Automatic Reassignment Following Resumption of Eligibility. Medicaid beneficiaries who lose eligibility for the West Virginia Mountain Health Trust or West Virginia Health Bridge programs and regain eligibility within one year will be automatically re- enrolled in the same MCO in which they were previously enrolled. BMS will perform this process and supply the necessary information to the enrollment broker. (If a previously eligible beneficiary has been ineligible for a period of time in excess of one year, the beneficiary will select a plan through the standard enrollment broker process.)
Automatic Reassignment Following Resumption of Eligibility. Medicaid beneficiaries who lose eligibility for the West Virginia Mountain Health Trust program and regain eligibility within 60 days will be automatically re-enrolled in the same MCO in which they were previously enrolled. BMS will perform this process and supply the necessary information to the enrollment broker. (If a previously eligible beneficiary has been ineligible for a period of time in excess of 60 days, the beneficiary will be permitted to select a plan through the standard enrollment broker process.) Medicaid beneficiaries will also be automatically re-enrolled in their previous Mountain Health Choices benefits package if they lose and regain eligibility within 60 days. Enrollment of Program Newborns The MCO must have written policies and procedures for enrolling newborn children of Medicaid members retroactively effective to the time of birth. These enrollment procedures must include transfer of newborn information to both BMS and the enrollment broker and must provide for processing completion within 30 days of the date of birth. Newborns of program- eligible mothers who are enrolled at the time of the child’s birth will be enrolled in the mother’s MCO. The MCO is responsible for all medically necessary services provided under the standard benefit package to the newborn child or an enrolled mother for the first 60 to 90 days of life based upon the cut-off date for MCO enrollment with the enrollment broker. The child’s date of birth shall be counted as day one. BMS will pay a full month’s capitation for all newborns. The MCO shall receive capitation payments for all subsequent months that the child remains enrolled with the MCO. The MCO must submit newborn enrollment forms to the enrollment broker within 60 days of the date of delivery or as soon thereafter as the MCO becomes aware of the delivery. Enrollment of Persons with Other Primary Coverage For enrollees with other primary coverage, the MCO must assume responsibility for Medicaid covered services that are not provided by the primary carrier. The MCO will defer utilization management decisions to the primary carrier, except for those Medicaid services and benefits that are carved out of the primary carrier’s benefits package, which are the sole responsibility of the MCO.
