Auto-Assignment Algorithm. Eligible individuals and members who do not exercise their right to choose an MCO and those who are not assigned to an MCO based on family continuity will be assigned to the MCO through an ODM-approved auto-assignment algorithm. ODM’s auto-assignment algorithm will account for specified lower and upper limits of MCO member enrollment. ODM will establish a lower limit of MCO enrollment. Should the MCO fall below the lower limit of MCO member enrollment, auto-assignment will be adjusted to favor the MCO until the MCO meets the lower limit. An upper limit of MCO enrollment will be established based upon the number of ODM-contracted MCOs in each region. Upon reaching the upper limit, ODM will stop the auto-assignment of members to the MCO until the MCO’s membership drops below the upper limit. ODM’s auto-assignment algorithm will work in conjunction with Quality Based Assignment percentages where MCOs are awarded a percentage of unassigned enrollees based upon the MCO’s performance relative to other ODM-contracted MCOs. Percentages will be allocated by region and by three population categories (i.e., Aged, Blind, and Disabled [ABD], Covered Families and Children, and Group VIII- Expansion). To preserve equal allocation of the Quality Based Assignments within the regional and auto-assignment for ABD, Covered Families and Children, and Group VIII- Expansion populations, exact percentage allocations shall not be guaranteed through the assignment processes, but will be adhered to as strictly as possible. MCOs are not entitled to an equal share or particular number of auto-assigned members, nor to a grouping of members with equivalent medical expenses. ODM’s algorithm may auto-assign members in different numbers and with different expenses. Because these members are new and their relative risk is unknown, ODM will make no warranty relative to the members’ risk profiles. The auto-assignment process will be used only to equitably distribute members in relatively comparable risk categories among ODM-contracted MCOs. Member choice and family continuity will not be impacted by an auto-assignment adjustment or stoppage. ODM may change the auto-assignment algorithm at any time during the term of this Agreement in response to MCO-specific performance and quality considerations or when ODM determines it is in the best interest of the state, the program, or members.
Auto-Assignment Algorithm i. Eligible individuals and members who do not exercise their right to choose an MCO and those who are not assigned to an MCO based on family continuity will be assigned to the MCO through an ODM-approved auto-assignment algorithm.
Auto-Assignment Algorithm. The Department shall update the managed care auto-assignment algorithm to direct beneficiaries to managed care health plans that have higher quality and performance measures, as reasonably determined by the Department or its designee.
