ENROLLMENT BY AUTOMATIC ASSIGNMENT. A Potential Enrollee who is subject to mandatory enrollment and who does not select an MCO will be enrolled by automatic assignment 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 implement an algorithm for enrollment by automatic assignment. The algorithm will consider existing PCP relationships based on 42 CFR 438.54(d)(7), residence, family member assignments, geography, and cost. In no event will assignments or enrollments exceed the capacity of an MCO. The Department shall provide Contractor with a description of the algorithm for enrollment by automatic assignment of Enrollees.
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.
ENROLLMENT BY AUTOMATIC ASSIGNMENT. A Potential Enrollee who is subject to mandatory enrollment and who does not select an MCO will be automatically assignedenrolled by automatic assignment 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 implement an algorithm for enrollment by automatic assignment. The algorithm will consider existing PCP relationships based on 42 CFR 438.54(d)(7), residence, family member assignments, geography, and cost. In no event will assignments or enrollments exceed the capacity of an MCO. The Department shall provide Contractor with a description of the algorithm for enrollment by automatic assignment of Enrollees. The Department reserves the right to reevaluate 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 the algorithm considerations include Contractor’s performance on quality measures, operational performance, and other measures relevant to program effectiveness. 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.
ENROLLMENT BY AUTOMATIC ASSIGNMENT. Contractor, to be a qualified MCO, cannot be subject to the intermediate sanction described in 42 CFR 438.702(a)(4), and must have the capacity to enroll Prospective Enrollees. In no event will assignments or enrollments exceed the capacity of an MCO.
