Common use of Enrollment and PCMP Selection Clause in Contracts

Enrollment and PCMP Selection. 3.1.1.1. The Department will enroll Clients with the Contractor based on the Department’s enrollment and reenrollment procedures. Eligible Clients will be passively enrolled into the ACC Program. Clients are notified of the Department’s intent to enroll them into the program at least thirty (30) days before they are enrolled. The Department’s enrollment broker sends the Client a letter notifying them of the Department’s intent to enroll them into the program and instructions for disenrolling from the ACC Program within the first ninety (90) days of the Client’s enrollment. 3.1.1.2. The Contractor shall accept all Clients, that the Department enrolls, that are eligible for enrollment. The Contractor shall accept individuals eligible for enrollment in the ACC Program in the order in which they are enrolled or apply without restriction. The Department may enroll any Client who is included in any of the eligibility categories shown in Exhibit F, Eligible Member Categories. 3.1.1.3. Each Member shall have the option to select a PCMP to provide comprehensive primary- care to the Member and a majority of all of the Member’s medical care. If a Member has not selected a PCMP prior to the Member’s enrollment, the Contractor shall attempt to contact the Member and assist the Member in selecting a PCMP. The Contractor shall make a minimum of two attempts to contact the Member, using different methods, if needed. The Contractor shall, on at least a quarterly basis, identify and implement strategies to reach Members whose phone or address information is incorrect. Once the Contractor has contacted the Member, it shall provide the Member with contact information for available geographically appropriate PCMPs who are enrolling new Members in the ACC Program and assist the Member in selecting a PCMP. The Contractor may act as a liaison between the Member and any PCMP the Member wishes to select. The Contractor shall document all attempts at contacting Members who have not selected a PCMP and the results of each attempt. The Contractor shall maintain a record of all attempts made to contact a Member. 3.1.1.3.1. The Department shall provide the Contractor with a Member eligibility report and a Member eligibility change report, on a monthly basis. The Member eligibility report shall contain the PCMP selected by each Member in the Contractor’s Region and the applicable demographics for each Member. The Member change report shall show any additions, deletions or changes to the existing PCMP selection records. 3.1.1.3.2. The Contractor shall provide the results of the attempts to contact Members who have not selected a PCMP during the calendar quarter in the Stakeholder Report. The report shall also contain a plan for the following calendar quarter regarding Member contact and how the Contractor will resolve any deficiencies identified during the prior quarter. 3.1.1.4. Members have the option to select PCMP or receive care within a Region other than the one in which they reside. In the event that a Member within Contractor’s Region selects a PCMP or selects to receive care within another RCCO’s Region, the Contractor shall coordinate with the other RCCO to ensure that the Member’s quality, quantity and timeliness of care are not affected by the Member’s choice. 3.1.1.4.1. The Department and Contractor shall work together to implement a report that will alert the Contractor when a Member in the Contractor’s Region selects a PCMP in another Region so that the Contractor may coordinate with that other Region’s RCCO. 3.1.1.5. The Contractor shall coordinate with any other RCCO, in the event that a Member residing within the other RCCO’s Region selects a PCMP or selects to receive care within the Contractor’s Region, to ensure that the Member’s quality, quantity and timeliness of care are not affected by the Member’s choice. 3.1.1.6. The Contractor shall only accept Members who reside within their Region and who reside sufficiently near the office of a PCMP in the Contractor’s network for the Member to reach that PCMP within a reasonable time and using available and affordable modes of transportation. 3.1.1.7. The Contractor shall not discriminate against Members eligible to enroll on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability, and shall not use any policy or practice that has the effect of discriminating on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability. The Contractor shall also not discriminate against Members in enrollment, disenrollment, and re-enrollment on the basis of health status or need for health care services. 3.1.1.8. The Contractor shall not discriminate against individuals eligible to enroll in the ACC Program on the basis of Member health status or need for health care services. 3.1.1.9. The Department will provide the Contractor with the following reports, from of the Colorado interChange and the BIDM, for the Contractor to verify Member eligibility and enrollment:

Enrollment and PCMP Selection. 3.1.1.1. The Department will enroll Clients with the Contractor based on the Department’s enrollment and reenrollment procedures. Eligible Clients will be passively enrolled into the ACC Program. Clients are notified of the Department’s intent to enroll them into the program at least thirty (30) days before they are enrolled. The Department’s enrollment broker sends the Client a letter notifying them of the Department’s intent to enroll them into the program and instructions for disenrolling from the ACC Program within the first ninety (90) days of the Client’s enrollment. 3.1.1.2. The Contractor shall accept all Clients, that the Department enrolls, that are eligible for enrollment. The Contractor shall accept individuals eligible for enrollment in the ACC Program in the order in which they are passively enrolled or apply without restriction. The Department may enroll any Client who is included in any of the eligibility categories shown in Exhibit FD, Eligible Member Categories. 3.1.1.3. Each Member shall have the option to select a PCMP to provide comprehensive primary- care to the Member and a majority of all of the Member’s medical care. If a Member has not selected a PCMP prior to the Member’s enrollment, the Contractor shall attempt to contact the Member and assist the Member in selecting a PCMP. The Contractor shall make a minimum of two attempts to contact the Member, using different methods, if needed. The Contractor shall, on at least a quarterly basis, identify and implement strategies to reach Members whose phone or address information is incorrect. Once the Contractor has contacted the Member, it shall provide the Member with contact information for available geographically appropriate PCMPs who are enrolling new Members in the ACC Program Member’s Region and assist the Member in selecting a PCMP. The Contractor may act as a liaison between the Member and any PCMP the Member wishes to select. The Contractor shall document all attempts at contacting Members who have not selected a PCMP and the results of each attempt. The Contractor shall maintain a record of all attempts made to contact a Member. 3.1.1.3.1. The Department shall provide the Contractor with a Member eligibility report and a Member eligibility change report, on a monthly basis. The Member eligibility report shall contain the PCMP selected by each Member in the Contractor’s Region and the applicable demographics for each Member. The Member change report shall show any additions, deletions or changes to the existing PCMP selection records. 3.1.1.3.2. The Contractor shall provide the results of the attempts to contact Members who have not selected a PCMP during the calendar quarter in the Stakeholder Report. The report shall also contain a plan for the following calendar quarter regarding Member contact and how the Contractor will resolve any deficiencies identified during the prior quarter. 3.1.1.4. Members have the option to select PCMP or receive care within a Region other than the one in which they reside. In the event that a Member within Contractor’s Region selects a PCMP or selects to receive care within another RCCO’s Region, the Contractor shall coordinate with the other RCCO to ensure that the Member’s quality, quantity and timeliness of care are not affected by the Member’s choice. 3.1.1.4.1. The Department and Contractor shall work together to implement a report that will alert the Contractor when a Member in the Contractor’s Region selects a PCMP in another Region so that the Contractor may coordinate with that other Region’s RCCO. 3.1.1.5. The Contractor shall coordinate with any other RCCO, in the event that a Member residing within the other RCCO’s Region selects a PCMP or selects to receive care within the Contractor’s Region, to ensure that the Member’s quality, quantity and timeliness of care are not affected by the Member’s choice. 3.1.1.6. The Contractor shall only accept Members who reside within their Region and who reside sufficiently near the office of a PCMP in the Contractor’s network for the Member to reach that PCMP within a reasonable time and using available and affordable modes of transportation. 3.1.1.7. The Contractor shall not discriminate against Members individuals eligible to enroll in the ACC Program on the basis of race, color, color or national origin, sex, sexual orientation, gender identity, or disability, and shall not use any policy or practice that has the effect of discriminating on the basis of race, color, color or national origin, sex, sexual orientation, gender identity, or disability. The Contractor shall also not discriminate against Members in enrollment, disenrollment, and re-enrollment on the basis of health status or need for health care services. 3.1.1.8. The Contractor shall not discriminate against individuals eligible to enroll in the ACC Program on the basis of Member health status or need for health care services. 3.1.1.9. The Department will provide the Contractor with the following reports, from of the Colorado interChange and the BIDMMMIS Medicaid Management Information System (MMIS), for the Contractor to verify Member eligibility and enrollment:

Enrollment and PCMP Selection. 3.1.1.1. The Department will enroll Clients with the Contractor based on the Department’s enrollment and reenrollment procedures. Eligible Clients will be passively enrolled into the ACC Program. Clients are notified of the Department’s intent to enroll them into the program at least thirty (30) days before they are enrolled. The Department’s enrollment broker sends the Client a letter notifying them of the Department’s intent to enroll them into the program and instructions for disenrolling from the ACC Program within the first ninety (90) days of the Client’s enrollment. 3.1.1.2. The Contractor shall accept all Clients, that the Department enrolls, that are eligible for enrollment. The Contractor shall accept individuals eligible for enrollment in the ACC Program in the order in which they are passively enrolled or apply without restriction. The Department may enroll any Client who is included in any of the eligibility categories shown in Exhibit FD, Eligible Member Categories. 3.1.1.3. Each Member shall have the option to select a PCMP to provide comprehensive primary- care to the Member and a majority of all of the Member’s medical care. If a Member has not selected a PCMP prior to the Member’s enrollment, the Contractor shall attempt to contact the Member and assist the Member in selecting a PCMP. The Contractor shall make a minimum of two attempts to contact the Member, using different methods, if needed. The Contractor shall, on at least a quarterly basis, identify and implement strategies to reach Members whose phone or address information is incorrect. Once the Contractor has contacted the Member, it shall provide the Member with contact information for available geographically appropriate PCMPs who are enrolling new Members in the ACC Program Member’s Region and assist the Member in selecting a PCMP. The Contractor may act as a liaison between the Member and any PCMP the Member wishes to select. The Contractor shall document all attempts at contacting Members who have not selected a PCMP and the results of each attempt. The Contractor shall maintain a record of all attempts made to contact a Member. 3.1.1.3.1. The Department shall provide the Contractor with a Member eligibility report and a Member eligibility change report, on a monthly basis. The Member eligibility report shall contain the PCMP selected by each Member in the Contractor’s Region and the applicable demographics for each Member. The Member change report shall show any additions, deletions or changes to the existing PCMP selection records. 3.1.1.3.2. The Contractor shall provide the results of the attempts to contact Members who have not selected a PCMP during the calendar quarter in the Stakeholder Report. The report shall also contain a plan for the following calendar quarter regarding Member contact and how the Contractor will resolve any deficiencies identified during the prior quarter. 3.1.1.4. Members have the option to select PCMP or receive care within a Region other than the one in which they reside. In the event that a Member within Contractor’s Region selects a PCMP or selects to receive care within another RCCO’s Region, the Contractor shall coordinate with the other RCCO to ensure that the Member’s quality, quantity and timeliness of care are not affected by the Member’s choice. 3.1.1.4.1. The Department and Contractor shall work together to implement a report that will alert the Contractor when a Member in the Contractor’s Region selects a PCMP in another Region so that the Contractor may coordinate with that other Region’s RCCO. 3.1.1.5. The Contractor shall coordinate with any other RCCO, in the event that a Member residing within the other RCCO’s Region selects a PCMP or selects to receive care within the Contractor’s Region, to ensure that the Member’s quality, quantity and timeliness of care are not affected by the Member’s choice. 3.1.1.6. The Contractor shall only accept Members who reside within their Region and who reside sufficiently near the office of a PCMP in the Contractor’s network for the Member to reach that PCMP within a reasonable time and using available and affordable modes of transportation. 3.1.1.7. The Contractor shall not discriminate against Members eligible to enroll on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability, and shall not use any policy or practice that has the effect of discriminating on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability. The Contractor shall also not discriminate against Members in enrollment, disenrollment, and re-enrollment on the basis of health status or need for health care services. 3.1.1.8. The Contractor shall not discriminate against individuals eligible to enroll in the ACC Program on the basis of Member health status or need for health care services. 3.1.1.9. The Department will provide the Contractor with the following reports, from of the Colorado interChange and the BIDM, for the Contractor to verify Member eligibility and enrollment:

Enrollment and PCMP Selection. 3.1.1.1. The Department will enroll Clients with the Contractor based on the Department’s enrollment and reenrollment procedures. Eligible Clients will be passively enrolled into the ACC Program. Clients are notified of the Department’s intent to enroll them into the program at least thirty (30) days before they are enrolled. The Department’s enrollment broker sends the Client a letter notifying them of the Department’s intent to enroll them into the program and instructions for disenrolling from the ACC Program within the first ninety (90) days of the Client’s enrollment. 3.1.1.2. The Contractor shall accept all Clients, that the Department enrolls, that are eligible for enrollment. The Contractor shall accept individuals eligible for enrollment in the ACC Program in the order in which they are passively enrolled or apply without restriction. The Department may enroll any Client who is included in any of the eligibility categories shown in Exhibit F, Eligible Member Categories. 3.1.1.3. Each Member shall have the option to select a PCMP to provide comprehensive primary- care to the Member and a majority of all of the Member’s medical care. If a Member has not selected a PCMP prior to the Member’s enrollment, the Contractor shall attempt to contact the Member and assist the Member in selecting a PCMP. The Contractor shall make a minimum of two attempts to contact the Member, using different methods, if needed. The Contractor shall, on at least a quarterly basis, identify and implement strategies to reach Members whose phone or address information is incorrect. Once the Contractor has contacted the Member, it shall provide the Member with contact information for available geographically appropriate PCMPs who are enrolling new Members in the ACC Program Member’s Region and assist the Member in selecting a PCMP. The Contractor may act as a liaison between the Member and any PCMP the Member wishes to select. The Contractor shall document all attempts at contacting Members who have not selected a PCMP and the results of each attempt. The Contractor shall maintain a record of all attempts made to contact a Member. 3.1.1.3.1. The Department shall provide the Contractor with a Member eligibility report and a Member eligibility change report, on a monthly basis. The Member eligibility report shall contain the PCMP selected by each Member in the Contractor’s Region and the applicable demographics for each Member. The Member change report shall show any additions, deletions or changes to the existing PCMP selection records. 3.1.1.3.2. The Contractor shall provide the results of the attempts to contact Members who have not selected a PCMP during the calendar quarter in the Stakeholder Report. The report shall also contain a plan for the following calendar quarter regarding Member contact and how the Contractor will resolve any deficiencies identified during the prior quarter. 3.1.1.4. Members have the option to select PCMP or receive care within a Region other than the one in which they reside. In the event that a Member within Contractor’s Region selects a PCMP or selects to receive care within another RCCO’s Region, the Contractor shall coordinate with the other RCCO to ensure that the Member’s quality, quantity and timeliness of care are not affected by the Member’s choice. 3.1.1.4.1. The Department and Contractor shall work together to implement a report that will alert the Contractor when a Member in the Contractor’s Region selects a PCMP in another Region so that the Contractor may coordinate with that other Region’s RCCO. 3.1.1.5. The Contractor shall coordinate with any other RCCO, in the event that a Member residing within the other RCCO’s Region selects a PCMP or selects to receive care within the Contractor’s Region, to ensure that the Member’s quality, quantity and timeliness of care are not affected by the Member’s choice. 3.1.1.6. The Contractor shall only accept Members who reside within their Region and who reside sufficiently near the office of a PCMP in the Contractor’s network for the Member to reach that PCMP within a reasonable time and using available and affordable modes of transportation. 3.1.1.7. The Contractor shall not discriminate against Members eligible to enroll on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability, and shall not use any policy or practice that has the effect of discriminating on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability. The Contractor shall also not discriminate against Members in enrollment, disenrollment, and re-enrollment on the basis of health status or need for health care services. 3.1.1.8. The Contractor shall not discriminate against individuals eligible to enroll in the ACC Program on the basis of Member health status or need for health care services. 3.1.1.9. The Department will provide the Contractor with the following reports, from of the Colorado interChange and the BIDM, for the Contractor to verify Member eligibility and enrollment:

Enrollment and PCMP Selection. 3.1.1.1. The Department will enroll Clients with the Contractor based on the Department’s enrollment and reenrollment procedures. Eligible Clients will be passively enrolled into the ACC Program. Clients are notified of the Department’s intent to enroll them into the program at least thirty (30) days before they are enrolled. The Department’s enrollment broker sends the Client a letter notifying them of the Department’s intent to enroll them into the program and instructions for disenrolling from the ACC Program within the first ninety (90) days of the Client’s enrollment. 3.1.1.2. The Contractor shall accept all Clients, that the Department enrolls, that are eligible for enrollment. The Contractor shall accept individuals eligible for enrollment in the ACC Program in the order in which they are enrolled or apply without restriction. The Department may enroll any Client who is included in any of the eligibility categories shown in Exhibit F, Eligible Member Categories. 3.1.1.3. Each Member shall have the option to select a PCMP to provide comprehensive primary- primary-care to the Member and a majority of all of the Member’s medical care. If a Member has not selected a PCMP prior to the Member’s enrollment, the Contractor shall attempt to contact the Member and assist the Member in selecting a PCMP. The Contractor shall make a minimum of two attempts to contact the Member, using different methods, if needed. The Contractor shall, on at least a quarterly basis, identify and implement strategies to reach Members whose phone or address information is incorrect. Once the Contractor has contacted the Member, it shall provide the Member with contact information for available geographically appropriate PCMPs who are enrolling new Members in the ACC Program and assist the Member in selecting a PCMP. The Contractor may act as a liaison between the Member and any PCMP the Member wishes to select. The Contractor shall document all attempts at contacting Members who have not selected a PCMP and the results of each attempt. The Contractor shall maintain a record of all attempts made to contact a Member. 3.1.1.3.1. The Department shall provide the Contractor with a Member eligibility report and a Member eligibility change report, on a monthly basis. The Member eligibility report shall contain the PCMP selected by each Member in the Contractor’s Region and the applicable demographics for each Member. The Member change report shall show any additions, deletions or changes to the existing PCMP selection records. 3.1.1.3.2. The Contractor shall provide the results of the attempts to contact Members who have not selected a PCMP during the calendar quarter in the Stakeholder Report. The report shall also contain a plan for the following calendar quarter regarding Member contact and how the Contractor will resolve any deficiencies identified during the prior quarter. 3.1.1.4. Members have the option to select PCMP or receive care within a Region other than the one in which they reside. In the event that a Member within Contractor’s Region selects a PCMP or selects to receive care within another RCCO’s Region, the Contractor shall coordinate with the other RCCO to ensure that the Member’s quality, quantity and timeliness of care are not affected by the Member’s choice. 3.1.1.4.1. The Department and Contractor shall work together to implement a report that will alert the Contractor when a Member in the Contractor’s Region selects a PCMP in another Region so that the Contractor may coordinate with that other Region’s RCCO. 3.1.1.5. The Contractor shall coordinate with any other RCCO, in the event that a Member residing within the other RCCO’s Region selects a PCMP or selects to receive care within the Contractor’s Region, to ensure that the Member’s quality, quantity and timeliness of care are not affected by the Member’s choice. 3.1.1.6. The Contractor shall only accept Members who reside within their Region and who reside sufficiently near the office of a PCMP in the Contractor’s network for the Member to reach that PCMP within a reasonable time and using available and affordable modes of transportation. 3.1.1.7. The Contractor shall not discriminate against Members eligible to enroll on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability, and shall not use any policy or practice that has the effect of discriminating on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability. The Contractor shall also not discriminate against Members in enrollment, disenrollment, and re-enrollment on the basis of health status or need for health care services. 3.1.1.8. The Contractor shall not discriminate against individuals eligible to enroll in the ACC Program on the basis of Member health status or need for health care services. 3.1.1.9. The Department will provide the Contractor with the following reports, from of the Colorado interChange and the BIDM, for the Contractor to verify Member eligibility and enrollment: