. § 438.56(b)]‌438.56(b)] 2.11. If a Member assigned to the Contractor automatically discontinues assignment as a result of the loss of eligibility for AHCCCS’ Medicaid program, AHCCCS will automatically re-enroll assign the Member with the Contractor if the Member becomes eligible for the Fee-For-Service American Indian Health Program within two months of the date of the loss of AHCCCS eligibility.

Assignment of Members. 2.1. Except as provided in Section 2.2, any Indian, as defined by 42 C.F.R. § 438.14(a), enrolled with AHCCCS to receive Medicaid-funded services through the Fee-For-Service American Indian Health Program may enroll choose assignment with the Contractor to receive primary care case management services. 2.2. The following individuals are not eligible for enrollment assignment in the Contractor’s AIMH:‌AIMH: 2.2.1. Persons enrolled in another managed care program; 2.2.2. Persons enrolled in the Tribal ALTCS program;program;‌ 2.2.3. Persons enrolled through hospital presumptive eligibility; 2.2.4. Persons enrolled in Fee-For-Service Temporary, Fee-For-Service Regular, or Federal Emergency Services Only; 2.2.5. Persons residing in Nursing Facilities or Intermediate Care Facilities for the Mentally Retarded (also known as Intermediate Care Facilities for the Intellectually Disabled); andand‌ 2.2.6. Persons enrolled in prior quarter coverage or any other retroactive eligibility category (during the period of retroactive eligibility). 2.3. A Member’s enrollment and disenrollment with assignment to the Contractor is completely voluntarily and at the will of the Member. At any time and without cause, a Member may opt into or out of the AIMH program, or move to another AIMH that is not operated by the Contractor by notifying AHCCCS or the Contractor. [42 C.F.R. § 438.3(d) (2438.3(d)(2) & (q) (5q)(5); 42 C.F.R. § 438.54(c); 42 C.F.R. 438.56(c) & (d)]‌d)] 2.4. Upon enrollment in the Fee-For-Service American Indian Health Program, AHCCCS will provide the Member with the opportunity to enroll in request assignment to an AIMH and will provide the information required by 42 C.F.R. § 438.10(e)(2). At any time after enrollment in the Fee-For-Service American Indian Health Program, a Member may contact AHCCCS and request placement into an AIMH. If the Member contacts AHCCCS to request assignment to a Contractor as his or her AIMH, AHCCCS XXXXXX will notify the Contractor. 2.5. The Contractor will maintain forms, in both electronic and paper formats, that an individual may complete to enroll or disenroll for assignment with the Contractor, or select a new AIMH. The Contractor must use the forms approved by AHCCCS that are available on AHCCCS’ website.website.‌ 2.5.1. AHCCCS will ensure that the template enrollment and disenrollment assignment request forms comply with 42 C.F.R. § 438.10(e) (2438.10(e)(2) by including the following: information about enrolling and disenrolling choosing assignment at will; the basic features of managed care; the populations included and excluded from the AIMH program; the benefits of the AIMH program including the Contractor’s responsibility for coordinating care; and the lack of Member cost for the program. [42 C.F.R. § 438.10(e) (2438.10(e)(2)] 2.5.2. With AHCCCS’ approval, the Contractor may modify the enrollment and disenrollment assignment request forms to provide specific information about the Contractor. The Contractor will add to its enrollment and disenrollment assignment request forms information about the service area covered by the Contractor. [42 C.F.R. § 438.10(e) (2) (iv438.10(e)(2)(iv)] 2.5.3. Electronic enrollment and disenrollment assignment request forms must meet the following federal requirements:‌ 2.5.3.1. The format must be readily accessible, and placed in a prominent and readily accessible space on the Contractor’s website; [42 C.F.R. § 438.10(c) (6) (i438.10(c)(6)(i) & (ii)] 2.5.3.2. The information is an electronic format that can be electronically retained and printed; 42 C.F.R. § 438.10(c) (6) (iii438.10(c)(6)(iii)] 2.5.3.3. The information meets the requirements of Section 4.4.1; [42 C.F.R. § 438.10(c) (6) (iv438.10(c)(6)(iv)] and‌ 2.5.3.4. The Contractor will make the electronic information available to Members and potential Members in paper form and without charge within five business days of a Member or potential Member’s request for the electronic information in paper form. [42 C.F.R. § 438.10(c) (6) (v438.10(c)(6)(v)] 2.5.4. The Contractor will assist the Member in completing enrollment and disenrollment assignment request forms. The Contractor will manage assignment of members electronically through the AHCCCS Online web portal and will keep the signed enrollment assignment request forms on file. 2.6. AHCCCS may, unilaterally or at the request of the Contractor made pursuant to Section 2.10, restrict enrollment assignment with the Contractor to individuals who reside sufficiently near the Contractor to reach the Contractor within a reasonable time using available and affordable modes of transportation. [42 C.F.R. § 438.3(q) (2438.3(q)(2)] 2.7. Upon a Member’s request, AHCCCS will assign, and notify the Contractor of the member’s request; , individuals eligible for enrollment assignment pursuant to Section 2.1 in the order in which they applied, without restriction. [42 C.F.R. § 438.3(d) (1438.3(d)(1)] 2.8. The Contractor will not, on the basis of health status or need for health care services, discriminate against individuals eligible to enroll be assigned pursuant to Section 2.1. [42 C.F.R. § 438.3(d) (3438.3(d)(3) & (q) (4q)(4)] 2.9. The Contractor will not discriminate against individuals eligible to enroll be assigned pursuant to Section 2.1 on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability and will not use any policy or practice that has the effect of discriminating on the basis of race, color, or national origin, sex, sexual orientation gender identity, or disability, except that the Contractor may restrict its enrollment assignment and service delivery to “Indians” (as defined by 42 C.F.R. § 438.14(a)). [42 C.F.R. § 438.3(d) (4438.3(d)(4); 42 C.F.R. § 438.14(d)] 2.10. A Contractor may request, in writing, that AHCCCS discontinue assignment of a Member from the Contractor’s AIMH for good cause. The Contractor may not request disenrollment discontinuation of assignment because of an adverse change in the Member’s health status, or because of the Member's utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs (except when his or her continued enrollment assignment with the Contractor seriously impairs the Contractor's ability to furnish services to either this particular Member or other Members). [42 C.F.R. § 438.56(b)]‌ 2.11. If a Member assigned to the Contractor automatically discontinues assignment as a result of the loss of eligibility for AHCCCS’ Medicaid program, AHCCCS will automatically re-enroll assign the Member with the Contractor if the Member becomes eligible for the Fee-For-Service American Indian Health Program within two months of the date of the loss of AHCCCS eligibility.

Assignment of Members. 2.1. Except as provided in Section 2.2, any Indian, as defined by 42 C.F.R. § 438.14(a), enrolled with AHCCCS to receive Medicaid-funded services through the Fee-For-Service American Indian Health Program may enroll choose assignment with the Contractor to receive primary care case management services. 2.2. The following individuals are not eligible for enrollment assignment in the Contractor’s AIMH:‌AIMH: 2.2.1. Persons enrolled in another managed care program; 2.2.2. Persons enrolled in the Tribal ALTCS program; 2.2.3. Persons enrolled through hospital presumptive eligibility; 2.2.4. Persons enrolled in Fee-For-Service Temporary, Fee-For-Service Regular, or Federal Emergency Services Only; 2.2.5. Persons residing in Nursing Facilities or Intermediate Care Facilities for the Mentally Retarded (also known as Intermediate Care Facilities for the Intellectually Disabled); and 2.2.6. Persons enrolled in prior quarter coverage or any other retroactive eligibility category (during the period of retroactive eligibility). 2.3. A Member’s enrollment and disenrollment with assignment to the Contractor is completely voluntarily and at the will of the Member. At any time and without cause, a Member may opt into or out of the AIMH program, or move to another AIMH that is not operated by the Contractor by notifying AHCCCS or the Contractor. [42 C.F.R. § 438.3(d) (2438.3(d)(2) & (q) (5q)(5); 42 C.F.R. § 438.54(c); 42 C.F.R. 438.56(c) & (d)]‌d)] 2.4. Upon enrollment in the Fee-For-Service American Indian Health Program, AHCCCS will provide the Member with the opportunity to enroll in request assignment to an AIMH and will provide the information required by 42 C.F.R. § 438.10(e)(2). At any time after enrollment in the Fee-For-Service American Indian Health Program, a Member may contact AHCCCS and request placement into an AIMH. If the Member contacts AHCCCS to request assignment to a Contractor as his or her AIMH, AHCCCS will notify the Contractor. 2.5. The Contractor will maintain forms, in both electronic and paper formats, that an individual may complete to enroll or disenroll for assignment with the Contractor, or select a new AIMH. The Contractor must use the forms approved by AHCCCS that are available on AHCCCS’ website. 2.5.1. AHCCCS will ensure that the template enrollment and disenrollment forms comply with 42 C.F.R. § 438.10(e) (2438.10(e)(2) by including the following: information about enrolling and disenrolling choosing assignment at will; the basic features of managed care; the populations included and excluded from the AIMH program; the benefits of the AIMH program including the Contractor’s responsibility for coordinating care; and the lack of Member cost for the program. [42 C.F.R. § 438.10(e) (2438.10(e)(2)] 2.5.2. With AHCCCS’ approval, the Contractor may modify the enrollment and disenrollment assignment request forms to provide specific information about the Contractor. The Contractor will add to its enrollment and disenrollment forms assignment request form information about the service area covered by the Contractor. [42 C.F.R. § 438.10(e) (2) (iv438.10(e)(2)(iv)] 2.5.3. Electronic enrollment and disenrollment assignment request forms must meet the following federal requirements:‌requirements: 2.5.3.1. The format must be readily accessible, and placed in a prominent and readily accessible space on the Contractor’s website; [42 C.F.R. § 438.10(c) (6) (i438.10(c)(6)(i) & (ii)] 2.5.3.2. The information is an electronic format that can be electronically retained and printed; 42 C.F.R. § 438.10(c) (6) (iii438.10(c)(6)(iii)] 2.5.3.3. The information meets the requirements of Section 4.4.1; [42 C.F.R. § 438.10(c) (6) (iv438.10(c)(6)(iv)] and‌and 2.5.3.4. The Contractor will make the electronic information available to Members and potential Members in paper form and without charge within five business days of a Member or potential Member’s request for the electronic information in paper form. [42 C.F.R. § 438.10(c) (6) (v438.10(c)(6)(v)] 2.5.4. The Contractor will assist the Member in completing enrollment and disenrollment assignment request forms. The Contractor will manage assignment of members electronically through the AHCCCS Online web portal and will keep the signed enrollment assignment request forms on file. 2.6. AHCCCS may, unilaterally or at the request of the Contractor made pursuant to Section 2.10, restrict enrollment assignment with the Contractor to individuals who reside sufficiently near the Contractor to reach the Contractor within a reasonable time using available and affordable modes of transportation. [42 C.F.R. § 438.3(q) (2438.3(q)(2)] 2.7. Upon a Member’s request, request AHCCCS will assign, and notify the Contractor of the member’s request; individuals are eligible for enrollment assignment pursuant to Section 2.1 in the order in which they applied, without restriction. [42 C.F.R. § 438.3(d) (1438.3(d)(1)] 2.8. The Contractor will not, on the basis of health status or need for health care services, discriminate against individuals eligible to enroll be assigned pursuant to Section 2.1. [42 C.F.R. § 438.3(d) (3438.3(d)(3) & (q) (4q)(4)] 2.9. The Contractor will not discriminate against individuals eligible to enroll be assigned pursuant to Section 2.1 on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability and will not use any policy or practice that has the effect of discriminating on the basis of race, color, or national origin, sex, sexual orientation gender identity, or disability, except that the Contractor may restrict its enrollment assignment and service delivery to “Indians” (as defined by 42 C.F.R. § 438.14(a)). [42 C.F.R. § 438.3(d) (4438.3(d)(4); 42 C.F.R. § 438.14(d)] 2.10. A Contractor may request, in writing, that AHCCCS discontinue assignment of a Member from the Contractor’s AIMH for good cause. The Contractor may not request disenrollment discontinuation of assignment because of an adverse change in the Member’s health status, or because of the Member's utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs (except when his or her continued enrollment assignment with the Contractor seriously impairs the Contractor's ability to furnish services to either this particular Member or other Members). [42 C.F.R. § 438.56(b)]‌438.56(b)] 2.11. If a Member assigned to the Contractor automatically discontinues assignment as a result of the loss of eligibility for AHCCCS’ Medicaid program, AHCCCS will automatically re-enroll assign the Member with the Contractor if the Member becomes eligible for the Fee-For-Service American Indian Health Program within two months of the date of the loss of AHCCCS eligibility.

Assignment of Members. 2.1. Except as provided in Section 2.2, any Indian, as defined by 42 C.F.R. § 438.14(a), enrolled with AHCCCS to receive Medicaid-funded services through the Fee-For-Service American Indian Health Program may enroll choose assignment with the Contractor to receive primary care case management services. 2.2. The following individuals are not eligible for enrollment assignment in the Contractor’s AIMH:‌AIMH: 2.2.1. Persons enrolled in another managed care program; 2.2.2. Persons enrolled in the Tribal ALTCS program;program;‌ 2.2.3. Persons enrolled through hospital presumptive eligibility; 2.2.4. Persons enrolled in Fee-For-Service Temporary, Fee-For-Service Regular, or Federal Emergency Services Only; 2.2.5. Persons residing in Nursing Facilities or Intermediate Care Facilities for the Mentally Retarded (also known as Intermediate Care Facilities for the Intellectually Disabled); andand‌ 2.2.6. Persons enrolled in prior quarter coverage or any other retroactive eligibility category (during the period of retroactive eligibility). 2.3. A Member’s enrollment and disenrollment with assignment to the Contractor is completely voluntarily and at the will of the Member. At any time and without cause, a Member may opt into or out of the AIMH program, or move to another AIMH that is not operated by the Contractor by notifying AHCCCS or the Contractor. [42 C.F.R. § 438.3(d) (2438.3(d)(2) & (q) (5q)(5); 42 C.F.R. § 438.54(c); 42 C.F.R. 438.56(c) & (d)]‌d)] 2.4. Upon enrollment in the Fee-For-Service American Indian Health Program, AHCCCS will provide the Member with the opportunity to enroll in request assignment to an AIMH and will provide the information required by 42 C.F.R. § 438.10(e)(2). At any time after enrollment in the Fee-For-Service American Indian Health Program, a Member may contact AHCCCS and request placement into an AIMH. If the Member contacts AHCCCS to request assignment to a Contractor as his or her AIMH, AHCCCS will notify the Contractor. 2.5. The Contractor will maintain forms, in both electronic and paper formats, that an individual may complete to enroll or disenroll for assignment with the Contractor, or select a new AIMH. The Contractor must use the forms approved by AHCCCS that are available on AHCCCS’ website.website.‌ 2.5.1. AHCCCS will ensure that the template enrollment and disenrollment assignment request forms comply with 42 C.F.R. § 438.10(e) (2438.10(e)(2) by including the following: information about enrolling and disenrolling choosing assignment at will; the basic features of managed care; the populations included and excluded from the AIMH program; the benefits of the AIMH program including the Contractor’s responsibility for coordinating care; and the lack of Member cost for the program. [42 C.F.R. § 438.10(e) (2438.10(e)(2)] 2.5.2. With AHCCCS’ approval, the Contractor may modify the enrollment and disenrollment assignment request forms to provide specific information about the Contractor. The Contractor will add to its enrollment and disenrollment assignment request forms information about the service area covered by the Contractor. [42 C.F.R. § 438.10(e) (2) (iv438.10(e)(2)(iv)] 2.5.3. Electronic enrollment and disenrollment assignment request forms must meet the following federal requirements:‌ 2.5.3.1. The format must be readily accessible, and placed in a prominent and readily accessible space on the Contractor’s website; [42 C.F.R. § 438.10(c) (6) (i438.10(c)(6)(i) & (ii)] 2.5.3.2. The information is an electronic format that can be electronically retained and printed; 42 C.F.R. § 438.10(c) (6) (iii438.10(c)(6)(iii)] 2.5.3.3. The information meets the requirements of Section 4.4.1; [42 C.F.R. § 438.10(c) (6) (iv438.10(c)(6)(iv)] and‌ 2.5.3.4. The Contractor will make the electronic information available to Members and potential Members in paper form and without charge within five business days of a Member or potential Member’s request for the electronic information in paper form. [42 C.F.R. § 438.10(c) (6) (v438.10(c)(6)(v)] 2.5.4. The Contractor will assist the Member in completing enrollment and disenrollment assignment request forms. The Contractor will manage assignment of members electronically through the AHCCCS Online web portal and will keep the signed enrollment assignment request forms on file. 2.6. AHCCCS may, unilaterally or at the request of the Contractor made pursuant to Section 2.10, restrict enrollment assignment with the Contractor to individuals who reside sufficiently near the Contractor to reach the Contractor within a reasonable time using available and affordable modes of transportation. [42 C.F.R. § 438.3(q) (2438.3(q)(2)] 2.7. Upon a Member’s request, AHCCCS will assign, and notify the Contractor of the member’s request; , individuals eligible for enrollment assignment pursuant to Section 2.1 in the order in which they applied, without restriction. [42 C.F.R. § 438.3(d) (1438.3(d)(1)] 2.8. The Contractor will not, on the basis of health status or need for health care services, discriminate against individuals eligible to enroll be assigned pursuant to Section 2.1. [42 C.F.R. § 438.3(d) (3438.3(d)(3) & (q) (4q)(4)] 2.9. The Contractor will not discriminate against individuals eligible to enroll be assigned pursuant to Section 2.1 on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability and will not use any policy or practice that has the effect of discriminating on the basis of race, color, or national origin, sex, sexual orientation gender identity, or disability, except that the Contractor may restrict its enrollment assignment and service delivery to “Indians” (as defined by 42 C.F.R. § 438.14(a)). [42 C.F.R. § 438.3(d) (4438.3(d)(4); 42 C.F.R. § 438.14(d)] 2.10. A Contractor may request, in writing, that AHCCCS discontinue assignment of a Member from the Contractor’s AIMH for good cause. The Contractor may not request disenrollment discontinuation of assignment because of an adverse change in the Member’s health status, or because of the Member's utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs (except when his or her continued enrollment assignment with the Contractor seriously impairs the Contractor's ability to furnish services to either this particular Member or other Members). [42 C.F.R. § 438.56(b)]‌ 2.11. If a Member assigned to the Contractor automatically discontinues assignment as a result of the loss of eligibility for AHCCCS’ Medicaid program, AHCCCS will automatically re-enroll assign the Member with the Contractor if the Member becomes eligible for the Fee-For-Service American Indian Health Program within two months of the date of the loss of AHCCCS eligibility.