Enrollment and Disenrollment. The Division or its Agent shall send written notification to the Member to inform the Member of Enrollment into CHIP and to select a Contractor and Primary Care Provider (PCP).
Enrollment and Disenrollment. Enrollment
Enrollment and Disenrollment. The Division or its Agent shall send written notification to the Member to inform the Member of Enrollment into the MississippiCAN Program and to select a CCO and PCP.
Enrollment and Disenrollment. The Division or its Agent shall send written and electronic (if available) notification to the Member to inform the Member of the Member’s Enrollment into MississippiCAN or CHIP and to select a Contractor and PCP. The Division and its Agent will be responsible for Choice Counseling for the Member. Upon enrollment, a Member must either choose a Contractor in which to enroll or be passively auto enrolled to a Contractor by the Division. Regardless of whether the Member chooses a Contractor or is passively auto enrolled, the Member may change Contractor membership within ninety (90) calendar days from the date of enrollment if desired. The Member will remain a Member of the Contractor in which the Member is enrolled on the 90th day after the date of enrollment until the next open enrollment period unless the Member becomes ineligible for the program or is otherwise disenrolled. Passive auto enrollment rules will include provisions to determine the following:
1. Prior Enrollment: The Division will determine whether the Member was enrolled with a Contractor within the previous sixty (60) calendar days and assign the Member to that Contractor.
Enrollment and Disenrollment. In accordance with A.R.S. §8-512, CMDP provides comprehensive medical and dental care for each child who is: a) placed in a xxxxxx home; b) in the custody of DES and placed with a relative, in a certified adoptive home prior to the final order of adoption, or in an independent living program as provided in A.R.S. §8-512; and c) in the custody of the Arizona Department of Juvenile Corrections (ADJC) or the Administrative Office of the Courts/Juvenile Probation Office (AOC/JPO) and placed in xxxxxx care. Children who are enrolled with CMDP when placed temporarily in detention may remain Title XIX or Title XXI eligible. When it is determined that the child does not meet the “inmate of a public institution” status as determined by the Children in Detention Policy, AHCCCS enrollment will remain with CMDP. The Division of Children, Youth and Families (DCYF) is responsible for determining Title XIX eligibility for the children entitled to CMDP coverage. Upon notification from DCYF that a CMDP covered child qualifies for Title XIX, AHCCCS, will enroll the child with CMDP as the Title XIX health plan. AHCCCS shall in turn notify CMDP of the child’s AHCCCS enrollment, and CMDP shall ensure that the member is enrolled in CMDP’s Title XIX line of business. DCYF is responsible for timely notification to AHCCCS that a member is no longer eligible for Title XIX or that member no longer meets the criteria for CMDP coverage as set forth in A.R.S. §8-512. As a result of the DCYF notification that a member no longer qualifies for CMDP, AHCCCS shall notify CMDP of a member’s termination from CMDP. CMDP shall timely disenroll the member from CMDP’s Title XIX line of business. AHCCCS is responsible for determining Title XXI eligibility. AHCCCS shall notify CMDP when a child qualifies for Title XXI and CMDP coverage. CMDP shall ensure that the member is enrolled in CMDP’s Title XXI line of business. AHCCCS shall notify CMDP if a Title XXI child no longer meets the criteria for Title XXI eligibility, and CMDP shall disenroll such child from the Title XXI line of business. If a Title XXI eligible child no longer meets the criteria for CMDP coverage as set forth in A.R.S. §8.512, CMDP shall notify AHCCCS, and the child shall be disenrolled from CMDP, by AHCCCS and CMDP. CMDP may not disenroll because of an adverse change in the member’s health status, or because of the member’s utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resu...
Enrollment and Disenrollment. 1.5.1 Non-Discrimination
Enrollment and Disenrollment. DOM or its Agent shall send written notification to the Member to inform the Member of Enrollment into CHIP and to select a CCO and Primary Care Provider (PCP).
Enrollment and Disenrollment. Procedures
i) Where appropriate, explanation of Lock-In requirements, and initial grace period when person may change plans, or return to fee-for-service in voluntary areas.
ii) Choice of PCP (each person can have his/her own PCP and can change thirty (30) days after the initial appointment with their PCP, and once every six months thereafter).
iii) Procedures for disenrollment.
iv) Opportunities for change
v) LDSS/or enrollment broker phone number for information on enrollment and disenrollment.
Enrollment and Disenrollment. A. Enrollment
1. Enrollment Authority BadgerCare Plus Enrollment in the HMO is voluntary by the member except where limited by departmental implementation of a State Plan Amendment or a Section 1115(a) waiver. The current State Plan Amendment and 1115(a) waiver require mandatory enrollment into an HMO for those service areas in which there are two or more HMOs with sufficient slots for the HMO eligible population and in rural areas, as defined in 42 CFR 438.52, where there is only one HMO with an adequate provider network as determined by the Department.
Enrollment and Disenrollment. A. Enrollment Discrimination Prohibited
1. Contractor must not discriminate against individuals eligible to enroll on the basis of:
a. Health status or the need for health services b. Race, color, national origin, age, disability, sex, or other factors identified in 42 CFR 438.3(d) and will not use any policy or practice that has the effect of discriminating as such
2. Contractor must accept Enrollees for enrollment in the order in which they apply without restriction.
B. Enrollment Services Contractor MDHHS contracts with an Enrollment Services Contractor to contact and educate Medicaid beneficiaries regarding managed care and assist beneficiaries to enroll, disenroll, and change enrollment with their Contractor. Because MDHHS holds the contract with the Enrollment Services Contractor, this contract may reference MDHHS and by extension the Enrollment Services Contractor may actually perform the service. Contractor must work with the Enrollment Services Contractor as directed by MDHHS.
C. Initial Enrollment and Automatic Reenrollment
1. Contractor must accept as enrolled all beneficiaries listed on all HIPAA-compliant enrollment files/reports and infants enrolled by virtue of the mother's enrollment status (see IV-D (1)).
2. Enrollees disenrolled from the Contractor due to loss of Medicaid eligibility or other action will be retroactively reenrolled to the same Contractor automatically, provided eligibility is regained within two months.
D. Newborn Enrollment
1. Newborns will be automatically enrolled with the mother's Contractor at the time of birth.
2. Contractors will receive a full Capitation Payment for the month of birth.
3. Contractor must reconcile their birth records with the enrollment information supplied by MDHHS.
4. Contactors must submit a newborn service request to MDHHS no later than six months following the month for which the Contractor has a record of birth if:
a. MDDHS has not notified the Contractor of an Enrollee birth for two months or more following the month for which the Contractor has a record of birth.
b. The child is born outside Michigan.
E. Auto-assignment of Beneficiaries
1. Beneficiaries who do NOT select a health plan within the allotted time period will be automatically assigned to a Contractor based on the Contractor’s capacity to accept new Enrollees and performance in areas specified by MDHHS (e.g., quality metrics).
2. MDHHS will automatically assign a larger proportion of beneficiaries to the highest performing Contr...
