Common use of MCO-Initiated Nursing Facility Disenrollment requests Clause in Contracts

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. 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) 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 assignment start reason then: The MCO submits a nursing facility disenrollment request on 2/12/2022, which is prior to 2/28/2022. Both the initial enrollment of 2/1/2022 and First Month Enrollment of 1/1/2022 will be deleted. The MCO submits a nursing facility disenrollment request on 3/15/2022, which is after 2/28/2022. The First Month Enrollment of 1/1/2022 to 1/31/2022, the initial enrollment of 2/1/2022 through the month of submission (3/31/2022) will be covered by the MCO. In all cases, the MCO is responsible for coverage of services and payment through the disenrollment date.

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. 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) ) 2. 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. 3. 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. 4. 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. 5. 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 assignment start reason then: The MCO submits a nursing facility disenrollment request on 2/12/2022, which is prior to 2/28/2022. Both the initial enrollment of 2/1/2022 and First Month Enrollment of 1/1/2022 will be deleted. The MCO submits a nursing facility disenrollment request on 3/15/2022, which is after 2/28/2022. The First Month Enrollment of 1/1/2022 to 1/31/2022, the initial enrollment of 2/1/2022 through the month of submission (3/31/2022) will be covered by the MCO. 6. In all cases, the MCO is responsible for coverage of services and payment through the disenrollment date.