Enrollment and Disenrollment Processes Sample Clauses

Enrollment and Disenrollment Processes. Eligible individuals will be notified of their right to select among contracted Demonstration Plans. No earlier than 90 days prior to October 1, 2013, eligible individuals will have the opportunity to opt into the Demonstration to begin receiving services on October 1, 2013. Beginning January 1, 2014 and on a monthly basis, if no active choice has been made, enrollment for eligible beneficiaries (as described above in C.1.) into a Demonstration Plan may be conducted using a seamless, Passive Enrollment process that provides the opportunity for Enrollees to make a voluntary choice to enroll or disenroll from the Demonstration Plan on a monthly basis. Enrollees will receive sufficient notice of and information on Passive Enrollment no fewer than 60 days prior to the effective date of enrollment, and will have the opportunity to opt out up until the last day of the month prior to the effective date of Enrollment, as further detailed in Appendix 7. Disenrollment from Demonstration Plans shall be allowed on a month-to-month basis any time during the year; however, coverage for these individuals will continue through the end of the month in which they disenroll. CMS and the State will monitor Enrollments and Disenrollments for both evaluation purposes and for the purpose of identifying any inappropriate or illegal marketing practices. As part of this analysis, CMS and the State will monitor any unusual shifts in Enrollment by individuals identified for Passive Enrollment into a particular Demonstration Plan to a Medicare Advantage plan operated by the same parent organization. If those shifts appear to be due to inappropriate or illegal marketing practices, CMS and the State may issue corrective action. Any illegal marketing practices will be referred to appropriate agencies for investigation. As mutually agreed upon, CMS and the State will utilize an independent, third party entity to facilitate enrollment into the Demonstration Plans. Demonstration Plan enrollments, including transfers between Demonstration Plans, and Disenrollments shall become effective on the same day for both Medicare and Medicaid, as discussed above and in greater detail in Appendix 7. For those who lose Medicaid eligibility during the month, coverage and FFP will continue through the end of that month. See Appendix 7 for a more detailed discussion on timing of Enrollments and Disenrollments.
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Enrollment and Disenrollment Processes. Enrollment into a Participating Plan may be conducted using a seamless, passive enrollment process that provides the opportunity for beneficiaries to make a voluntary choice to enroll or disenroll from the Participating Plan at any time. Prior to the effective date of their enrollment, individuals who would be passively enrolled will have the opportunity to opt-out and will receive sufficient notice and information with which to do so, as further detailed in Appendix 7. Disenrollment from Participating Plans and transfers between Participating Plans shall be allowed on a month-to- month basis any time during the year; however, coverage for these individuals will continue through the end of the month. CMS and the Commonwealth will monitor enrollments and disenrollments for both evaluation purposes and for compliance with applicable marketing laws, for the purposes of identifying any inappropriate or illegal marketing practices. Any illegal marketing practices will be referred to appropriate agencies for investigation. As mutually agreed upon, and as discussed further in Appendix 7 and the three-way contract, CMS and the Commonwealth will utilize an independent third party entity to facilitate all enrollment into the Participating Plans. Participating Plan enrollments and disenrollments shall become effective on the same day for both Medicare and Medicaid (the first of the month). For those who lose Medicaid eligibility during the month, coverage and Federal financial participation will continue through the end of that month.
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Enrollment and Disenrollment Processes a) QUEST, QUEST-Net, and QUEST-ACE Programs. The State must maintain a managed care enrollment and disenrollment process that complies with 42 CFR Part 438, except that disenrollment without cause from a MCO will be more limited in cases where the enrollee was not auto-assigned to the MCO. If the enrollee was not auto-assigned to the MCO, the State must maintain a process by which the enrollee may change MCOs only if both MCOs agree to the change. The State must track and report to CMS these requests on an annual basis; along with MCO choice rates and MCO change rates that occur during the annual open enrollment period.
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Enrollment and Disenrollment Processes. The Department has developed ACC Program enrollment processes that identify and minimize disruption to existing enrollee-provider relationships. The Department will use these processes to enroll Medicare-Medicaid beneficiaries into the Demonstration, taking into account existing beneficiary relationships with Medicare providers. The SDAC will look at a Medicare-Medicaid enrollee’s previous 12 months of Medicare and Medicaid claims history to understand which medical provider the beneficiary has seen most frequently. Enrollment in the Demonstration will be closely related to attributing a beneficiary to a PCMP. The PCMP is a fundamental component of the ACC Program and the Demonstration, and the Department’s objective is to maintain existing beneficiary-provider relationships to avoid disruption in care and services. Appendix 7 further describes the enrollment process. Enrollment into the ACC Program does not reduce entitlement or access to Medicaid or Medicare services. The Demonstration will not require that any beneficiaries change providers.
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Enrollment and Disenrollment Processes. The Demonstration will use an integrated enrollment system to simplify the enrollment experience for Beneficiaries and improve the accuracy of the enrollment process.
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Enrollment and Disenrollment Processes. All Enrollment and Disenrollment-related transactions, including enrollments from one MMIP to a different MMIP, will be processed through Washington’s MMIS system – ProviderOne – except those transactions related to non-Demonstration plans participating in Medicare Advantage. The State will submit enrollment transactions to the CMS Medicare Advantage Prescription Drug (XXXx) enrollment system directly or via a third party CMS designates to receive such transactions. CMS will also submit a file to the State identifying individuals who have elected to disenroll from a MMIP, opt-out of Passive Enrollment or enroll in another type of available Medicare coverage. The State will share enrollment, disenrollment and opt-out transactions with MMIPs. Enrollment and disenrollment methods include enrollment and disenrollment forms, Medical Assistance Customer Service Center (MACSC) staff, an Interactive Voice Recognition system and a web-based portal. Enrollees may access independent enrollment assistance and options counseling offered by the State’s Area Agencies on Aging (AAA) to help them make an enrollment decision that best meets their needs. CMS and the State will work together to support the State Health Insurance Assistance Program (SHIP), ADRC options counseling, and other community-based, nonprofit organizations to ensure ongoing outreach, education and support to Enrollees in understanding their health care coverage and LTSS options.
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Enrollment and Disenrollment Processes. NYSDOH will open enrollment to the community-based LTSS eligible population no earlier than July 1, 2014 and will open enrollment to the facility-based LTSS eligible population no earlier than October 1, 2014.
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Enrollment and Disenrollment Processes. All Enrollment and Disenrollment-related transactions, including enrollments from one CICO to a different CICO, will be processed by the State (or its vendor). The enrollment entity will submit enrollment transactions to the CMS Medicare Advantage Prescription Drug (XXXx) enrollment system directly or via a third party CMS designates to receive such transactions. CMS will also submit a file to the State identifying individuals who have elected to disenroll from a CICO, opt-out of passive enrollment, or enroll in another type of available Medicare coverage. The State or its designated vendor will share enrollment, disenrollment and opt-out transactions with CICOs.
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Related to Enrollment and Disenrollment Processes

  • Enrollment Process The Department may, at any time, revise the enrollment procedures. The Department will advise the Contractor of the anticipated changes in advance whenever possible. The Contractor shall have the opportunity to make comments and provide input on the changes. The Contractor will be bound by the changes in enrollment procedures.

  • Enrollment Procedures The District shall establish an open enrollment period each year for unit members to participate in the Catastrophic Leave Bank. The enrollment period shall be September 1 through December 1. Once a unit member becomes a participant in the Catastrophic Leave Bank, he/she shall not be required to reenroll each year.

  • Disenrollment Adverse Benefit Determination taken by the Division, or its Agent, to remove a Member's name from the monthly Member Listing report following the Division's receipt and approval of a request for Disenrollment or a determination that the Member is no longer eligible for Enrollment in the Contractor.

  • Re-enrollment Any eligible employees who wish to join the Sick Leave Bank after their first year of eligibility will contribute two (2) days upon joining. Such membership may only be made during the month of October using the appropriate forms. The two (2) required days of leave shall be donated from their account upon enrollment in the Classified Employee Council (CEC).

  • Enrollment The School shall maintain accurate and complete enrollment data and daily records of student attendance.

  • Initial Enrollment Upon retirement, each new retiree who is eligible to enroll in plans under the Health Benefits Program shall receive uninterrupted coverage under the plan in which he or she was enrolled as an active employee, provided the employee submits all necessary applications and other required documentation in a timely fashion.

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • How to File an Appeal of a Prescription Drug Denial For denials of a prescription drug claim based on our determination that the service was not medically necessary or appropriate, or that the service was experimental or investigational, you may request an appeal without first submitting a request for reconsideration. You or your physician may file a written or verbal prescription drug appeal with our pharmacy benefits manager (PBM). The prescription drug appeal must be submitted to us within one hundred and eighty (180) calendar days of the initial determination letter. You will receive written notification of our determination within thirty (30) calendar days from the receipt of your appeal. How to File an Expedited Appeal Your appeal may require immediate action if a delay in treatment could seriously jeopardize your health or your ability to regain maximum function, or would cause you severe pain. To request an expedited appeal of a denial related to services that have not yet been rendered (a preauthorization review) or for on-going services (a concurrent review), you or your healthcare provider should call: • our Grievance and Appeals Unit; or • our pharmacy benefits manager for a prescription drug appeal. Please see Section 9 for contact information. You will be notified of our decision no later than seventy-two (72) hours after our receipt of the request. You may not request an expedited review of covered healthcare services already received.

  • Notice of Enrollment Said meeting and conferring shall not be subject to the impasse procedures in Government Code Section 3557. The Department sponsoring the NEO shall provide the foregoing information no less than five (5) business days prior to the NEO taking place. The Department will make best efforts to notify the Union NEO Coordinator of any last-minute changes. Onboarding of individual employees for administrative purposes is excluded from this notice requirement.

  • Open Enrollment There shall be an open enrollment period each enrollment year during which eligible employees may change plans. The District shall establish and announce the dates of such open enrollment period, and shall mail open enrollment materials to employees fourteen or more days before the beginning of the open enrollment period. If an eligible employee requests a change of plan, he or she shall continue to be covered under his or her existing plan until coverage under the new plan can be instituted.

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