Common use of Default Enrollment Process Clause in Contracts

Default Enrollment Process. On behalf of currently enrolled AHCCCS categorically eligible members who receive full medical assistance benefits, and who become newly Medicare eligible either by age or disability, and that such Medicare eligibility results in Full Benefit Dual Eligible status for such members , MAO shall perform the default enrollment process as provided by 42 CFR 422.66 and 422.68. Through this Agreement, in conformance with 42 CFR 422.66(c)(2)(i)(B) and 42 CFR 422.107, AHCCCS approves MAO’s implementation of the default enrollment process subject to CMS’ prior approval as per the requirements of 42 CFR 422.66(c)(2)(i)(E), (F), and (G) inclusive; 422.66(c)(2)(ii); and other CMS-published regulatory guidance as applicable. MAO shall be responsible for timely obtaining initial default enrollment process approval from CMS no later than 120 calendar days prior to the Effective Date of this Agreement as specified in paragraph 3.1: Term of Agreement. MAO shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS prior approval. MAO shall forward to AHCCCS a copy of CMS’ default enrollment process prior approval notification or correspondence to the MAO within 10 calendar days of receipt, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall also be responsible for coordinating those necessary activities to renew any existing default enrollment process approval(s) with CMS, as per the requirements of 42 CFR 422.66(c)(2)(ii), so that any such subsequent CMS approval(s)/renewal(s) of an existing approved default enrollment process shall be effective no later than 120 calendar days prior to the expiration of the existing CMS approval requested to be renewed. MAO shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS renewal approval(s) of an existing default enrollment process. MAO shall forward to AHCCCS copies of its default enrollment process renewal notification and materials to CMS, and CMS’ renewal approval(s) notification or correspondence to the MAO, within 10 calendar days of receipt, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall maintain a minimum 3.0 overall plan Star rating as assigned by CMS to implement the default enrollment process. MAO implementation of the default enrollment process shall be revoked by CMS if a minimum 3.0 overall plan Star rating is not maintained, and default enrollment cannot be re-applied for with CMS until the MAO has subsequently achieved this minimum Star rating. See paragraph 2.11: Medicare Star Ratings for additional Star rating requirements. Through implementation of the default enrollment process, AHCCCS shall provide MAO with information necessary to prospectively identify those AHCCCS categorically eligible members who are or will be in their Medicare Initial Coverage Election Period. On an informational basis only, MAO shall report quarterly, by month, to AHCCCS of its default enrollment process activities and results, as specified in Attachment 1: Chart of Deliverables and Attachment 5: Default Enrollment Process Reporting Requirements.

Default Enrollment Process. On behalf of currently enrolled AHCCCS categorically eligible members who receive full medical assistance benefits, and who become newly Medicare eligible either by age or disability, and that such Medicare eligibility results in Full Benefit Dual Eligible Member status for such members members, MAO XXX shall perform the default enrollment process as provided by 42 CFR 422.66 and 422.68. Through this Agreement, in conformance with 42 CFR 422.66(c)(2)(i)(B) and 42 CFR 422.107, AHCCCS approves MAO’s implementation of the default enrollment process subject to CMS’ prior approval as per the requirements of 42 CFR 422.66(c)(2)(i)(E), (F), and (G) inclusive; 422.66(c)(2)(ii); and other CMS-published regulatory guidance as applicable. MAO XXX shall be responsible for timely obtaining initial default enrollment process approval from CMS no later than 120 60 calendar days prior to the Effective Date of this Agreement as specified in paragraph 3.1: Term of Agreement. MAO XXX shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS prior approval. MAO shall forward to AHCCCS a copy of CMS’ default enrollment process prior approval notification or correspondence to the MAO within 10 ten (10) calendar days of receiptreceipt from CMS, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall also be responsible for coordinating those activities necessary activities to renew any existing default enrollment process approval(s) with CMS, as per the requirements of 42 CFR 422.66(c)(2)(ii), so that any such subsequent CMS approval(s)/renewal(s) of an existing approved default enrollment process shall be effective no later than 120 60 calendar days prior to the expiration of the existing CMS approval requested to be renewed. MAO shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS renewal approval(s) of an existing default enrollment process. MAO shall forward to AHCCCS copies of its default enrollment process renewal notification and materials to CMS, and CMS’ renewal approval(s) notification or correspondence to the MAO, within 10 ten (10) calendar days of receiptreceipt from CMS, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall maintain a minimum 3.0 overall plan Star rating as assigned by CMS to implement the default enrollment process. MAO implementation of the default enrollment process shall be revoked by CMS if a minimum 3.0 overall plan Star rating is not maintained, and default enrollment cannot be re-applied for with CMS until the MAO has subsequently achieved this minimum Star rating. See paragraph 2.11: Medicare Star Ratings for additional Star rating requirements. Through implementation of the default enrollment process, AHCCCS shall provide MAO with information necessary to prospectively identify those AHCCCS categorically eligible members who are or will be in their Medicare Initial Coverage Election Period. On an informational basis only, MAO shall report quarterly, by month, to AHCCCS of its default enrollment process activities and results, as specified in Attachment 1: Chart of Deliverables and Attachment 5: Default Enrollment Process Reporting Requirements.

Default Enrollment Process. On behalf of currently enrolled AHCCCS categorically eligible members who receive full medical assistance benefits, and who become newly Medicare eligible either by age or disability, and that such Medicare eligibility results in Full Benefit Dual Eligible status for such members , MAO shall perform the default enrollment process as provided by 42 CFR 422.66 and 422.68. Through this Agreement, in conformance with 42 CFR 422.66(c)(2)(i)(B) and 42 CFR 422.107, AHCCCS approves MAO’s implementation of the default enrollment process subject to CMS’ prior approval as per the requirements of 42 CFR 422.66(c)(2)(i)(E), (F), and (G) inclusive; 422.66(c)(2)(ii); and other CMS-published regulatory guidance as applicable. MAO shall be responsible for timely obtaining initial default enrollment process approval from CMS no later than 120 calendar days prior to the Effective Date of this Agreement as specified in paragraph 3.1: Term of Agreement. MAO shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS prior approval. MAO shall forward to AHCCCS a copy of CMS’ default enrollment process prior approval notification or correspondence to the MAO within 10 calendar days of receipt, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall also be responsible for coordinating those necessary activities to renew any existing default enrollment process approval(s) with CMS, as per the requirements of 42 CFR 422.66(c)(2)(ii), so that any such subsequent CMS approval(s)/renewal(s) of an existing approved default enrollment process shall be effective no later than 120 calendar days prior to the expiration of the existing CMS approval requested to be renewed. MAO shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS renewal approval(s) of an existing default enrollment process. MAO shall forward to AHCCCS copies of its default enrollment process renewal notification and materials to CMS, and CMS’ renewal approval(s) notification or correspondence to the MAO, within 10 calendar days of receipt, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall maintain a minimum 3.0 overall plan Star rating as assigned by CMS to implement the default enrollment process. MAO implementation of the default enrollment process shall be revoked by CMS if a minimum 3.0 overall plan Star rating is not maintained, and default enrollment cannot be re-applied for with CMS until the MAO has subsequently achieved this minimum Star rating. See paragraph 2.11: Medicare Star Ratings for additional Star rating requirements. Through implementation of the default enrollment process, AHCCCS shall provide MAO with information necessary to prospectively identify those AHCCCS categorically eligible members who are or will be in their Medicare Initial Coverage Election Period. On an informational basis only, MAO shall report quarterly, by month, monthly to AHCCCS of its default enrollment process activities and results, as specified in Attachment 1: Chart of Deliverables and Attachment 5: Default Enrollment Process Reporting Requirements.

Default Enrollment Process. On behalf of currently enrolled AHCCCS categorically eligible members who receive full medical assistance benefits, and who become newly Medicare eligible either by age or disability, and that such Medicare eligibility results in Full Benefit Dual Eligible Member status for such members members, MAO shall perform the default enrollment process as provided by 42 CFR 422.66 and 422.68. Through this Agreement, in conformance with 42 CFR 422.66(c)(2)(i)(B) and 42 CFR 422.107, AHCCCS approves MAO’s implementation of the default enrollment process subject to CMS’ prior approval as per the requirements of 42 CFR 422.66(c)(2)(i)(E), (F), and (G) inclusive; 422.66(c)(2)(ii); and other CMS-published regulatory guidance as applicable. MAO XXX shall be responsible for timely obtaining initial default enrollment process approval from CMS no later than 120 60 calendar days prior to the Effective Date of this Agreement as specified in paragraph 3.1: Term of Agreement. MAO XXX shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS prior approval. MAO shall forward to AHCCCS a copy of CMS’ default enrollment process prior approval notification or correspondence to the MAO within 10 ten (10) calendar days of receiptreceipt from CMS, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall also be responsible for coordinating those activities necessary activities to renew any existing default enrollment process approval(s) with CMS, as per the requirements of 42 CFR 422.66(c)(2)(ii), so that any such subsequent CMS approval(s)/renewal(s) of an existing approved default enrollment process shall be effective no later than 120 60 calendar days prior to the expiration of the existing CMS approval requested to be renewed. MAO shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS renewal approval(s) of an existing default enrollment process. MAO shall forward to AHCCCS copies of its default enrollment process renewal notification and materials to CMS, and CMS’ renewal approval(s) notification or correspondence to the MAO, within 10 ten (10) calendar days of receiptreceipt from CMS, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall maintain a minimum 3.0 overall plan Star rating as assigned by CMS to implement the default enrollment process. MAO implementation of the default enrollment process shall be revoked by CMS if a minimum 3.0 overall plan Star rating is not maintained, and default enrollment cannot be re-applied for with CMS until the MAO has subsequently achieved this minimum Star rating. See paragraph 2.11: Medicare Star Ratings for additional Star rating requirements. Through implementation of the default enrollment process, AHCCCS shall provide MAO with information necessary to prospectively identify those AHCCCS categorically eligible members who are or will be in their Medicare Initial Coverage Election Period. On an informational basis only, MAO shall report quarterly, by month, to AHCCCS of its default enrollment process activities and results, as specified in Attachment 1: Chart of Deliverables and Attachment 5: Default Enrollment Process Reporting Requirements.

Default Enrollment Process. On behalf of currently enrolled AHCCCS categorically eligible members who receive full medical assistance benefits, and who become newly Medicare eligible either by age or disability, and that such Medicare eligibility results in Full Benefit Dual Eligible status for such members , MAO shall perform the default enrollment process as provided by 42 CFR 422.66 and 422.68. Through this Agreement, in conformance with 42 CFR 422.66(c)(2)(i)(B) and 42 CFR 422.107, AHCCCS approves MAO’s implementation of the default enrollment process subject to CMS’ prior approval as per the requirements of 42 CFR 422.66(c)(2)(i)(E), (F), and (G) inclusive; 422.66(c)(2)(ii); and other CMS-published regulatory guidance as applicable. MAO XXX shall be responsible for timely obtaining initial default enrollment process approval from CMS no later than 120 calendar days prior to the Effective Date of this Agreement as specified in paragraph 3.1: Term of Agreement. MAO XXX shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS prior approval. MAO shall forward to AHCCCS a copy of CMS’ default enrollment process prior approval notification or correspondence to the MAO within 10 calendar days of receipt, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall also be responsible for coordinating those necessary activities to renew any existing default enrollment process approval(s) with CMS, as per the requirements of 42 CFR 422.66(c)(2)(ii), so that any such subsequent CMS approval(s)/renewal(s) of an existing approved default enrollment process shall be effective no later than 120 calendar days prior to the expiration of the existing CMS approval requested to be renewed. MAO shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS renewal approval(s) of an existing default enrollment process. MAO shall forward to AHCCCS copies of its default enrollment process renewal notification and materials to CMS, and CMS’ renewal approval(s) notification or correspondence to the MAO, within 10 calendar days of receipt, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall maintain a minimum 3.0 overall plan Star rating as assigned by CMS to implement the default enrollment process. MAO implementation of the default enrollment process shall be revoked by CMS if a minimum 3.0 overall plan Star rating is not maintained, and default enrollment cannot be re-applied for with CMS until the MAO has subsequently achieved this minimum Star rating. See paragraph 2.11: Medicare Star Ratings for additional Star rating requirements. Through implementation of the default enrollment process, AHCCCS shall provide MAO with information necessary to prospectively identify those AHCCCS categorically eligible members who are or will be in their Medicare Initial Coverage Election Period. On an informational basis only, MAO shall report quarterly, by month, to AHCCCS of its default enrollment process activities and results, as specified in Attachment 1: Chart of Deliverables and Attachment 5: Default Enrollment Process Reporting Requirements.

Default Enrollment Process. On behalf of currently enrolled AHCCCS categorically eligible members who receive full medical assistance benefits, and who become newly Medicare eligible either by age or disability, and that such Medicare eligibility results in Full Benefit Dual Eligible Member status for such members MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND Participant Health Choice Arizona, MAO Inc. d/b/a Health Choice Pathway AHCCCS AGREEMENT # YH23-0010-03 members, XXX shall perform the default enrollment process as provided by 42 CFR 422.66 and 422.68. Through this Agreement, in conformance with 42 CFR 422.66(c)(2)(i)(B) and 42 CFR 422.107, AHCCCS approves MAO’s implementation of the default enrollment process subject to CMS’ prior approval as per the requirements of 42 CFR 422.66(c)(2)(i)(E), (F), and (G) inclusive; 422.66(c)(2)(ii); and other CMS-published regulatory guidance as applicable. MAO XXX shall be responsible for timely obtaining initial default enrollment process approval from CMS no later than 120 60 calendar days prior to the Effective Date of this Agreement as specified in paragraph 3.1: Term of Agreement. MAO XXX shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS prior approval. MAO shall forward to AHCCCS a copy of CMS’ default enrollment process prior approval notification or correspondence to the MAO within 10 ten (10) calendar days of receiptreceipt from CMS, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall also be responsible for coordinating those activities necessary activities to renew any existing default enrollment process approval(s) with CMS, as per the requirements of 42 CFR 422.66(c)(2)(ii), so that any such subsequent CMS approval(s)/renewal(s) of an existing approved default enrollment process shall be effective no later than 120 60 calendar days prior to the expiration of the existing CMS approval requested to be renewed. MAO shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS renewal approval(s) of an existing default enrollment process. MAO shall forward to AHCCCS copies of its default enrollment process renewal notification and materials to CMS, and CMS’ renewal approval(s) notification or correspondence to the MAO, within 10 ten (10) calendar days of receiptreceipt from CMS, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall maintain a minimum 3.0 overall plan Star rating as assigned by CMS to implement the default enrollment process. MAO implementation of the default enrollment process shall be revoked by CMS if a minimum 3.0 overall plan Star rating is not maintained, and default enrollment cannot be re-applied for with CMS until the MAO has subsequently achieved this minimum Star rating. See paragraph 2.11: Medicare Star Ratings for additional Star rating requirements. Through implementation of the default enrollment process, AHCCCS shall provide MAO with information necessary to prospectively identify those AHCCCS categorically eligible members who are or will be in their Medicare Initial Coverage Election Period. On an informational basis only, MAO shall report quarterly, by month, to AHCCCS of its default enrollment process activities and results, as specified in Attachment 1: Chart of Deliverables and Attachment 5: Default Enrollment Process Reporting Requirements.. MEDICARE ADVANTAGE ORGANIZATION AGREEMENT BETWEEN AHCCCS AND Participant Health Choice Arizona, Inc. d/b/a Health Choice Pathway AHCCCS AGREEMENT # YH23-0010-03