ENROLLMENT BY AUTOMATIC ASSIGNMENT Sample Clauses

ENROLLMENT BY AUTOMATIC ASSIGNMENT. A Potential Enrollee who is subject to mandatory enrollment and who does not select a MCO will be automatically assigned to a qualified MCO by the ICES. To be a qualified MCO, Contractor cannot be subject to the intermediate sanction described in 42 CFR 438.702(a)(4), and must have the capacity to enroll Prospective Enrollees. On a daily basis, the ICES will inform Contractor of Prospective Enrollees who have been enrolled with Contractor by automatic assignment and the PCPs to whom they were assigned. The Department and the ICES will design and shall implement an algorithm for enrollment by automatic assignment. Any algorithm will attempt, to the extent possible, to maintain an existing relationship between an Enrollee and a PCP as set forth in 42 CFR 438.54(c)(6). The Department shall provide Contractor with a description of the algorithm for enrollment by automatic assignment of Enrollees and of the algorithm for assignment of Enrollees to PCPs. 4.5.1 The Department reserves the right to re‐evaluate and modify the algorithm for enrollment by automatic assignment at any time for any reason during the term of this Contract, and may provide that enrollment by automatic assignment will be based on Contractor’s performance on quality measures. The Department shall provide written notice to Contractor at least sixty (60) days before implementation of any significant modification, as determined by the Department, of the algorithm for enrollment by automatic assignment. 4.5.2 The Department reserves the right to develop an algorithm for Enrollee PCP assignment, when no active choice made by an Enrollee, that may be based upon PCPs’ performance measures and metrics as determined by the Department. The Department shall provide written notice to Contractor at least sixty (60) days before implementation of any significant modification, as determined by the Department, of the algorithm for Enrollee PCP assignment.