ENROLLMENT GENERALLY Clause Samples

ENROLLMENT GENERALLY. 4.1.1 All Potential Enrollees who live in the Contracting Area shall be required to become Enrollees in a Health Plan, except those Potential Enrollees who, pursuant to federal law or a waiver approved by Federal CMS, are subject only to voluntary enrollment or are part of an excluded population. The ICES shall be responsible for the enrollment of Potential Enrollees, including the provision of all education regarding Health Plan choices, enrollment by active choice, and enrollment by automatic assignment. Contractor shall continue to accept Potential Enrollees for enrollment until the Department determines that any further enrollments would exceed Contractor’s capacity based on a review conducted pursuant to section 4.15. Contractor shall accept each Potential Enrollee whose name appears on the 834 Audit File and 834 Daily File. Enrollment shall be without restriction and shall be in the order in which Potential Enrollees apply or are assigned. Contractor will not discriminate against Potential Enrollees based on health status or need for healthcare services. Contractor shall not participate in facilitating enrollment, including during the Open Enrollment Period. Contractor may educate a Potential Enrollee regarding the specific elements of Contractor, provided that Contractor engages in no Marketing activities prohibited under section 4.17. Contractor shall refer all requests for enrollment to the ICES, which shall not be considered “facilitating enrollment.” Nothing in this Contract shall be deemed to be a guarantee of any Potential Enrollee’s enrollment with Contractor. 4.1.2 For new Enrollees transferring from another MCO, the Department will notify Contractor of the Enrollee’s previous MCO, and Contractor shall request the Enrollee’s IPoC from that MCO. 4.1.3 For past Enrollees who have left Contractor’s Health Plan, Contractor shall provide an Enrollee’s IPoC within ten (10) Business Days after receiving a request for it from the MCO in which the individual is enrolled.

ENROLLMENT GENERALLY. 4.1.1.1 For enrollments of DCFS Youth in Care effective on the Comprehensive Implementation Date, the Department shall assign the DCFS Youth in Care into Contractor’s DCFS Youth Managed Care Specialty Plan. The DCFS Guardianship Administrator will have a ninety (90)-day change period after the Effective Enrollment Date to select another Health Plan as provided in Section 4.10.1. 4.1.1.2 For enrollments of Former Youth in Care effective on the Comprehensive Implementation Date, the Department shall assign the Former Youth in Care to Contractor. The Department will mail the Prospective Enrollee notice of the enrollment assignment at least thirty (30) days prior to the Effective Enrollment Date. The notice will include the provision of all education regarding Health Plan choices, and the ninety (90)-day change period after the Effective Enrollment Date to select another Health Plan as provided in Section 4.10.1. 4.1.1.3 For enrollments of DCFS Youth in Care effective after the Comprehensive Implementation Date, the DCFS Guardianship Administrator shall select a Health Plan for the Prospective Enrollee. The Department will process the Health Plan enrollment received from the DCFS Guardianship Administrator. All Enrollees will have a ninety (90)-day change period after the Effective Enrollment Date to select another Health Plan as provided in Section 4.10.1. All Enrollees will have the opportunity to retain their current Medicaid Providers, including HealthWorks Providers, as long as that Medicaid Provider is within the selected Health Plan’s network. 4.1.1.4 At the time a DCFS Youth in Care Enrollee becomes a Former Youth in Care, the Enrollee will remain enrolled with Contractor. The ICES will mail an enrollment notice to the Enrollee within five (5) Business Days of the Enrollee becoming a Former Youth in Care. The mailed enrollment notice will include the notice of continued Health Plan assignment and the provision of all education regarding Health Plan choices, and the ninety (90)-day change period after the Effective Enrollment Date to select another Health Plan as provided in Section 4.10.1.

ENROLLMENT GENERALLY. Any Potential Enrollee who resides, at the time of Enrollment, in the Contracting Area shall be eligible to become an Enrollee except as described in Article IX, Section 9.12. Enrollment shall be voluntary, except as provided in Article IV, Section 4.1

ENROLLMENT GENERALLY. Any Eligible Enrollee who resides, a the time of Enrollment, in the Contracting Area shall be eligible to become a Beneficiary except as described in Article IX, Section

ENROLLMENT GENERALLY. Any Potential Enrollee who resides, at the time of enrollment, in the Contracting Area shall be eligible to become an Enrollee. Enrollment shall be voluntary. Except as provided herein, enrollment shall be open during the entire period of this Contract until the enrollment limit of the Contractor, as set forth in Attachment I, is reached. The Contractor must continue to accept enrollment until such enrollment limit is reached. Such enrollment shall be without restriction and in the order in which Potential Enrollees apply. The Contractor shall not discriminate against Potential Enrollees on the basis of such individuals' health status or need for health services. Similarly, Contractor will not discriminate against Potential Enrollees on the basis of race, color, or national origin, and will not use any policy or practice that has the effect of discriminating on the basis of race, color, or national origin. The Contractor shall accept each Enrollee whose name appears on the 834 Audit File.

ENROLLMENT GENERALLY. (A) The Contractor shall have a continuous open enrollment period for new Enrollees. Enrollment is open to any qualified Medicaid Eligible Individual who meets the eligibility requirements for enrollment. The Department shall certify, and the Contractor agrees to accept, individuals who are eligible to be enrolled in the Health Plan. Contractor shall accept Enrollees in the order in which they apply. (B) New Enrollees shall be selected based upon the eligibility requirement that the Medicaid Eligible Individual has a development disability that is medically complex with major developmental challenges due to mental illness or behavioral problems. (C) Enrollees may be made retroactively eligible up to 6 months.

ENROLLMENT GENERALLY. For enrollment of the Immigrant Adults and Immigrant Seniors populations on the Implementation Date, the Department shall auto-assign in accordance with Section 4.5.