Common use of MCO Enrollment Responsibilities Clause in Contracts

MCO Enrollment Responsibilities. The MCO shall: (1) Maintain records of all persons who inquire about XxXXX, and who reasonably appear to be eligible for the program, including but not limited to the individual’s enrollment outcome, and shall at the request of the STATE make this information available to the STATE. (2) Assure that Potential Enrollees are eligible for Medical Assistance by checking the Medicaid eligibility verification system (EVS) before having the Recipient complete an enrollment form. Persons who are found to be ineligible for Medical Assistance are ineligible for enrollment in MnDHO. (3) Prior to submitting or entering an enrollment form to the STATE, the MCO must verify Medicare status (Parts A and B) of the Potential Enrollee via the Medicare Advantage and Prescription Drug User Interface (XXXx) or other system as directed by the STATE and CMS. A copy of the CMS eligibility screen print must be included with any enrollment form submitted to the STATE. (4) Ensure that appropriate MCO staff has access to the MN-ITS and appropriate Medicare eligibility and managed care systems as directed by the STATE. (5) Have Recipients sign an enrollment form which incorporates a “Statement of Informed Enrollment and Enrollee Rights” prior to conducting: (a) Long Term Care Consultation (LTCC) and OBRA Level 1 screening or development of the Comprehensive Care Plan. This Statement of Informed Enrollment shall include, but is not limited to the following: (i) The Enrollee’s right to disenroll on a monthly basis and that upon disenrollment from MnDHO, they will return to the FFS program, unless they are otherwise required to enroll in PMAP. (6) Unless requested by the Enrollee, the MCO may not disenroll any Enrollee who is part of the eligible population, as long as the Enrollee meets enrollment criteria.

MCO Enrollment Responsibilities. The MCO shall: (1) Maintain records of all persons who inquire about XxXXX, 3.6.1 Utilize integrated enrollment forms and who reasonably appear to be eligible process as defined under this contract for enrollment under both Medicare and Medicaid. The form shall include primary language spoken by the programmember, including but not limited to the individual’s enrollment outcomeAmerican Sign Language and preferred modes for those who use assistive devices, and shall at the request of the STATE make this information available to the STATEincluding email, for communications. (2) 3.6.2 Assure that Potential prospective Enrollees are eligible for Medical Assistance by checking the Medicaid eligibility verification system (EVS) or MN-ITS, before having the Recipient complete an enrollment form. Persons who are found to be ineligible for Medical Assistance are ineligible for enrollment in MnDHOSNBC. (3) 3.6.3 Prior to submitting or entering an enrollment form to the STATE, or entering enrollment information on MMIS, the MCO must verify Medicare status (Parts A and B) of the Potential Enrollee via the Medicare Advantage and Prescription Drug User Interface (XXXx) or other system as directed by the STATE and CMS. A copy of the CMS eligibility screen print must be included with any enrollment form submitted to the STATE. (4) Ensure 3.6.4 The MCO must ensure that appropriate MCO staff has access to the MN-ITS and appropriate Medicare eligibility and managed care systems or Case Management systems as directed by the STATESTATE and CMS, including XXXx. (5) Have Recipients 3.6.5 The MCO must have recipients sign an enrollment form which that incorporates a “Statement of Informed Enrollment and Enrollee Rights” prior to conducting:. (a) Long Term Care Consultation (LTCC) and OBRA Level 1 screening or development of the Comprehensive Care Plan. 3.6.6 This Statement of Informed Enrollment shall include, but is not limited to the following: (iA) An explanation that the Enrollee is assigning their Medicaid benefits, and for Dual Eligibles, also their Medicare benefits to the MCO. (B) The Enrollee’s Enrollees right to disenroll on a monthly basis basis, and that upon disenrollment from MnDHOdisenrollment, they will return to the FFS programfee-for-service system, unless they are otherwise required to enroll in PMAPPMAP or MSC+. (6C) Unless requested by the Enrollee, the MCO may not disenroll any Enrollee who is part of the eligible population, as long as the Enrollee meets enrollment criteria. (D) For Recipients or Enrollees who are under Adult Guardianship, the MCO must ensure that the State Legal Guardian signs the enrollment form. 3.6.7 Medicare Advantage Enrollment A STATE and MCO workgroup will develop a process to provide seamless enrollment for current SNBC Enrollees who become eligible for Medicare, and require conversion into the SNBC integrated Medicare Advantage program. (Seamless enrollment does not apply to the PIN.)

MCO Enrollment Responsibilities. The MCO shall: (1A) Maintain records Submission/and Data Entry of all persons who inquire about XxXXX, and who reasonably appear to be eligible for the program, including but not limited to the individual’s enrollment outcome, and shall at the request of the STATE make this information available to the STATE. (2) Assure that Potential Enrollees are eligible for Medical Assistance by checking the Medicaid eligibility verification system (EVS) before having the Recipient complete an enrollment formEnrollment Forms. Persons who are found to be ineligible for Medical Assistance are ineligible for enrollment in MnDHO. (3) Prior to submitting or entering an enrollment form to the STATE, or entering enrollment information on MMIS, the MCO must verify (or must contractually arrange for verification of) Medicare status (Parts A and B) of the Potential Enrollee via the Medicare Advantage and Prescription Drug User user Interface (XXXx) or other system as directed by the STATE and CMS. A copy of the CMS eligibility screen print must be included with any enrollment form submitted to the STATE. (4B) Ensure The MCO must ensure that appropriate MCO staff has have access to the MN-ITS and appropriate Medicare eligibility and managed care systems as directed by the STATE and CMS, including XXXx. (C) Agreement Not to Limit Enrollment. The MCO agrees not to set any enrollment limits on the number of Medical Assistance Recipients that it will serve, except as provided under Minnesota Statutes, § 62D.04, subd. 5, and Minnesota Statutes, § 256B.0644. (D) LTCC Screening Document Entry. The MCO will be responsible to enter all screening documents into MMIS for all LTCC screenings performed, for the purpose of determining Rate Cell and payment. The MCO may enter the screening documents or may contract with a Local Agency or Care System to enter screening documents. The MCO shall submit to the STATE’s security liaison a signed data privacy statement for all MCO employees and subcontractors who will be responsible for entering screening documents into MMIS. (1) The STATE shall offer training to MCOs and its subcontractors on this process. (2) The MCO shall download and install the required internet access software “Blue Zone” onto workstations for those staff that will be responsible for entering Screening Documents. (3) The MCO shall be responsible for entering initial LTCC screenings, reassessments, telephone screenings for Nursing Facility placements, and other forms required by this contract. (4) The MCO shall be responsible for entering screenings for Non-EW community Enrollees. (E) STATE and CMS MSHO Enrollment; Enrollment TPA Services. (1) Enrollment in MSHO for Medicaid in MMIS will be performed by the STATE or MCO. (a) The STATE and MCO agree that coordination of enrollment processes for Medicare SNP and Medicaid benefits will be consistent with the requirements of 42 CFR § 422.107 (c) (6), regarding verification of the Enrollee’s eligibility for both Medicare and Medicaid. (b) MCO agrees to use the real-time data exchange and enrollment processes further described in sections 3.1.2 (Enrollment), 3.1.3(F) (Capability to Receive Enrollment Data Electronically), 3.1.3(D)(3), and the timeframes in 3.2.6, (2) Assignment of Rate Cell Categories will be done by the STATE, based on information in MMIS at the time of capitation. (3) The STATE will continue to be available to provide enrollment TPA services to the MSHO MCOs. The charge and scope of duties for this service will be negotiated between the MCO and the State in an additional contract. These duties will include, but not be limited to the submission of Medicare SNP enrollment to CMS on a monthly basis. (F) Capability to Receive Enrollment Data Electronically. The MCO shall have the capability to receive enrollment data electronically via a medium prescribed by the STATE. (51) Have Recipients sign an enrollment form which incorporates If there is a “Statement of Informed Enrollment and Enrollee Rights” prior to conducting: (a) Long Term Care Consultation (LTCC) and OBRA Level 1 screening or development disruption of the Comprehensive Care Plan. This Statement STATE’s electronic capabilities, the MCO has fifteen (15) days to disseminate enrollment information to its Enrollees, pursuant to section 3.2.6 of Informed Enrollment shall include, but is not limited to the following: (i) The Enrollee’s right to disenroll on a monthly basis and that upon disenrollment from MnDHO, they will return to the FFS program, unless they are otherwise required to enroll in PMAPthis Contract. (62) Unless requested The MCO shall provide valid enrollment data to Providers for Enrollee coverage verification by the Enrollee, the MCO may not disenroll any Enrollee who is part first day of the eligible populationmonth and within two working days of availability of enrollment data at the time of reinstatement, as long as the Enrollee meets enrollment criteriapursuant to section 3.4.

MCO Enrollment Responsibilities. The MCO shall: (1) Maintain records of all persons who inquire about XxXXX, 3.6.1 Utilize integrated enrollment forms and who reasonably appear to be eligible process as defined under this contract for enrollment under both Medicare and Medicaid. The form shall include primary language spoken by the programmember, including but not limited to the individual’s enrollment outcomeAmerican Sign Language and preferred modes for those who use assistive devices, and shall at the request of the STATE make this information available to the STATEincluding email, for communications. (2) 3.6.2 Assure that Potential prospective Enrollees are eligible for Medical Assistance by checking the Medicaid eligibility verification system (EVS) or MN-ITS, before having the Recipient complete an enrollment form. Persons who are found to be ineligible for Medical Assistance are ineligible for enrollment in MnDHOSNBC. (3) 3.6.3 Prior to submitting or entering an enrollment form to the STATE, or entering enrollment information on MMIS, the MCO must verify Medicare status (Parts A and B) of the Potential Enrollee via the Medicare Advantage and Prescription Drug User Interface (XXXx) or other system as directed by the STATE and CMS. A copy of the CMS eligibility screen print must be included with any enrollment form submitted to the STATE. (4) Ensure 3.6.4 The MCO must ensure that appropriate MCO staff has access to the MN-ITS and appropriate Medicare eligibility and managed care systems or Case Management systems as directed by the STATESTATE and CMS, including XXXx. (5) Have Recipients 3.6.5 The MCO must have recipients sign an enrollment form which that incorporates a “Statement of Informed Enrollment and Enrollee Rights” prior to conducting:. (a) Long Term Care Consultation (LTCC) and OBRA Level 1 screening or development of the Comprehensive Care Plan. 3.6.6 This Statement of Informed Enrollment shall include, but is not limited to the following: (iA) An explanation that the Enrollee is assigning their Medicaid benefits, and for Dual Eligibles, also their Medicare benefits to the MCO. (B) The Enrollee’s Enrollees right to disenroll on a monthly basis basis, and that upon disenrollment from MnDHOdisenrollment, they will return to the FFS programfee-for-service system, unless they are otherwise required to enroll in PMAPPMAP or MSC+. (6C) Unless requested by the Enrollee, the MCO may not disenroll any Enrollee who is part of the eligible population, as long as the Enrollee meets enrollment criteria. (D) For Recipients or Enrollees who are under Adult Guardianship, the MCO must ensure that the State Legal Guardian signs the enrollment form. 3.6.7 Medicare Advantage Enrollment A STATE and MCO workgroup will develop a process to provide seamless enrollment for current SNBC Enrollees who become eligible for Medicare, and require conversion into the SNBC integrated Medicare Advantage program.