Enrollment Levels. The Agency assigns the Health Plan an authorized maximum Enrollment level for each operational county. The authorized maximum Enrollment level is in effect on September 1, 2006, or upon Contract execution, whichever is later.
a. The Agency must approve, in writing, any increase in the Health Plan’s maximum Enrollment level for each operational county and subpopulation to be served, as applicable. Such approval shall not be unreasonably withheld, and shall be based upon the Health Plan’s satisfactory performance of terms of the Contract and upon the Agency’s approval of the Health Plan’s administrative and service resources, as specified in this Contract, in support of each Enrollment level.
b. Exhibit I, Table 1, attached hereto, indicates the Health Plan’s maximum authorized Enrollment levels for each Medicaid Reform county and each applicable authorized eligibility category.
Enrollment Levels. The Contractor shall accept all Members, regardless of overall plan enrollment. Enrollment shall be without restriction and shall be in the order in which potential Members apply or are assigned. The Contractor shall maintain staffing and service delivery network necessary to adhere to minimum standards for Covered Services. Members may voluntarily choose a Contractor. Members who do not select a Contractor will be auto-assigned to a Contractor by the Department. The Department reserves the right to re-evaluate and modify the auto-assignment algorithm anytime for any reason, provided however, the Department shall provide written notice to Contractor of any modification of the auto-assignment algorithm before the implementation of such modification. The Department may develop specific limitations regarding Member enrollment with the Contractor to take into consideration quality, cost, competition and adverse selection.
Enrollment Levels. The HMO, for BadgerCare Plus or Medicaid SSI, must designate a maximum enrollment level for each service area. The Department may take up to 60 days from the date of written notification to implement maximum enrollment level changes. The HMO must accept as enrolled all persons who appear as members on the HMO Enrollment Rosters up to the HMO specified enrollment level for its service area. The number of members may exceed the maximum enrollment level by 5% on a temporary basis. The Department does not guarantee any minimum enrollment level. The maximum enrollment level for a service area may be increased or decreased during the course of the Contract period based on mutual acceptance of a different maximum enrollment level. The HMO must not obtain enrollment through the offer of any compensation, reward, or benefit to the member except for additional health-related services that have been approved by the Department.
Enrollment Levels. The Contractor shall maintain a caseload of no less than 95 percent and no more than 105 percent of the specified number of participant slots for the term of contract (12 months). This is a performance requirement to ensure compliance with the terms and conditions of this Agreement and Waiver requirements. If the Contractor’s active participant count falls below ninety-five percent (95%) of the number of budgeted participant slots for more than three (3) consecutive months, the Contractor shall be required to submit an enrollment plan for review, approval, and monitoring by CDA.
Enrollment Levels. The Health Plan is assigned an authorized maximum Enrollment level for each operational county. The authorized maximum Enrollment level is in effect on September 1, 2006, or upon Contract execution, whichever is later.
1. The Agency must approve in writing any increase in the Health Plan’s maximum Enrollment level for each operational county and subpopulation to be served, as applicable. Such approval shall not be unreasonably withheld, and shall be based on the Health Plan’s satisfactory performance of terms of the Contract and approval of the Health Plan’s administrative and service resources, as specified in this Contract, in support of each Enrollment level
2. Authorized Enrollment Levels in Attachment I indicate the Health Plan’s maximum authorized Enrollment levels for each Medicaid Reform county and each applicable authorized eligibility category.
Enrollment Levels a. The Agency does not guarantee that the Managed Care Plan will receive any particular enrollment level.
Enrollment Levels. The PIHP must designate a maximum enrollment level for its entire service area. The Department may take up to 60 days from the date of written notification to implement maximum enrollment level changes. The PIHP must accept as enrolled all persons who appear as members on the PIHP Enrollment Rosters up to the PIHP specified enrollment level for its service area. The number of members may exceed the maximum enrollment level by 5% on a temporary basis. The Department does not guarantee any minimum enrollment level. The maximum enrollment level for the service area may be increased or decreased during the course of the Contract period based on mutual acceptance of a different maximum enrollment level. The PIHP must not obtain enrollment through the offer of any compensation, reward, or benefit to the member except for additional health-related services that have been approved by the Department. Effective January 1, 2023 maximum enrollment levels will be eliminated and the PIHP will be required to serve all eligible members who choose to enrollwith the PIHP.
Enrollment Levels. As specified in Article XVI and Addendum X of this Contract, the HMO must designate its maximum enrollment level for its entire service area. The Department may take up to 60 days from the date of written notification to implement maximum enrollment level changes. The HMO must accept as enrolled all persons who appear as enrollees on the HMO Enrollment Reports and newborns up to the HMO specified enrollment level for its service area. The number of enrollees may exceed the maximum enrollment level by 5% on a temporary basis. The Department does not guarantee any minimum enrollment level. The maximum enrollment level for a service area may be increased or decreased during the course of the contract period based on mutual acceptance of a different maximum enrollment level.
Enrollment Levels. The PDHP is assigned maximum enrollment levels for the operational area(s) indicated in Section 90.0, Payment and Maximum Authorized Enrollment Levels, of this contract. The number of Medicaid beneficiaries enrolled in the PDHP may not exceed the maximum authorized enrollment level for Miami-Dade County. Medicaid uses the generally accepted ratio of one FTE primary care dentist per 1,500 patients (includes Medicaid, commercial, and fee-for-service). General dentistry practitioners and pediatric dentists are considered primary care dentists. The cost of care for any Medicaid beneficiaries enrolled over the maximum level per county is a liability for the PDHP and shall not be charged to the Agency or the enrolled beneficiary. The PDHP shall notify the Agency when enrollment has reached the maximum number authorized and request an increased enrollment level.
Enrollment Levels. The HMO, for BadgerCare Plus or Medicaid SSI, must designate a maximum enrollment level for each service area. The Department may take up to 60 days from the date of written notification to implement maximum enrollment level changes. The HMO must accept as enrolled all persons who appear as members on the HMO Enrollment Rosters up to the HMO specified enrollment level for its service area. The number of members may exceed the maximum enrollment level by 5% on a temporary basis. The maximum enrollment level for a service area may be increased or decreased during the course of the Contract period based on mutual acceptance of a different maximum enrollment level. The HMO must not obtain enrollment through the offer of any compensation, reward, or benefit to the member except for additional health-related services that have been approved by the Department. The Department does not guarantee and minimum enrollment level. Effective January 1, 2023 maximum enrollment levels will be eliminated and the HMO will be required to serve all eligible members who choose to enroll, or who are automatically enrolled, with the HMO.
