Enrollment Procedures. The State will conduct enrollment activities for eligible individuals under this agreement. All eligible children and/or young adults will be enrolled in the RIte Smiles program by the State. The State will supply the Contractor monthly with a list of members newly enrolled into the Dental Plan, as discussed in Section 2.5.D below. Contractor agrees to accept enrollment information in the data format submitted by the State. Contractor agrees to have written policies and procedures for enrolling newly enrolled members effective on the first (1st) day of the following month after receiving notification from the State. Members must be mailed notification of enrollment including effective date and how to access care within ten (10) days after receiving notification from the State of their enrollment. Contractor agrees to enroll, in the order in which he or she applies or is assigned, any eligible beneficiary who selects it or is assigned to it, regardless of the beneficiary’s race, color, national origin, sex, sexual orientation, gender identity, disability, age, ethnicity, language needs, health status, or need for health services. Contractor agrees to have written policies and procedures for enrolling members, which specifically address the requirements for these members as set forth in this Agreement. The State will, at times mutually agreed upon by the State and the Contractor (such approval not to be unreasonably withheld), conduct an open enrollment process for existing Rite Smiles members. Each member will be given the choice of the Rite Smiles program participating dental plans. Siblings within a family unit will be required to participate in the same dental plan, unless there is a compelling reason as determined by the State. Members who are so auto-assigned will be allowed to choose a different dental plan within the first ninety (90) days of being assigned to the plan, pursuant to the terms as outlined in Section 2.4.J. Enrollment shall be assigned to the Contractor following the effective date upon reasonable determination of the Contractors readiness. The State may institute a Market Share cap as outlined in section 2.4.M of this Agreement. The Contractor shall not use any policy or practice that has the effect of discriminating against individuals eligible to enroll on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability.
Appears in 4 contracts
Samples: Medicaid Program Agreement, Medicaid Rite Smiles Program Agreement, Agreement for the Medicaid Rite Smiles Program
