Common use of Maximum Enrollment Clause in Contracts

Maximum Enrollment. ‌ 2.4.3.1 The CONTRACTOR agrees to accept enrollment in the CONTRACTOR’s MCO of up to fifty percent (50%) of the eligible population in the applicable Grand Region. TENNCARE shall determine and notify the CONTRACTOR of the number of eligibles in the applicable Grand Region and the CONTRACTOR’s maximum enrollment limit, which shall be approximately fifty percent (50%) of the eligible population in the applicable Grand Region. 2.4.3.1.1 If TENNCARE determines an MCO (hereafter called an Underperforming MCO), other than the CONTRACTOR, is not adequately serving one or more Grand Regions and determines the CONTRACTOR has adequate capacity and it is necessary to transfer additional enrollment from the Underperforming MCO into the CONTRACTOR’s plan, the CONTRACTOR agrees to accept enrollment of up to seventy percent (70%) of the eligible population in the applicable Grand Region. 2.4.3.2 TENNCARE may establish an enrollment threshold for the CONTRACTOR at a percentage of the CONTRACTOR’s maximum enrollment limit and may limit enrollee assignment in certain circumstances in order to remain within the threshold. This enrollment threshold may be adjusted by TENNCARE at its discretion. 2.4.3.3 Once the CONTRACTOR’s enrollment threshold is met, TENNCARE may discontinue default assignment of enrollees to the CONTRACTOR’s MCO. Enrollees who select the CONTRACTOR or whose family members are enrolled in the CONTRACTOR’s MCO shall continue to be enrolled in the CONTRACTOR’s MCO until the maximum enrollment limit established in Section A.2.4.3.1 above is met. 2.4.3.4 Both TENNCARE and the CONTRACTOR recognize that management of the CONTRACTOR’s maximum enrollment limit and enrollment threshold within exact limits may not be possible. In the event enrollment in the CONTRACTOR’s MCO exceeds the maximum enrollment limit, TENNCARE may reduce enrollment in the CONTRACTOR’s MCO based on a plan established by TENNCARE that provides appropriate notice to the CONTRACTOR, allows appropriate choice of MCOs for enrollees, and meets the objectives of the TennCare program. 2.4.3.5 The establishment of a maximum enrollment limit and/or of an enrollment threshold does not obligate the State to enroll a certain number of TennCare enrollees in the CONTRACTOR’s MCO and does not create in the CONTRACTOR any rights, interests or claims of entitlement to enrollment. The CONTRACTOR’s actual enrollment level will be determined through the MCO selection and assignment process described in Section A.2.4.4 below. 2.4.3.6 Upon the request of TENNCARE, the CONTRACTOR shall demonstrate to the satisfaction of TENNCARE it has the capacity to serve the number of enrollees in the maximum enrollment limit.

Maximum Enrollment. ‌ 2.4.3.1 The CONTRACTOR agrees to accept enrollment in the CONTRACTOR’s MCO of up to fifty seventy percent (5070%) of the eligible population in the applicable Grand Region. TENNCARE shall determine and notify the CONTRACTOR of the number of eligibles in the applicable Grand Region and the CONTRACTOR’s maximum enrollment limit, which shall be approximately fifty percent (50%) of the eligible population in the applicable Grand Region. 2.4.3.1.1 If TENNCARE determines an MCO (hereafter called an Underperforming MCO), other than the CONTRACTOR, is not adequately serving one or more Grand Regions and determines the CONTRACTOR has adequate capacity and it is necessary to transfer additional enrollment from the Underperforming MCO into the CONTRACTOR’s plan, the CONTRACTOR agrees to accept enrollment of up to seventy percent (70%) of the eligible population in the applicable Grand Region. 2.4.3.2 TENNCARE may shall establish an enrollment threshold for the CONTRACTOR at a percentage that will equal approximately ninety percent (90%) of the CONTRACTOR’s maximum enrollment limit and may limit enrollee assignment established in certain circumstances in order to remain within the thresholdSection 2.4.3.1 above. This enrollment threshold may be adjusted by TENNCARE at its discretion. 2.4.3.3 Once the CONTRACTOR’s enrollment threshold is met, TENNCARE may discontinue default assignment of enrollees to the CONTRACTOR’s MCO. Enrollees who select the CONTRACTOR or whose family members are enrolled in the CONTRACTOR’s MCO shall continue to be enrolled in the CONTRACTOR’s MCO until the maximum enrollment limit established in Section A.2.4.3.1 2.4.3.1 above is met. 2.4.3.4 Both TENNCARE and the CONTRACTOR recognize that management of the CONTRACTOR’s maximum enrollment limit and enrollment threshold within exact limits may not be possible. In the event enrollment in the CONTRACTOR’s MCO exceeds the maximum enrollment limit, TENNCARE may reduce enrollment in the CONTRACTOR’s MCO based on a plan established by TENNCARE that provides appropriate notice to the CONTRACTOR, allows appropriate choice of MCOs for enrollees, and meets the objectives of the TennCare program. 2.4.3.5 The establishment of a maximum enrollment limit and/or of an enrollment threshold does not obligate the State to enroll a certain number of TennCare enrollees in the CONTRACTOR’s MCO and does not create in the CONTRACTOR any rights, interests or claims of entitlement to enrollment. The CONTRACTOR’s actual enrollment level will be determined through the MCO selection and assignment process described in Section A.2.4.4 2.4.4 below. 2.4.3.6 Upon the request of TENNCARE, the The CONTRACTOR shall demonstrate to the satisfaction of TENNCARE it has the capacity to serve the number of enrollees in the maximum enrollment limitlimit prior to the assignment of any enrollees.

Maximum Enrollment. ‌ 2.4.3.1 The CONTRACTOR agrees to accept enrollment in the CONTRACTOR’s MCO of up to fifty seventy percent (5070%) of the eligible population in the applicable Grand Region. TENNCARE shall determine and notify the CONTRACTOR of the number of eligibles in the applicable Grand Region and the CONTRACTOR’s maximum enrollment limit, which shall be approximately fifty percent (50%) of the eligible population in the applicable Grand Region. 2.4.3.1.1 If TENNCARE determines an MCO (hereafter called an Underperforming MCO), other than the CONTRACTOR, is not adequately serving one or more Grand Regions and determines the CONTRACTOR has adequate capacity and it is necessary to transfer additional enrollment from the Underperforming MCO into the CONTRACTOR’s plan, the CONTRACTOR agrees to accept enrollment of up to seventy percent (70%) of the eligible population in the applicable Grand Region. 2.4.3.2 TENNCARE may shall establish an enrollment threshold for the CONTRACTOR at a percentage that will equal approximately ninety percent (90%) of the CONTRACTOR’s maximum enrollment limit and may limit enrollee assignment established in certain circumstances in order to remain within the thresholdSection 2.4.3.1 above. This enrollment threshold may be adjusted by TENNCARE at its discretion. 2.4.3.3 Once the CONTRACTOR’s enrollment threshold is met, TENNCARE may discontinue default assignment of enrollees to the CONTRACTOR’s MCO. Enrollees who select the CONTRACTOR or whose family members are enrolled in the CONTRACTOR’s MCO shall continue to be enrolled in the CONTRACTOR’s MCO until the maximum enrollment limit established in Section A.2.4.3.1 2.4.3.1 above is met. 2.4.3.4 Both TENNCARE and the CONTRACTOR recognize that management of the CONTRACTOR’s maximum enrollment limit and enrollment threshold within exact limits may not be possible. In the event enrollment in the CONTRACTOR’s MCO exceeds the maximum enrollment limit, TENNCARE may reduce enrollment in the CONTRACTOR’s MCO based on a plan established by TENNCARE that provides appropriate notice to the CONTRACTOR, allows appropriate choice of MCOs for enrollees, and meets the objectives of the TennCare program. 2.4.3.5 The establishment of a maximum enrollment limit and/or of an enrollment threshold does not obligate the State to enroll a certain number of TennCare enrollees in the CONTRACTOR’s MCO and does not create in the CONTRACTOR any rights, interests or claims of entitlement to enrollment. The CONTRACTOR’s actual enrollment level will be determined through the MCO selection and assignment process described in Section A.2.4.4 2.4.4 below. 2.4.3.6 Upon the request of TENNCARE, the CONTRACTOR shall demonstrate to the satisfaction of TENNCARE it has the capacity to serve the number of enrollees in the maximum enrollment limit.

Maximum Enrollment. ‌ 2.4.3.1 The CONTRACTOR agrees to accept enrollment in the CONTRACTOR’s MCO of up to fifty seventy percent (5070%) of the eligible population in the applicable Grand Region. TENNCARE shall determine and notify the CONTRACTOR of the number of eligibles in the applicable Grand Region and the CONTRACTOR’s maximum enrollment limit, which shall be approximately fifty percent (50%) of the eligible population in the applicable Grand Region. 2.4.3.1.1 If TENNCARE determines an MCO (hereafter called an Underperforming MCO), other than the CONTRACTOR, is not adequately serving one or more Grand Regions and determines the CONTRACTOR has adequate capacity and it is necessary to transfer additional enrollment from the Underperforming MCO into the CONTRACTOR’s plan, the CONTRACTOR agrees to accept enrollment of up to seventy percent (70%) of the eligible population in the applicable Grand Region. 2.4.3.2 TENNCARE may shall establish an enrollment threshold for the CONTRACTOR at a percentage that will equal approximately ninety percent (90%) of the CONTRACTOR’s maximum enrollment limit and may limit enrollee assignment established in certain circumstances in order to remain within the thresholdSection 2.4.3.1 above. This enrollment threshold may be adjusted by TENNCARE at its discretion. 2.4.3.3 Once the CONTRACTOR’s enrollment threshold is met, TENNCARE may discontinue default assignment of enrollees to the CONTRACTOR’s MCO. Enrollees who select the CONTRACTOR or whose family members are enrolled in the CONTRACTOR’s MCO shall continue to be enrolled in the CONTRACTOR’s MCO until the maximum enrollment limit established in Section A.2.4.3.1 2.4.3.1 above is met. 2.4.3.4 Both TENNCARE and the CONTRACTOR recognize that management of the CONTRACTOR’s maximum enrollment limit and enrollment threshold within exact limits may not be possible. In the event enrollment in the CONTRACTOR’s MCO exceeds the maximum enrollment limit, TENNCARE may reduce enrollment in the CONTRACTOR’s MCO based on a plan established by TENNCARE that provides appropriate notice to the CONTRACTOR, allows appropriate choice of MCOs for enrollees, and meets the objectives of the TennCare program. 2.4.3.5 The establishment of a maximum enrollment limit and/or of an enrollment threshold does not obligate the State to enroll a certain number of TennCare enrollees in the CONTRACTOR’s MCO and does not create in the CONTRACTOR any rights, interests or claims of entitlement to enrollment. The CONTRACTOR’s actual enrollment level will be determined through the MCO selection and assignment process described in Section A.2.4.4 2.4.4 below. 2.4.3.6 Upon the request of TENNCARE, the CONTRACTOR shall demonstrate to the satisfaction of TENNCARE it has the capacity to serve the number of enrollees in the maximum enrollment limit.