Common use of Enrollment Exclusions Clause in Contracts

Enrollment Exclusions. ‌ The following populations, both SNBC SNP and non-SNP, are excluded from enrollment in the MCO under the SNBC program [Minnesota Statutes, §256B.69, subd. 4; Minnesota Rules, Part 9500.1452]: 3.1.4.1 Beneficiaries eligible for the Refugee Assistance Program pursuant to 8 USC §1522(e). 3.1.4.2 Persons up to eighteen (18) years of age, or sixty-five (65) years of age and over. Enrollees who turn sixty-five (65) will no longer remain enrolled in SNBC. 3.1.4.3 Beneficiaries who are residents of state regional treatment centers or a state-owned long term care facility. 3.1.4.4 Beneficiaries who are eligible while receiving care and services from a non-profit center established to serve victims of torture. 3.1.4.5 Beneficiaries eligible for the emergency Medical Assistance program. 3.1.4.6 Non-citizen Beneficiaries who only receive emergency medical assistance under Minnesota Statutes, §256B.06, subd. 4. 3.1.4.7 Women receiving Medical Assistance through the Breast and Cervical Cancer Control Program. 3.1.4.8 Persons eligible for the Minnesota Family Planning Program (MFPP) in accordance with Minnesota Statutes, §256B.78. 3.1.4.9 Beneficiaries, who at the time of notification of enrollment in managed care, have a communicable disease whose prognosis is terminal and whose primary physician is not a Network Provider in the MCO, and that physician certifies that disruption of the existing physician-patient relationship is likely to result in the patient becoming noncompliant with medication or other health services. 3.1.4.10 Beneficiaries who are terminally ill as defined in Minnesota Rules, Part 9505.0297, subpart 2, item N (hospice) and who, at the time enrollment in SNBC would occur, have an established relationship with a primary physician who is not a Network Provider in the SNBC MCO. 3.1.4.11 Beneficiaries with private health care coverage through a HMO certified under Minnesota Statutes, Chapter 62D, not including Medicare Supplements. 3.1.4.12 Beneficiaries with cost effective employer-sponsored private health care coverage, or who are enrolled in a non-Medicare individual health plan determined to be cost-effective according to Minnesota Statutes, §256B.69, subd. 4 (b)(9). 3.1.4.13 Enrollees who are absent from Minnesota for more than thirty (30) consecutive days but who are still deemed a resident of Minnesota by the STATE. Covered services for these Enrollees are paid by FFS. 3.1.4.14 Individuals who are Qualified Medicare Beneficiaries (QMB), as defined in §1905(p) of the SSA, 42 USC §1396d(p), and who are not otherwise eligible for Medical Assistance. 3.1.4.15 Individuals who are Specified Low-Income Medicare Beneficiaries (SLMB), as defined in §1905(p) of the SSA, 42 USC §1396a(a)(10)(E)(iii) and §1396d(p), and who are not otherwise eligible for Medical Assistance. 3.1.4.16 Persons who are eligible for Medicare Part A only, or Medicare Part B only. 3.1.4.17 Incarcerated persons; see section 6.7.1.7.

Enrollment Exclusions. ‌ The following populations, both SNBC SNP and non-SNP, are excluded from enrollment in the MCO under the SNBC program [Minnesota Statutes, §256B.69, subd. 4; Minnesota Rules, Part 9500.1452]: 3.1.4.1 Beneficiaries eligible for the Refugee Assistance Program pursuant to 8 USC §1522(e). 3.1.4.2 Persons up to eighteen (18) years of age, or sixty-five (65) years of age and over. Enrollees who turn sixty-five (65) will no longer remain enrolled in SNBC. 3.1.4.3 Beneficiaries who are residents of state regional treatment centers or a state-owned long term care facility. 3.1.4.4 Beneficiaries who are eligible while receiving care and services from a non-profit center established to serve victims of torture. 3.1.4.5 Beneficiaries eligible for the emergency Medical Assistance program. 3.1.4.6 Non-citizen Beneficiaries who only receive emergency medical assistance under Minnesota Statutes, §256B.06, subd. 4. 3.1.4.7 Women receiving Medical Assistance through the Breast and Cervical Cancer Control Program. 3.1.4.8 Persons eligible for the Minnesota Family Planning Program (MFPP) in accordance with Minnesota Statutes, §256B.78. 3.1.4.9 Beneficiaries, who at the time of notification of enrollment in managed care, have a communicable disease whose prognosis is terminal and whose primary physician is not a Network Provider in the MCO, and that physician certifies that disruption of the existing physician-patient relationship is likely to result in the patient becoming noncompliant with medication or other health services. 3.1.4.10 Beneficiaries who are terminally ill as defined in Minnesota Rules, Part 9505.0297, subpart 2, item N (hospice) and who, at the time enrollment in SNBC would occur, have an established relationship with a primary physician who is not a Network Provider in the SNBC MCO. 3.1.4.11 Beneficiaries with private health care coverage through a HMO certified under Minnesota Statutes, Chapter 62D, not including Medicare Supplements.Supplements.‌ 3.1.4.12 Beneficiaries with cost effective employer-sponsored private health care coverage, or who are enrolled in a non-Medicare individual health plan determined to be cost-effective according to Minnesota Statutes, §256B.69, subd. 4 (b)(9). 3.1.4.13 Enrollees who are absent from Minnesota for more than thirty (30) consecutive days but who are still deemed a resident of Minnesota by the STATE. Covered services for these Enrollees are paid by FFS. 3.1.4.14 Individuals who are Qualified Medicare Beneficiaries (QMB), as defined in §1905(p) of the SSA, 42 USC §1396d(p), and who are not otherwise eligible for Medical Assistance. 3.1.4.15 Individuals who are Specified Low-Income Medicare Beneficiaries (SLMB), as defined in §1905(p) of the SSA, 42 USC §1396a(a)(10)(E)(iii) and §1396d(p), and who are not otherwise eligible for Medical Assistance. 3.1.4.16 Persons who are eligible for Medicare Part A only, or Medicare Part B only. 3.1.4.17 Incarcerated persons; see section 6.7.1.7Persons participating in the Navigator Pilot in Minnesota Statutes, §254B.13, if applicable.

Enrollment Exclusions. ‌ The following populations, both SNBC SNP and non-SNP, are excluded from enrollment in the MCO under the SNBC program [Minnesota Statutes, §256B.69, subd. 4; Minnesota Rules, Part 9500.1452]: 3.1.4.1 Beneficiaries eligible for the Refugee Assistance Program pursuant to 8 USC §1522(e). 3.1.4.2 Persons up to eighteen (18) years of age, or sixty-five (65) years of age and over. Enrollees who turn sixty-five (65) will no longer remain enrolled in SNBC. 3.1.4.3 Beneficiaries who are residents of state regional treatment centers or a state-owned long term care facility. 3.1.4.4 Beneficiaries who are eligible while receiving care and services from a non-profit center established to serve victims of torture. 3.1.4.5 Beneficiaries eligible for the emergency Medical Assistance program. 3.1.4.6 Non-citizen Beneficiaries who only receive emergency medical assistance under Minnesota Statutes, §256B.06, subd. 4. 3.1.4.7 Women receiving Medical Assistance through the Breast and Cervical Cancer Control Program. 3.1.4.8 Persons eligible for the Minnesota Family Planning Program (MFPP) in accordance with Minnesota Statutes, §256B.78. 3.1.4.9 Beneficiaries, who at the time of notification of enrollment in managed care, have a communicable disease whose prognosis is terminal and whose primary physician is not a Network Provider in the MCO, and that physician certifies that disruption of the existing physician-patient relationship is likely to result in the patient becoming noncompliant with medication or other health services. 3.1.4.10 Beneficiaries who are terminally ill as defined in Minnesota Rules, Part 9505.0297, subpart 2, item N (hospice) and who, at the time enrollment in SNBC would occur, have an established relationship with a primary physician who is not a Network Provider in the SNBC MCO. 3.1.4.11 Beneficiaries with private health care coverage through a HMO certified under Minnesota Statutes, Chapter 62D, not including Medicare Supplements.Supplements.‌‌ 3.1.4.12 Beneficiaries with cost effective employer-sponsored private health care coverage, or who are enrolled in a non-Medicare individual health plan determined to be cost-effective according to Minnesota Statutes, §256B.69, subd. 4 (b)(9). 3.1.4.13 Enrollees who are absent from Minnesota for more than thirty (30) consecutive days but who are still deemed a resident of Minnesota by the STATE. Covered services for these Enrollees are paid by FFS. 3.1.4.14 Individuals who are Qualified Medicare Beneficiaries (QMB), as defined in §1905(p) of the SSA, 42 USC §1396d(p), and who are not otherwise eligible for Medical Assistance. 3.1.4.15 Individuals who are Specified Low-Income Medicare Beneficiaries (SLMB), as defined in §1905(p) of the SSA, 42 USC §1396a(a)(10)(E)(iii) and §1396d(p), and who are not otherwise eligible for Medical Assistance. 3.1.4.16 Persons who are eligible for Medicare Part A only, or Medicare Part B only. 3.1.4.17 Incarcerated persons; see section 6.7.1.7Persons participating in the Navigator Pilot in Minnesota Statutes, §254B.13, if applicable.