MEMBER ENROLLMENT IN HOOSIER HEALTHWISE MANAGED CARE Sample Clauses

MEMBER ENROLLMENT IN HOOSIER HEALTHWISE MANAGED CARE. Initial applicants and re-applicants for Hoosier Healthwise will receive a presentation by the enrollment broker on Hoosier Healthwise managed care and assistance in selecting a PMP. Members are educated on the benefits of primary and preventive care, the differences between PrimeStep and the MCO networks, and the importance of choosing a PMP. Additionally, members receive educational materials and may watch a video describing Hoosier Healthwise. Benefit Advocates (BAs), who are employed by the enrollment broker, provide potential members with a list of their provider options and explain that they have 30 days from the date they are determined eligible for Hoosier Healthwise to choose a PMP. Whether the choice leads to enrollment in PrimeStep or RBMC will depend on the PMP's enrollment status at the time of selection. The education provided by the BAs focuses on the choice of a physician, but the implications of network choice are also discussed. MCOs are required to provide information regarding their network, grievance procedures, and any other information requested by the State, for use in member education and enrollment. If a potential member fails to make a PMP selection within thirty days, one will be made for him or her through an auto-assignment enrollment mechanism processed by the IndianaAIM system. Once a PMP is chosen, or when a PMP is assigned, the member is linked to a Hoosier Healthwise PMP, and thereby enrolled in managed care. For members who apply for Hoosier Healthwise from an outstation location (enrollment center), the same requirements apply to the MCO and OMPP. OMPP will assure that those individuals are educated and enrolled in Hoosier Healthwise. If the member does not choose a PMP within 30 days, a PMP will be assigned to the member through an auto-assignment process that complies with Section 1932(a)(4)(D) of Title XIX of the Social Security Act. This process automatically assigns a PMP to a member if he/she fails to select a PMP. A detailed description of the auto-assignment logic is contained in the MCO Policies and Procedures Manual. Once a member is linked to a PMP, either by self-selection or auto-assignment, the member will be informed by mail of the member's PMP and plan enrollment. The PMP and the MCO are informed of the enrollment on bi-monthly enrollment rosters, which are updated on the first and fifteenth of each month.
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