Enrollment and Disenrollment Processes Sample Clauses

Enrollment and Disenrollment Processes. Under passive enrollment, eligible individuals will be notified of their right to select among contracted Participating Plans no fewer than sixty (60) days prior to the effective date of enrollment, and will have the opportunity to opt out until the last day of the month prior to the effective date of enrollment. When no active choice has been made, 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 DMAS will monitor enrollments and disenrollments for both evaluation purposes and for compliance with applicable marketing and enrollment laws, regulations and CMS policies, for the purposes of identifying any inappropriate or illegal marketing practices. As part of this analysis, CMS and DMAS will monitor any unusual shifts in enrollment by individuals identified for passive enrollment into a particular Participating 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 DMAS may issue corrective action. 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 DMAS will utilize an independent third party entity to facilitate all enrollments into the Participating Plans. Participating Plan enrollments, transfers, and opt-outs shall become effective on the same day for both Medicare and Medicaid (the first day of the following 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.
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.
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
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 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. i. Integrated enrollment system: a. Currently the State serves as a third-party administrator (TPA) for some MSHO Plans to facilitate coordinated enrollment. This mechanism will be maintained, and enhanced, as necessary. b. Uniform Enrollment and Disenrollment Letters and Forms - Beneficiaries will enroll and disenroll from Medicare and Medicaid managed care simultaneously through an integrated form, notices, and process. The State will test new, simplified language on enrollment forms and notices, subject to CMS approval. ii. Accuracy of the Enrollment Process: a. Data in State and CMS systems will be reconciled on a timely basis to prevent discrepancies between the systems. For example, for the purpose of sending forms and notices, the Demonstration will use updated State mailing addresses where the State addresses are more likely to be more accurate than the addresses from CMS. b. Enrollment Effective Date(s) – D-SNPs are typically required to submit beneficiary enrollment requests to CMS within 7 days of verification. However, MSHO SNPs are currently exempted from requirements related to timely reporting of enrollments to allow time for Medicaid enrollments to be verified and finalized. In the demonstration, they will continue to be exempt from 7 day timeliness reporting requirements. This process allows for the completion of the Medicaid eligibility process prior to enrollment in the plan and enables the MSHO Plans and the State to promote overall integration of the enrollment process.
Enrollment and Disenrollment Processes. MMPs will begin to accept opt-in enrollments among those individuals eligible for the ICI Demonstration no sooner than September 1, 2015 for coverage starting no sooner than December 1, 2015. Enrollment requests received through the 10th day of the month will take effect on the first day of the following calendar month. Enrollment requests received on the 11th day of the month or later will take effect on the first day of the second month after the request was submitted.
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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.
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. a. Eligible community-based LTSS individuals will be informed no earlier than April 1, 2014 of the opportunity to opt into a FIDA Plan for coverage starting no earlier than July 1, 2014. Beginning no earlier than July 1 2014, eligible community-based LTSS individuals will be notified of the State’s plan for passive enrollment, which would begin no earlier than September 1, 2014. Specifically, they will be notified of their right to select among contracted FIDA Plans no fewer than sixty (60) days prior to their assigned effective date of enrollment and will have the opportunity to opt out until the last day of the month prior to the effective date of enrollment. When an eligible individual has not made an active choice, his/her enrollment into a FIDA Plan will be conducted using a seamless, passive enrollment process that provides the opportunity for Participants to opt out or disenroll from the FIDA 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. b. Eligible facility-based LTSS individuals will be informed no earlier than July1, 2014 of the opportunity to opt into a FIDA Plan for coverage starting October 1, 2014. Beginning in October 2014, eligible facility-based LTSS individuals will be notified of the State’s plan for passive enrollment, which would begin no earlier than January 1, 2015. Specifically, they will be notified of their right to select among contracted FIDA Plans no fewer than sixty (60) days prior to their assigned effective date of enrollment and will have the opportunity to opt out until the last day of the month prior to the effective date of enrollment. When an eligible individual has not made an active choice, his/her enrollment into an FIDA Plan will be conducted using a seamless, passive enrollment process that provides the opportunity for Participants to opt into or disenroll from the FIDA 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 detaile...
Enrollment and Disenrollment Processes. The State will open enrollment to the eligible population no earlier than April 1, 2016. Eligible individuals will be informed no earlier than March 1, 2016 of the opportunity to opt into the FIDA-IDD Plan for coverage starting no earlier than April 1, 2016. There is no passive enrollment for the FIDA-IDD Demonstration.
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