Common use of Dates of Enrollment and Disenrollment Clause in Contracts

Dates of Enrollment and Disenrollment. The enrollment date for an otherwise eligible individual can be set for the first day of the month in which she or he achieves the age specified in Article XIX, MCO Specific Contract Terms, Section E. The MCO shall begin serving individuals as of the effective date of enrollment recorded in ForwardHealth interChange. The MCO is responsible to monitor ForwardHealth interChange enrollment reports for discrepancies in persons the MCO considers enrolled. The Department will consider requests for correction of enrollment and payment discrepancies if the MCO: Submits the request to the Department on a Discrepancy Report F- 01655 (xxxxx://xxx.xxx.xxxxxxxxx.xxx/forms/f01655.xlsx); Follows all of the procedures and guidelines specified in technical assistance memo 15- 02, (xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p01048-15-02.pdf) effective 11/2/2015, as amended; Provides evidence of the individual’s effective date of enrollment or disenrollment and proof that during the time in question the MCO was providing services to the individual; and The date of the enrollment discrepancy does not exceed 18 months previous to the report submission or correction request date. A member-requested disenrollment shall be effective on the date indicated on the disenrollment form signed by the member or the member’s legal decision maker. The effective date cannot be earlier than the date the individual last received services authorized by the MCO. An MCO-requested disenrollment shall be effective on the date approved by the Department as the disenrollment date as follows: A disenrollment date due to member no longer accepting services will be set according to adverse action date logic, as defined in Article I.8. A disenrollment date due to inability to assure health and safety will be set according to adverse action date logic, as defined in Article I.8. A disenrollment date due to member acts that pose a threat will be set and processed immediately. If the member dies, the date of disenrollment shall be the date of death. Loss of eligibility resulting in disenrollment shall have the effective dates as identified in i. through v. below. If an MCO member is planning to or has moved out of the MCO service area, the date of disenrollment shall be the date the move occurs. If an individual has been incarcerated, the MCO shall report this change in circumstance to the income maintenance agency as this change may result in a loss of Medicaid eligibility. The MCO disenrollment date shall be the date of incarceration. If a member who is at least 21 years old and less than 65 years old has been admitted to an IMD, the MCO shall report this change in circumstance to the income maintenance agency as this change may result in a loss of Medicaid coverage of services. The MCO disenrollment date shall be the date of admission to the IMD. Members admitted to an IMD for purposes of RSUD treatment should not be disenrolled. For Partnership members this requirement does not apply when an IMD stay is covered as an in lieu of or alternate service. If an MCO member loses Medicaid eligibility for a reason other than those identified in (i) through (iii) above, the last day of eligibility shall be set by the CARES system or by SSA according to adverse action date logic, as defined in Article I.8. The disenrollment date will be the date eligibility ends. The MCO shall continue to provide services to the member through the date of disenrollment. If a member loses functional eligibility, the date of disenrollment shall be set according to adverse action date logic, as defined in Article I.8.

Dates of Enrollment and Disenrollment. The enrollment date for an otherwise eligible individual can be set for the first day of the month in which she or he achieves the age specified in Article XIX, MCO Specific Contract Terms, Section E. E, page 314, except for PACE, in which the individual must have achieved the age of 55 prior to enrollment. The MCO shall begin serving individuals as of the effective date of enrollment recorded in ForwardHealth interChange. The MCO is responsible to monitor ForwardHealth interChange enrollment reports for discrepancies in persons the MCO considers enrolled. The Department will consider requests for correction of correcting enrollment and payment discrepancies dates in the past if the MCO: ; Submits the request to the Department an enrollment discrepancy report on a Discrepancy Report F- 01655 form approved by the Department (xxxxx://xxx.xxx.xxxxxxxxx.xxx/forms/f01655.xlsx); the purpose of this report is to identify discrepancies between the MCO’s enrollment as documented in ForwardHealth interChange and the MCO’s internal enrollment records Follows all of the procedures and guidelines specified in technical assistance memo 15- 02, (xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p01048-15-02.pdf) effective 11/2/2015, as amended; Provides documented evidence of the individual’s effective date of enrollment or disenrollment and proof that during the time in question the individual was functionally and financially eligible and the MCO was providing services to the individual; and The date of the enrollment discrepancy does not exceed 18 months previous to the report submission or correction request date. A member-requested disenrollment shall be effective on the date indicated on the disenrollment form signed by the member or the member’s legal decision maker. The effective date cannot be earlier than the date the individual last received services authorized by the MCO. An MCO-requested disenrollment shall be effective on the date approved by the Department as the disenrollment date as follows: A disenrollment date due to member no longer accepting services will be set according to adverse action date logic, as defined in Article I.8. A disenrollment date due to inability to assure health and safety will be set according to adverse action date logic, as defined in Article I.8. A disenrollment date due to member acts that pose a threat will be set and processed immediately. If the member dies, the date of disenrollment shall be the date of death. Loss of eligibility resulting in disenrollment shall have the effective dates as identified in i. through v. below. If an MCO member is planning to or has moved out of the MCO service area, the date of disenrollment shall be the date the move occurs. If an individual has been incarcerated, the MCO shall report this change in circumstance to the income maintenance agency as this change may result in a loss of Medicaid eligibility. The MCO disenrollment date shall be the date of incarceration. If a member who is at least 21 years old and less than 65 years old has been admitted to an IMD, the MCO shall report this change in circumstance to the income maintenance agency as this change may result in a loss of Medicaid coverage of services. The MCO disenrollment date shall be the date of admission to the IMD. Members admitted to an IMD for purposes of RSUD treatment should not be disenrolled. For Partnership and PACE members this requirement does not apply when an IMD stay is covered as an in lieu of or alternate service. If an MCO member loses Medicaid eligibility for a reason other than those identified in (i) through (iii) above, the last day of eligibility shall be set by the CARES system or by SSA according to adverse action date logic, as defined in Article I.8. The disenrollment date will be the date eligibility ends. The MCO shall continue to provide services to the member through the date of disenrollment. If a member loses functional eligibility, the date of disenrollment shall be set according to adverse action date logic, as defined in Article I.8.

Dates of Enrollment and Disenrollment. The enrollment date for an otherwise eligible individual can be set for the first day of the month in which she or he achieves the age specified in Article XIX, MCO Specific Contract Terms, Section E. The MCO shall begin serving individuals as of the effective date of enrollment recorded in ForwardHealth interChange. The MCO is responsible to monitor ForwardHealth interChange enrollment reports for discrepancies in persons the MCO considers enrolled. The Department will consider requests for correction of enrollment and payment discrepancies if the MCO: Submits the request to the Department on a Discrepancy Report F- 01655 (xxxxx://xxx.xxx.xxxxxxxxx.xxx/forms/f01655.xlsx); Follows all of the procedures and guidelines specified in technical assistance memo 15- 02, (xxxxx://xxx.xxx.xxxxxxxxx.xxx/publications/p01048-15-02.pdf) effective 11/2/2015, as amended; Provides evidence of the individual’s effective date of enrollment or disenrollment and proof that during the time in question the MCO was providing services to the individual; and The date of the enrollment discrepancy does not exceed 18 months previous to the report submission or correction request date. A member-requested disenrollment shall be effective on the date indicated on the disenrollment form signed by the member or the member’s legal decision maker. The effective date cannot be earlier than the date the individual last received services authorized by the MCO. An MCO-requested disenrollment shall be effective on the date approved by the Department as the disenrollment date as follows: A disenrollment date due to member no longer accepting services will be set according to adverse action date logic, as defined in Article I.8. A disenrollment date due to inability to assure health and safety will be set according to adverse action date logic, as defined in Article I.8. A disenrollment date due to member acts that pose a threat will be set and processed immediately. If the member dies, the date of disenrollment shall be the date of death. Loss of eligibility resulting in disenrollment shall have the effective dates as identified in i. through v. below. If an MCO member is planning to or has moved out of the MCO service area, the date of disenrollment shall be the date the move occurs. If an individual has been incarcerated, the MCO shall report this change in circumstance to the income maintenance agency as this change may result in a loss of Medicaid eligibility. The MCO disenrollment date shall be the date of incarceration. If a member who is at least 21 years old and less than 65 years old has been admitted to an IMD, the MCO shall report this change in circumstance to the income maintenance agency as this change may result in a loss of Medicaid coverage of services. The MCO disenrollment date shall be the date of admission to the IMD. Members admitted to an IMD for purposes of RSUD treatment should not be disenrolled. For Partnership members this requirement does not apply when an IMD stay is covered as an in lieu of or alternate service. If an MCO member loses Medicaid eligibility for a reason other than those identified in (i) through (iii) above, the last day of eligibility shall be set by the CARES system or by SSA according to adverse action date logic, as defined in Article I.8. The disenrollment date will be the date eligibility ends. The MCO shall continue to provide services to the member through the date of disenrollment. If a member loses functional eligibility, the date of disenrollment shall be set according to adverse action date logic, as defined in Article I.8.