Health Plan Enrollment Procedures. EOHHS will conduct enrollment activities for eligible individuals under this Agreement. EOHHS will conduct an annual open enrollment. EOHHS will supply the Contractor with a list of members newly enrolled into the Health Plan, as discussed in Section 2.05.04 below. EOHHS will supply the Contractor on a daily basis for RIte Care members and on a monthly basis for Rhody Health Partners and ACA Adult Expansion members, with a list of members newly enrolled into the Health Plan, as discussed in Section 2.05.04 below. The Contractor agrees to accept enrollment information in the data format submitted by EOHHS. The Contractor agrees to have written policies and procedures for enrolling these members effective on the first day of the following month after receiving notification from EOHHS. (e.g., if the Contractor is informed of a new member on December 15th, the Contractor shall enroll the member effective January 1st). Members must be mailed notification of enrollment including effective date and how to access care within ten (10) calendar days after receiving notification from EOHHS of their enrollment. The 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, age, sex, sexual orientation, gender identity, ethnicity, language needs, disability, health status, or need for health services. The only exceptions will be if the member was previously disenrolled from the Health Plan as the result of a grievance filed by the Contractor, as described later in this section. The 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.
Appears in 11 contracts
Samples: Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement
