Common use of Auto Assignment Clause in Contracts

Auto Assignment. 2.4.4.6.1 TENNCARE will auto assign an enrollee to an MCO, in specified circumstances, including but not limited to, the enrollee does not request enrollment in a specified MCO, cannot be enrolled in the requested MCO, or is an adult eligible as a result of receiving SSI benefits. 2.4.4.6.2 The current auto assignment process does not apply to children eligible for TennCare as a result of being eligible for SSI or children in the state’s custody. 2.4.4.6.3 There are four different levels to the current auto assignment process: 2.4.4.6.3.1 If the enrollee was previously enrolled with an MCO and lost TennCare eligibility for a period of two (2) months or less, the enrollee will be re-enrolled with that MCO. 2.4.4.6.3.2 If the enrollee has family members in an MCO (other than TennCare Select), the enrollee will be enrolled in that MCO. 2.4.4.6.3.3 If the enrollee is a newborn, the enrollee will be assigned to his/her mother’s MCO. 2.4.4.6.3.4 If none of the above applies, the enrollee will be assigned using default logic that randomly assigns enrollees to MCOs (other than TennCare Select). 2.4.4.6.4 TENNCARE may modify the auto assignment algorithm to change or add criteria including but not limited to quality measures or cost or utilization management performance. 2.4.4.6.5 During implementation of this Contract there may be a one-time exception to the auto assignment process described above. If an incumbent MCO (defined herein as an MCO other than TennCare Select that had a contract with the Bureau of TennCare immediately preceding the start date of operations under this Contract) will provide covered services as of the start date of operations under this Contract in the same Grand Region as the previous contract, current TennCare enrollees who are known to be members of the incumbent MCO may be assigned by TENNCARE to remain with the incumbent MCO with enrollment effective the start date of operations. Current TennCare enrollees who are not known to be members of an incumbent MCO will be assigned by TENNCARE to an MCO in accordance with the process described in Section A.2.

Auto Assignment. 2.4.4.6.1 TENNCARE will auto assign an enrollee to an MCO, in specified circumstances, including but not limited to, the enrollee does not request enrollment in a specified MCO, cannot be enrolled in the requested MCO, or is an adult eligible as a result of receiving SSI benefits. 2.4.4.6.2 The current auto assignment process does not apply to children eligible for TennCare as a result of being eligible for SSI or children in the state’s custody. 2.4.4.6.3 There are four different levels to the current auto assignment process: 2.4.4.6.3.1 If the enrollee was previously enrolled with an MCO and lost TennCare eligibility for a period of two (2) months or less, the enrollee will be re-enrolled with that MCO. 2.4.4.6.3.2 If the enrollee has family members in an MCO (other than TennCare Select), the enrollee will be enrolled in that MCO. 2.4.4.6.3.3 If the enrollee is a newborn, the enrollee will be assigned to his/her mother’s MCO. 2.4.4.6.3.4 If none of the above applies, the enrollee will be assigned using default logic that randomly assigns enrollees to MCOs (other than TennCare Select). 2.4.4.6.4 TENNCARE may modify the auto assignment algorithm to change or add criteria including but not limited to quality measures or cost or utilization management performancemeasures. 2.4.4.6.5 During implementation of this Contract Agreement there may be a one-time exception to the auto assignment process described above. If an incumbent MCO (defined herein as an MCO other than TennCare Select that had a contract with the Bureau of TennCare immediately preceding the start date of operations under this ContractAgreement) will provide covered services as of the start date of operations under this Contract Agreement in the same Grand Region as the previous contract, current TennCare enrollees who are known to be members of the incumbent MCO may will be assigned by TENNCARE to remain with the incumbent MCO with enrollment effective the start date of operations. Current TennCare enrollees who are not known to be members of an incumbent MCO will be assigned by TENNCARE to an MCO in accordance with the process described in Section A.22.4.4.6. However, TENNCARE will assign current TennCare enrollees (and current State Onlys and Judicials) to ensure similar levels of enrollment as of the start date of operations for the two MCOs serving the Grand Region.

Auto Assignment. 2.4.4.6.1 TENNCARE will auto assign an enrollee to an MCO, in specified circumstances, including but not limited to, the enrollee does not request enrollment in a specified MCO, cannot be enrolled in the requested MCO, or is an adult eligible as a result of receiving SSI benefits. 2.4.4.6.2 The current auto assignment process does not apply to children eligible for TennCare as a result of being eligible for SSI or children in the state’s custody. 2.4.4.6.3 There are four different levels to the current auto assignment process: 2.4.4.6.3.1 If the enrollee was previously enrolled with an MCO and lost TennCare eligibility for a period of two (2) months or less, the enrollee will be re-enrolled with that MCO. 2.4.4.6.3.2 If the enrollee has family members in an MCO (other than TennCare Select), the enrollee will be enrolled in that MCO. 2.4.4.6.3.3 If the enrollee is a newborn, the enrollee will be assigned to his/her mother’s MCO. 2.4.4.6.3.4 If none of the above applies, the enrollee will be assigned using default logic that randomly assigns enrollees to MCOs (other than TennCare Select). 2.4.4.6.4 TENNCARE may modify the auto assignment algorithm to change or add criteria including but not limited to quality measures or cost or utilization management performance. 2.4.4.6.5 During implementation of this Contract Agreement there may be a one-time exception to the auto assignment process described above. If an incumbent MCO (defined herein as an MCO other than TennCare Select that had a contract with the Bureau of TennCare immediately preceding the start date of operations under this ContractAgreement) will provide covered services as of the start date of operations under this Contract Agreement in the same Grand Region as the previous contract, current TennCare enrollees who are known to be members of the incumbent MCO may will be assigned by TENNCARE to remain with the incumbent MCO with enrollment effective the start date of operations. Current TennCare enrollees who are not known to be members of an incumbent MCO will be assigned by TENNCARE to an MCO in accordance with the process described in Section A.22.4.4.6. However, TENNCARE will assign current TennCare enrollees to ensure similar levels of enrollment as of the start date of operations for the two MCOs serving the Grand Region.

Auto Assignment. 2.4.4.6.1 TENNCARE will auto assign an enrollee to an MCO, in specified circumstances, including but not limited to, the enrollee does not request enrollment in a specified MCO, cannot be enrolled in the requested MCO, or is an adult eligible as a result of receiving SSI benefits. 2.4.4.6.2 The current auto assignment process does not apply to children eligible for TennCare as a result of being eligible for SSI or children in the state’s custody. 2.4.4.6.3 There are four different levels to the current auto assignment process: 2.4.4.6.3.1 If the enrollee was previously enrolled with an MCO and lost TennCare eligibility for a period of two (2) months or less, the enrollee will be re-enrolled with that MCO. 2.4.4.6.3.2 If the enrollee has family members in an MCO (other than TennCare Select), the enrollee will be enrolled in that MCO. 2.4.4.6.3.3 If the enrollee is a newborn, the enrollee will be assigned to his/her mother’s MCO. 2.4.4.6.3.4 If none of the above applies, the enrollee will be assigned using default logic that randomly assigns enrollees to MCOs (other than TennCare Select). 2.4.4.6.4 TENNCARE may modify the auto assignment algorithm to change or add criteria including but not limited to quality measures or cost or utilization management performance. 2.4.4.6.5 During implementation of this Contract there may be a one-time exception to the auto assignment process described above. If an incumbent MCO (defined herein as an MCO other than TennCare Select that had a contract with the Bureau Division of TennCare immediately preceding the start date of operations under this Contract) will provide covered services as of the start date of operations under this Contract in the same Grand Region as the previous contract, current TennCare enrollees who are known to be members of the incumbent MCO may be assigned by TENNCARE to remain with the incumbent MCO with enrollment effective the start date of operations. Current TennCare enrollees who are not known to be members of an incumbent MCO will be assigned by TENNCARE to an MCO in accordance with the process described in Section A.2.