MCO-Initiated Nursing Facility Disenrollment requests Sample Clauses

MCO-Initiated Nursing Facility Disenrollment requests. Excluding Group VIII-Expansion, pursuant to OAC rule 5160-26-02.1, the MCO must submit MCO-initiated nursing facility disenrollment requests for Modified Adjusted Gross Income (MAGI) and ABD in the format specified by ODM. See disenrollment table below. Table A.1 Disenrollment Requests Month of Nursing Facility Admission Next Two Consecutive Months Earliest Disenrollment Date January February & March March 31 February March & April April 30 March April & May May 31 April May & June June 30 Month of Nursing Facility Admission Next Two Consecutive Months Earliest Disenrollment Date May June & July July 31 June July & August August 31 July August & September September 30 August September & October October 31 September October & November November 30 October November & December December 31 November December & January (next CY) January 31 (next CY) December January & February (next CY) Last Day of February (next CY) If a member is admitted to a nursing facility while enrolled with the MCO and the MCO disenrollment request is submitted after the Earliest Disenrollment Date, the member will be disenrolled as of the last calendar day of the submission month. When a member is admitted to a nursing facility while enrolled with one MCO, then changes to a different MCO: If the admission date is three months or less prior to the initial enrollment month, the MCO must align the disenrollment request with the Disenrollment Requests table dates. If the admission date is more than three months prior to the initial enrollment month, the MCO must submit the disenrollment request during the initial enrollment month to disenroll the member the last calendar day of the month prior to the initial enrollment. If a member is admitted to a nursing facility prior to being enrolled with the MCO and was admitted under fee-for-service Medicaid, the MCO must submit a disenrollment request during the initial enrollment month to disenroll the member the last calendar day of the month prior to the initial enrollment. Otherwise, the member will be disenrolled as of the last calendar day of the submission month. In instances where the initial enrollment month is accompanied by an enrollment span with a start reason of First Month Enrollment due to Day 1 Managed Care enrollment, the First Month Enrollment span will also be removed. For example, if HIPAA 834 contains a 1/1/2022 to 1/31/2022 enrollment with a First Month Enrollment start reason and a 2/1/2022 to 12/31/2299 enrollment with assign...
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MCO-Initiated Nursing Facility Disenrollment requests. Excluding Group VIII-Expansion, pursuant to OAC rule 5160-26-02.1, the MCO must submit MCO-initiated nursing facility disenrollment requests for Modified Adjusted Gross Income (MAGI) and ABD in the format specified by ODM. See disenrollment table below. Table A.1 Disenrollment Requests Month of Nursing Facility Admission Next Two Consecutive Months Earliest Disenrollment Date January February & March March 31 February March & April April 30 March April & May May 31 April May & June June 30 Month of Nursing Facility Admission Next Two Consecutive Months Earliest Disenrollment Date May June & July July 31 June July & August August 31 July August & September September 30 August September & October October 31 September October & November November 30 October November & December December 31 November December & January (next CY) January 31 (next CY) December January & February (next CY) Last Day of February (next CY) If a member is admitted to a nursing facility while enrolled with the MCO and the MCO disenrollment request is submitted after the Earliest Disenrollment Date, the member will be disenrolled as of the last calendar day of the submission month. When a member is admitted to a nursing facility while enrolled with one MCO, then changes to a different MCO:
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MCO-Initiated Nursing Facility Disenrollment requests. 1. Excluding Group VIII-Expansion, pursuant to OAC rule 5160-26-02.1, the MCO must submit MCO-initiated nursing facility disenrollment requests for Modified Adjusted Gross Income (MAGI) and ABD in the format specified by ODM. See disenrollment table below. Table A.1 Disenrollment Requests Month of Nursing Facility Admission Next Two Consecutive Months Earliest Disenrollment Date January February & March March 31 February March & April April 30 March April & May May 31 April May & June June 30 May June & July July 31 June July & August August 31 July August & September September 30 August September & October October 31 September October & November November 30 October November & December December 31 November December & January (next CY) January 31 (next CY) December January & February (next CY) Last Day of February (next CY)
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Related to MCO-Initiated Nursing Facility Disenrollment requests

  • Enrollment Period 4.2.9.1 After enrolling in the CONTRACTOR’s MCO (whether as the result of selection, assignment, or auto assignment), Members shall have one (1) opportunity anytime during the three (3) month period immediately following the effective date of enrollment with the CONTRACTOR’s MCO to request to change MCOs. After exercising this right to change MCOs, a Member shall remain enrolled with the MCO until the annual choice period described in Section 4.2.9.2 of this Agreement, unless disenrolled in accordance with Section

  • Initial Enrollment Upon retirement, each new retiree who is eligible to enroll in plans under the Health Benefits Program shall receive uninterrupted coverage under the plan in which he or she was enrolled as an active employee, provided the employee submits all necessary applications and other required documentation in a timely fashion.

  • Leave of Absence for College Committees An employee whose assigned work schedule would prevent her/him from attending meetings of a college committee to which s/he has been elected or appointed, will be granted a leave of absence from her/his regular duties without loss of pay or other entitlements to attend such meeting(s). Where such leave is granted, the employer will replace the employee as necessary. Costs arising from this provision will not be charged against the program area of the participating employee.

  • Enrollment Requirements You must maintain with Blue Cross and Blue Shield a current and updated listing of covered employees. You will be responsible for all claims costs and expenses associated with failure to maintain an accurate and current listing with Blue Cross and Blue Shield, unless such claims costs and expenses are due to an error on Blue Cross and Blue Shield’s part. Eligibility of an Employee In order to maintain health care coverage with Blue Cross and Blue Shield, an employee must meet the written eligibility requirements (such as length of service, active employment and number of hours worked) you impose as long as they do not conflict with Blue Cross and Blue Shield’s eligibility requirements. An eligible employee as defined by Blue Cross and Blue Shield means: • A permanent full-time employee regularly working 30 hours or more each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A permanent part-time employee regularly working at least 20 hours but less than 30 hours each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A disabled permanent full-time or part-time employee who is actively working despite the disability (including one who is engaged in a trial work period) and a disabled employee who is not actively working but whom the employer treats as an employee; or • A former employee (or a former covered dependent of the employee of the group) who qualifies for continued group coverage under federal or state law, but only if the employer maintains Blue Cross and Blue Shield group coverage for permanent full-time employees as defined in (a) above; or • A retired employee of the employer. Enrollment of a Member Newly hired employees who are eligible for group benefits can enroll in the benefits plan according to your eligibility requirements for coverage, provided that your requirements comply with Blue Cross and Blue Shield’s eligibility and enrollment requirements. The effective date of an eligible employee’s (or his or her dependent’s) membership in the benefits plan may be the Member’s initial eligibility date or your subsequent anniversary/renewal date, as long as: (a) Blue Cross and Blue Shield receives your written notice no later than 30 days after the Member’s enrollment notification period applicable to membership modifications (as described in the Subscriber Certificate for your benefits plan); and (b) you pay the applicable premium charges.

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