Common use of Enrollment of Program Newborns Clause in Contracts

Enrollment of Program Newborns. The MCO must have written policies and procedures for enrolling newborn children of Medicaid members retroactively effective to the time of birth. These enrollment procedures must include transfer of newborn information to both BMS and the enrollment broker and must provide for processing completion within thirty (30) days of the date of birth. Newborns of program-eligible mothers who are enrolled at the time of the child’s birth will be enrolled in the mother’s MCO. The MCO is responsible for all Medically Necessary covered services provided under the standard benefit package to the newborn child or an enrolled mother for the first sixty (60) to ninety (90) days of life based upon the cut-off date for MCO enrollment with the enrollment broker. The child’s date of birth will be counted as day one. BMS will pay a full month’s capitation for all newborns. The MCO will receive capitation payments for all subsequent months that the child remains enrolled with the MCO. The MCO must submit newborn enrollment forms to the enrollment broker within sixty (60) days of the date of delivery or as soon thereafter as the MCO becomes aware of the delivery. Enrollment of Persons with Other Primary Coverage For enrollees with other primary coverage, the MCO must assume responsibility for Medicaid covered services that are not provided by the primary carrier. The MCO will defer utilization management decisions to the primary carrier, except for those Medicaid services and benefits that are carved out of the primary carrier’s benefits package, which are the sole responsibility of the MCO.

Enrollment of Program Newborns. The MCO must have written policies and procedures for enrolling newborn children of Medicaid members retroactively effective to the time of birth. These enrollment procedures must include transfer of newborn information to both BMS and the enrollment broker and must provide for processing completion within thirty (30) 30 days of the date of birth. Newborns of program-program- eligible mothers who are enrolled at the time of the child’s birth will be enrolled in the mother’s MCO. The MCO is responsible for all Medically Necessary covered medically necessary services provided under the standard benefit package to the newborn child or an enrolled mother for the first sixty (60) 60 to ninety (90) 90 days of life based upon the cut-off date for MCO enrollment with the enrollment broker. The child’s date of birth will be counted as day one. BMS will pay a full month’s capitation for all newborns. The MCO will receive capitation payments for all subsequent months that the child remains enrolled with the MCO. The MCO must submit newborn enrollment forms to the enrollment broker within sixty (60) 60 days of the date of delivery or as soon thereafter as the MCO becomes aware of the delivery. Enrollment of Persons with Other Primary Coverage For enrollees with other primary coverage, the MCO must assume responsibility for Medicaid covered services that are not provided by the primary carrier. The MCO will defer utilization management decisions to the primary carrier, except for those Medicaid services and benefits that are carved out of the primary carrier’s benefits package, which are the sole responsibility of the MCO.

Enrollment of Program Newborns. The MCO must have written policies and procedures for enrolling newborn children of Medicaid members retroactively effective to the time of birth. These enrollment procedures must include transfer of newborn information to both BMS and the enrollment broker and must provide for processing completion within thirty (30) 30 days of the date of birth. Newborns of program-program- eligible mothers who are enrolled at the time of the child’s birth will be enrolled in the mother’s MCO. The MCO is responsible for all Medically Necessary covered services provided under the standard benefit package to the newborn child or an enrolled mother for the first sixty (60) 60 to ninety (90) 90 days of life based upon the cut-off date for MCO enrollment with the enrollment broker. The child’s date of birth will be counted as day one. BMS will pay a full month’s capitation for all newborns. The MCO will receive capitation payments for all subsequent months that the child remains enrolled with the MCO. The MCO must submit newborn enrollment forms to the enrollment broker within sixty (60) 60 days of the date of delivery or as soon thereafter as the MCO becomes aware of the delivery. Enrollment of Persons with Other Primary Coverage For enrollees with other primary coverage, the MCO must assume responsibility for Medicaid covered services that are not provided by the primary carrier. The MCO will defer utilization management decisions to the primary carrier, except for those Medicaid services and benefits that are carved out of the primary carrier’s benefits package, which are the sole responsibility of the MCO.