Common use of MCO Enrollment Responsibilities Clause in Contracts

MCO Enrollment Responsibilities. The MCO shall: (A) Submission/and Data Entry of Enrollment Forms. Prior to submitting 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 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. (B) The MCO must ensure that appropriate MCO staff 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. (1) If there is a disruption of the STATE’s electronic capabilities, the MCO has fifteen (15) days to disseminate enrollment information to its Enrollees, pursuant to section 3.2.6 of this Contract. (2) The MCO shall provide valid enrollment data to Providers for Enrollee coverage verification by the first day of the month and within two working days of availability of enrollment data at the time of reinstatement, pursuant to section 3.4.

MCO Enrollment Responsibilities. The MCO shall: 3.6.1 Utilize integrated enrollment forms and process as defined under this contract for enrollment under both Medicare and Medicaid. The form shall include primary language spoken by the member, including American Sign Language and preferred modes for those who use assistive devices, including email, for communications. 3.6.2 Assure that prospective Enrollees are eligible for Medical Assistance by checking the Medicaid eligibility verification system (AEVS) Submission/and Data Entry of Enrollment Formsor 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 SNBC. 3.6.3 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 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. (B) 3.6.4 The MCO must ensure that appropriate MCO staff have has access to the MN-ITS and appropriate Medicare eligibility and managed care systems or Case Management systems as directed by the STATE and CMS, including XXXx. 3.6.5 The MCO must have recipients sign an enrollment form that incorporates a Statement of Informed Enrollment and Enrollee Rights. 3.6.6 This Statement of Informed Enrollment shall include, but is not limited to the following: (A) An explanation that the Enrollee is assigning their Medicaid benefits, and for Dual Eligibles, also their Medicare benefits to the MCO. (B) The Enrollees right to disenroll on a monthly basis, and that upon disenrollment, they will return to the fee-for-service system, unless otherwise required to enroll in PMAP or MSC+. (C) Agreement Not to Limit Enrollment. The Unless requested by the Enrollee, the MCO agrees may not to set disenroll any Enrollee who is part of the eligible population, as long as the Enrollee meets 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.0644criteria. (D) LTCC Screening Document Entry. The For Recipients or Enrollees who are under Adult Guardianship, the MCO will be responsible to enter all screening documents into MMIS for all LTCC screenings performed, for must ensure that the purpose of determining Rate Cell and payment. The MCO may enter State Legal Guardian signs 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 MMISenrollment form. (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; 3.6.7 Medicare Advantage Enrollment TPA Services. (1) Enrollment in MSHO for Medicaid in MMIS will be performed by the STATE or MCO. (a) The A STATE and MCO agree that coordination of workgroup will develop a process to provide seamless 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 current SNBC Enrollees who become eligible 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)Medicare, and require conversion into the timeframes in 3.2.6, SNBC integrated Medicare Advantage program. (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 Seamless enrollment TPA services does not apply 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 basisPIN. (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. (1) If there is a disruption of the STATE’s electronic capabilities, the MCO has fifteen (15) days to disseminate enrollment information to its Enrollees, pursuant to section 3.2.6 of this Contract. (2) The MCO shall provide valid enrollment data to Providers for Enrollee coverage verification by the first day of the month and within two working days of availability of enrollment data at the time of reinstatement, pursuant to section 3.4.)

MCO Enrollment Responsibilities. The MCO shall: 3.6.1 Utilize integrated enrollment forms and process as defined under this contract for enrollment under both Medicare and Medicaid. The form shall include primary language spoken by the member, including American Sign Language and preferred modes for those who use assistive devices, including email, for communications. 3.6.2 Assure that prospective Enrollees are eligible for Medical Assistance by checking the Medicaid eligibility verification system (AEVS) Submission/and Data Entry of Enrollment Formsor 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 SNBC. 3.6.3 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 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. (B) 3.6.4 The MCO must ensure that appropriate MCO staff have has access to the MN-ITS and appropriate Medicare eligibility and managed care systems or Case Management systems as directed by the STATE and CMS, including XXXx. 3.6.5 The MCO must have recipients sign an enrollment form that incorporates a Statement of Informed Enrollment and Enrollee Rights. 3.6.6 This Statement of Informed Enrollment shall include, but is not limited to the following: (A) An explanation that the Enrollee is assigning their Medicaid benefits, and for Dual Eligibles, also their Medicare benefits to the MCO. (B) The Enrollees right to disenroll on a monthly basis, and that upon disenrollment, they will return to the fee-for-service system, unless otherwise required to enroll in PMAP or MSC+. (C) Agreement Not to Limit Enrollment. The Unless requested by the Enrollee, the MCO agrees may not to set disenroll any Enrollee who is part of the eligible population, as long as the Enrollee meets 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.0644criteria. (D) LTCC Screening Document Entry. The For Recipients or Enrollees who are under Adult Guardianship, the MCO will be responsible to enter all screening documents into MMIS for all LTCC screenings performed, for must ensure that the purpose of determining Rate Cell and payment. The MCO may enter State Legal Guardian signs 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 MMISenrollment form. (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; 3.6.7 Medicare Advantage Enrollment TPA Services. (1) Enrollment in MSHO for Medicaid in MMIS will be performed by the STATE or MCO. (a) The A STATE and MCO agree that coordination of workgroup will develop a process to provide seamless 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 current SNBC Enrollees who become eligible 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)Medicare, and require conversion into 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 capitationSNBC integrated Medicare Advantage program. (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. (1) If there is a disruption of the STATE’s electronic capabilities, the MCO has fifteen (15) days to disseminate enrollment information to its Enrollees, pursuant to section 3.2.6 of this Contract. (2) The MCO shall provide valid enrollment data to Providers for Enrollee coverage verification by the first day of the month and within two working days of availability of enrollment data at the time of reinstatement, pursuant to section 3.4.

MCO Enrollment Responsibilities. The MCO shall: (A1) Submission/Maintain records of all persons who inquire about XxXXX, and Data Entry 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 Enrollment Formsthe 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, 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. (B4) The MCO must ensure Ensure that appropriate MCO staff have has access to the MN-ITS and appropriate Medicare eligibility and managed care systems as directed by the STATE and CMS, including XXXxSTATE. (C5) Agreement Not Have Recipients sign an enrollment form which incorporates a “Statement of Informed Enrollment and Enrollee Rights” prior 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.conducting: (a) The STATE Long Term Care Consultation (LTCC) 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 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 eligibility for both Medicare right to disenroll on a monthly basis and Medicaidthat upon disenrollment from MnDHO, they will return to the FFS program, unless they are otherwise required to enroll in PMAP. (b6) 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 Unless requested 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. (1) If there is a disruption of the STATE’s electronic capabilitiesEnrollee, the MCO has fifteen (15) days to disseminate enrollment information to its Enrollees, pursuant to section 3.2.6 of this Contract. (2) The MCO shall provide valid enrollment data to Providers for may not disenroll any Enrollee coverage verification by the first day who is part of the month and within two working days of availability of eligible population, as long as the Enrollee meets enrollment data at the time of reinstatement, pursuant to section 3.4criteria.