Common use of Auto Assignment Clause in Contracts

Auto Assignment. 4.2.5.1 HCA will auto-assign a Recipient to a Turquoise Care MCO in specified circumstances, including but not limited to: (i) the Recipient does not select an MCO at the time of eligibility or (ii) the Recipient cannot be enrolled in the requested MCO pursuant to the terms of this Agreement (e.g., the CONTRACTOR is subject to and has reached its enrollment limit). 4.2.5.2 Auto-assignment during the initial open enrollment period for Turquoise Care will be determined by HCA. However, during initial enrollment: 4.2.5.2.1 Turquoise Care MCO enrollment will be driven by Recipient and Member choice. 4.2.5.2.2 Centennial Care 2.0 Members who do not select a Turquoise Care MCO and whose current Centennial Care 2.0 is awarded a contract to become a Turquoise Care MCO will remain enrolled in their current MCO. Centennial Care 2.0 Members who do not select a Turquoise Care MCO and whose current Centennial Care 2.0 MCO is not awarded a contract to become a Turquoise Care MCO will be auto-assigned during initial enrollment as determined by HCA. 4.2.5.2.3 Members currently enrolled in a Centennial Care 2.0 MCO awarded a contract for Turquoise Care will remain in their current plan, unless they elect a different Turquoise Care MCO through open enrollment. 4.2.5.2.4 The upper enrollment limit established by HCA pursuant to 4.2.8 of this Section will not prevent or limit enrollment in any Turquoise Care MCO based upon Recipient/Member choice. 4.2.5.3 Following the initial open enrollment period for Turquoise Care, the auto- assignment process will consider the following: 4.2.5.3.1 If a Recipient was previously enrolled with a Turquoise Care MCO and loses eligibility for a period of three (3) months or less, the Recipient will be re- enrolled with that Turquoise Care MCO; 4.2.5.3.2 If the Recipient has family Members in a Turquoise Care MCO, the Recipient will be enrolled in that Turquoise Care MCO; 4.2.5.3.3 If the Recipient is a newborn, the Recipient will be assigned to their mother’s Turquoise Care MCO; and 4.2.5.3.4 If none of the above applies, the Recipient will be assigned using an auto- assignment algorithm default logic that considers nationally-recognized quality standards or other auto-assignment algorithm methodologies that reward MCOs that demonstrate superior performance on one (1) or more key dimensions of performance as determined by HCA. HCA will notify the CONTRACTOR at least twelve (12) months in advance of changes to the quality metrics impacting the auto-assignment algorithm. 4.2.5.3.5 If a Turquoise Care MCO exceeds the upper enrollment limit established by HCA pursuant to 4.2.8 of this Section, auto-assignment into that Turquoise Care MCO will be limited to Recipients meeting the auto-assignment criteria as described in 4.2.5.3.1 through 4.2.5.3.5 of this Section. 4.2.5.4 HCA reserves the right to modify the auto-assignment methodology any time at its discretion. 4.2.5.5 Recipient and Member choice shall be the primary driver for MCO enrollment and supersedes auto-assignment in all cases during the initial enrollment and open enrollment periods.

Auto Assignment. 4.2.5.1 HCA HSD will auto-assign a Recipient to a Turquoise Care MCO in specified circumstances, including but not limited to: (i) the Recipient does not select an MCO at the time of eligibility or (ii) the Recipient cannot be enrolled in the requested MCO pursuant to the terms of this Agreement (e.g., the CONTRACTOR is subject to and has reached its enrollment limit). 4.2.5.2 Auto-assignment during the initial open enrollment period for Turquoise Care will be determined by HCAHSD. However, during initial enrollment: 4.2.5.2.1 Turquoise Care MCO enrollment will be driven by Recipient and Member choice. 4.2.5.2.2 Centennial Care 2.0 Members who do not select a Turquoise Care MCO and whose current Centennial Care 2.0 is awarded a contract to become a Turquoise Care MCO will remain enrolled in their current MCO. Centennial Care 2.0 Members who do not select a Turquoise Care MCO and whose current Centennial Care 2.0 MCO is not awarded a contract to become a Turquoise Care MCO will be auto-assigned during initial enrollment as determined by HCA. 4.2.5.2.3 Members currently enrolled in a Centennial Care 2.0 MCO awarded a contract for Turquoise Care will remain in their current plan, unless they elect a different Turquoise Care MCO through open enrollment. 4.2.5.2.4 The upper enrollment limit established by HCA pursuant to 4.2.8 of this Section will not prevent or limit enrollment in any Turquoise Care MCO based upon Recipient/Member choice. 4.2.5.3 Following the initial open enrollment period for Turquoise Care, the auto- auto-assignment process will consider the following: 4.2.5.3.1 4.2.5.2.1 If a Recipient was previously enrolled with a Turquoise Care MCO and loses eligibility for a period of three (3) months or less, the Recipient will be re- enrolled with that Turquoise Care MCO; 4.2.5.3.2 4.2.5.2.2 If the Recipient has family Members in a Turquoise Care MCO, the Recipient will be enrolled in that Turquoise Care MCO; 4.2.5.3.3 4.2.5.2.3 If the Recipient is a newborn, the Recipient will be assigned to their mother’s Turquoise Care MCO; and 4.2.5.3.4 4.2.5.2.4 If none of the above applies, the Recipient will be assigned using an auto- assignment algorithm default logic that considers nationally-recognized quality standards or other auto-assignment algorithm methodologies that reward MCOs that demonstrate superior performance on one (1) or more key dimensions of performance as determined by HCA. HCA will notify the CONTRACTOR at least twelve following factors: (12i) months in advance Member experience based upon Consumer Assessment of changes to the quality metrics impacting the auto-assignment algorithmHealthcare Providers and Systems (CAHPS) survey results and (ii) MCO enrollment size and financial viability. 4.2.5.3.5 4.2.5.2.5 If a Turquoise Care MCO exceeds has fifty-five percent (55%) or more of the upper enrollment limit established by HCA pursuant to 4.2.8 of this Sectionstatewide enrollment, auto-assignment into that Turquoise Care MCO will be limited to Recipients meeting the auto-assignment criteria as described in 4.2.5.3.1 through 4.2.5.3.5 of this Section.in 4.2.5.4 HCA 4.2.5.3 HSD reserves the right to modify the auto-assignment methodology any time at its discretion. 4.2.5.5 Recipient and Member choice shall be the primary driver for MCO enrollment and supersedes auto-assignment in all cases during the initial enrollment and open enrollment periods.

Auto Assignment. 4.2.5.1 HCA will auto-assign a Recipient to a Turquoise Care MCO in specified circumstances, including but not limited to: (i) the Recipient does not select an MCO at the time of eligibility or (ii) the Recipient cannot be enrolled in the requested MCO pursuant to the terms of this Agreement (e.g., the CONTRACTOR is subject to and has reached its enrollment limit). 4.2.5.2 Auto-assignment during the initial open enrollment period for Turquoise Care will be determined by HCA. However, during initial enrollment: 4.2.5.2.1 Turquoise Care MCO enrollment will be driven by Recipient and Member choice. 4.2.5.2.2 Centennial Care 2.0 Members who do not select a Turquoise Care MCO and whose current Centennial Care 2.0 is awarded a contract to become a Turquoise Care MCO will remain enrolled in their current MCO. Centennial Care 2.0 Members who do not select a Turquoise Care MCO and whose current Centennial Care 2.0 MCO is not awarded a contract to become a Turquoise Care MCO will be auto-assigned during initial enrollment as determined by HCA. 4.2.5.2.3 Members currently enrolled in a Centennial Care 2.0 MCO awarded a contract for Turquoise Care will remain in their current plan, unless they elect a different Turquoise Care MCO through open enrollment. 4.2.5.2.4 The upper enrollment limit established by HCA pursuant to 4.2.8 4.2.7 of this Section will not prevent or limit enrollment in any Turquoise Care MCO based upon Recipient/Member choice. 4.2.5.3 Following the initial open enrollment period for Turquoise Care, the auto- assignment process will consider the following: 4.2.5.3.1 If a Recipient was previously enrolled with a Turquoise Care MCO and loses eligibility for a period of three (3) months or less, the Recipient will be re- enrolled with that Turquoise Care MCO; 4.2.5.3.2 If the Recipient has family Members in a Turquoise Care MCO, the Recipient will be enrolled in that Turquoise Care MCO; 4.2.5.3.3 If the Recipient is a newborn, the Recipient will be assigned to their mother’s Turquoise Care MCO; and 4.2.5.3.4 If none of the above applies, the Recipient will be assigned using an auto- assignment algorithm default logic that considers nationally-recognized quality standards or other auto-assignment algorithm methodologies that reward MCOs that demonstrate superior performance on one (1) or more key dimensions of performance as determined by HCA. HCA will notify the CONTRACTOR at least twelve (12) months in advance of changes to the quality metrics impacting the auto-assignment algorithm. 4.2.5.3.5 If a Turquoise Care MCO exceeds the upper enrollment limit established by HCA pursuant to 4.2.8 4.2.7 of this Section, auto-assignment into that Turquoise Care MCO will be limited to Recipients meeting the auto-assignment criteria as described in 4.2.5.3.1 through 4.2.5.3.5 of this Section. 4.2.5.4 HCA reserves the right to modify the auto-assignment methodology any time at its discretion. 4.2.5.5 Recipient and Member choice shall be the primary driver for MCO enrollment and supersedes auto-assignment in all cases during the initial enrollment and open enrollment periods.