Common use of NEWBORN ENROLLMENTS Clause in Contracts

NEWBORN ENROLLMENTS. The Contractor agrees to enroll and provide coverage for eligible newborn children of Enrollees effective from the time of birth. SDOH Responsibilities: 1. The SDOH will update WMS with information on the newborn received from hospitals, consistent with the requirements of Section 366-g of the Social Services Law as amended by Chapter 412 of the Laws of 1999. APPENDIX H October 1, 2004 H-4 2. Upon notification of the birth by the hospital or birthing center, the SDOH will update WMS with the demographic data for the newborn and enroll the newborn in the mother's MCO if not already enrolled. The newborn will be retroactively enrolled back to the first (1st) day of the month of birth. Based on the transaction date of the enrollment of the newborn on the PCP subsystem, the newborn will appear on either the next month's roster or the subsequent month's roster. On plan rosters for upstate and NYC, the "PCP Effective From Date" will indicate the first day of the month of birth, as described in 01 OMM/ADM 5 "Automatic Medicaid Enrollment for Newborns." LDSS Responsibilities: 1. Grant Medicaid eligibility for newborns for one (1) year if born to a woman eligible for and receiving MA assistance on the date of birth. (SOCIAL SERVICES LAW SECTION 366 (4) (1)) 2. LDSS must add eligible unborns to all WMS cases that include a pregnant woman as soon as the pregnancy is medically verified. (NYS DSS ADMINISTRATIVE DIRECTIVE 85 ADM-33) 3. In the event that the LDSS learns of an Enrollee's pregnancy prior to the Contractor, the LDSS is to establish MA eligibility and enroll the unborn in the Contractor's plan. 4. The LDSS is responsible for newborn enrollment should it not be successfully competed under the "SDOH Responsibilities" process as outlined in #2 above. 5. When a newborn is enrolled in managed care, the LDSS must send an Enrollment Confirmation Notice to inform the mother of the Effective Date of Enrollment, which is the first (1st) day of the month of birth, and the plan in which the newborn is enrolled. 6. The LDSS may develop a transmittal form to be used for unborn/newborn notification between the Contractor and the LDSS.

NEWBORN ENROLLMENTS. The Contractor agrees to enroll and provide coverage for eligible newborn children of Enrollees effective from the time of birth. SDOH Responsibilities: 1. The SDOH will update WMS with information on the newborn received from hospitals, consistent with the requirements of Section 366-g of the Social Services Law as amended by Chapter 412 of the Laws of 1999. APPENDIX H October 1, 2004 H-42004 2. Upon notification of the birth by the hospital or birthing center, the SDOH will update WMS with the demographic data for the newborn and enroll the newborn in the mother's MCO if not already enrolled. The newborn will be retroactively enrolled back to the first (1st) day of the month of birth. Based on the transaction date of the enrollment of the newborn on the PCP subsystem, the newborn will appear on either the next month's roster or the subsequent month's roster. On plan rosters for upstate and NYC, the "PCP Effective From Date" will indicate the first day of the month of birth, as described in 01 OMM/ADM 5 "Automatic Medicaid Enrollment for Newborns." LDSS Responsibilities: 1. Grant Medicaid eligibility for newborns for one (1) year if born to a woman eligible for and receiving MA assistance on the date of birth. (SOCIAL SERVICES LAW SECTION 366 (4) (1)) 2. LDSS must add eligible unborns to all WMS cases that include a pregnant woman as soon as the pregnancy is medically verified. (NYS DSS ADMINISTRATIVE DIRECTIVE 85 ADM-33) 3. In the event that the LDSS learns of an Enrollee's pregnancy prior to the Contractor, the LDSS is to establish MA eligibility and enroll the unborn in the Contractor's plan. 4. The LDSS is responsible for newborn enrollment should it not be successfully competed under the "SDOH Responsibilities" process as outlined in #2 above. 5. When a newborn is enrolled in managed care, the LDSS must send an Enrollment Confirmation Notice to inform the mother of the Effective Date of Enrollment, which is the first (1st) day of the month of birth, and the plan in which the newborn is enrolled. 6. The LDSS may develop a transmittal form to be used for unborn/newborn notification between the Contractor and the LDSS.

NEWBORN ENROLLMENTS. The Contractor agrees to enroll and provide coverage for eligible newborn children of Enrollees effective from the time of birth. SDOH Responsibilities: 1. The SDOH will update WMS with information on the newborn received from hospitals, consistent with the requirements of Section 366-g of the Social Services Law as amended by Chapter 412 of the Laws of 1999. APPENDIX H October 1, 2004 H-4 2. Upon notification of the birth by the hospital or birthing center, the SDOH will update WMS with the demographic data for the newborn and enroll the newborn in the mother's MCO if not already enrolled. The newborn will be retroactively enrolled back to the first (1st) day of the month of birth. Based on the transaction date of the enrollment of the newborn on the PCP subsystem, the newborn will appear on either the next month's roster or the subsequent month's roster. On plan rosters for upstate and NYC, the "PCP Effective From Date" will indicate the first day of the month of birth, as described in 01 OMM/ADM 5 "Automatic Medicaid Enrollment for Newborns." LDSS ResponsibilitiesRESPONSIBILITIES: 1. Grant Medicaid eligibility for newborns for one (1) year if born to a woman eligible for and receiving MA assistance on the date of birth. (SOCIAL SERVICES LAW SECTION 366 (4) (1366(4)(1)) 2. LDSS must add eligible unborns to all WMS cases that include a pregnant woman as soon as the pregnancy is medically verified. (NYS DSS ADMINISTRATIVE DIRECTIVE 85 ADM-33) 3. In the event that the LDSS learns of an Enrollee's pregnancy prior to the Contractor, the LDSS is to establish MA eligibility and enroll the unborn in the Contractor's plan. 4. The LDSS is responsible for newborn enrollment should it not be successfully competed under the "SDOH Responsibilities" process as outlined in #2 above. 5. When a newborn is enrolled in managed care, the LDSS must send an Enrollment Confirmation Notice to inform the mother of the Effective Date of Enrollment, which is the first (1st) day of the month of birth, and the plan in which the newborn is enrolled. 6. The LDSS may develop a transmittal form to be used for unborn/newborn notification between the Contractor and the LDSS.

NEWBORN ENROLLMENTS. The Contractor agrees to enroll and provide coverage for eligible newborn children of Enrollees effective from the time of birth. | SDOH Responsibilities: 1. The SDOH will update WMS with information on the newborn received from hospitals, consistent with the requirements of Section 366-g of the Social Services Law as amended by Chapter 412 of the Laws of 1999. APPENDIX H October 1, 2004 H-4 2. Upon notification of the birth by the hospital or birthing center, the SDOH will update WMS with the demographic data for the newborn and enroll the newborn in the mother's MCO if not already enrolled. The newborn will be retroactively enrolled back to the first (1st) day of the month of birth. Based on the transaction date of the enrollment of the newborn on the PCP subsystem, the newborn will appear on either the next month's roster or the subsequent month's roster. On plan rosters for upstate and NYC, the "PCP Effective From Date" will indicate the first day of the month of birth, as described in 01 OMM/ADM 5 "Automatic Medicaid Enrollment for Newborns." LDSS Responsibilities: 1. Grant Xxxxx Medicaid eligibility for newborns newborn for one (1) year if born to a woman eligible for and receiving MA assistance on the date of birth. (SOCIAL SERVICES LAW SECTION 366 (4) (1)) 2. LDSS must add eligible unborns to all WMS cases that include a pregnant woman as soon as the pregnancy is medically verified. verified (NYS DSS ADMINISTRATIVE DIRECTIVE 85 ADM-33) 3. In the event that the LDSS learns of an Enrollee's pregnancy prior to the Contractor, the LDSS is to establish MA eligibility and enroll the unborn in the Contractor's plan. 4. The LDSS is responsible for newborn enrollment should it not be successfully competed under the "SDOH Responsibilities" process as outlined in #2 above. 5. When a newborn is enrolled in managed care, the LDSS must send an Enrollment Confirmation Notice to inform the mother of the Effective Date of Enrollment, which is the first (1st) day of the month of birth, and the plan in which the newborn is enrolled. 6. The LDSS may develop a transmittal form to be used for unborn/newborn notification between the Contractor and the LDSS.

NEWBORN ENROLLMENTS. The Contractor agrees to enroll and provide coverage for eligible newborn children of Enrollees effective from the time of birth. SDOH Responsibilities: 1. The SDOH will update WMS with information on the newborn received from hospitals, consistent with the requirements of Section 366-g of the Social Services Law as amended by Chapter 412 of the the, Laws of 1999. APPENDIX H October 1, 2004 H-4. 2. Upon notification of the birth by the hospital or birthing center, the SDOH will update WMS with the demographic data for the newborn and enroll the newborn in the mother's MCO if not already enrolled. The newborn will be retroactively enrolled back to the first (1st) day of the month of birth. Based on the transaction date of the enrollment of the newborn on the PCP subsystem, the newborn will appear on either the next month's roster or the subsequent month's roster. On plan rosters for upstate and NYC, the "PCP Effective From Date" will indicate the first day of the month of birth, as described in 01 OMM/ADM 5 "Automatic Medicaid Enrollment for Newborns." LDSS Responsibilities: 1. Grant Medicaid eligibility for newborns for one (1) year if born to a woman eligible for and receiving MA assistance on the date of birth. (SOCIAL SERVICES LAW SECTION 366 (4) (1)) 2. LDSS must add eligible unborns to all WMS cases that include a pregnant woman as soon as the pregnancy is medically verified. (NYS DSS ADMINISTRATIVE DIRECTIVE 85 ADM-33) 3. In the event that the LDSS learns of an Enrollee's pregnancy prior to the Contractor, the LDSS is to establish MA eligibility and enroll the unborn in the Contractor's plan. 4. The LDSS is responsible for newborn enrollment should it not be successfully competed under the "SDOH Responsibilities" process as outlined in #2 above. 5. When a newborn is enrolled in managed care, the LDSS must send an Enrollment Confirmation Notice to inform the mother of the Effective Date of Enrollment, which is the first (1st) day of the month of birth, and the plan in which the newborn is enrolled. 6. The LDSS may develop a transmittal form to be used for unborn/newborn notification between the Contractor and the LDSS.

NEWBORN ENROLLMENTS. The If the Contractor is also a Medicaid MCO, the Contractor agrees to enroll and provide coverage for eligible newborn children of FHPlus Enrollees effective from the time of birth. SDOH Responsibilities: 1. The SDOH will update WMS with information on the newborn received from hospitals, consistent with the requirements its of Section 366-g of the Social Services Law as amended by Chapter 412 of the Laws of 1999. APPENDIX H October 1, 2004 H-4 2. Upon notification of the birth by the hospital or birthing center, the SDOH will update WMS with the demographic data for the newborn and enroll the newborn in the mother's MCO if not already enrolled. The newborn will be retroactively enrolled back to the first (1st) day of the month of birth. Based on the transaction date of the enrollment of the newborn on the PCP subsystem, the newborn will appear on either the next month's roster or the subsequent month's roster. On plan rosters for upstate and NYC, the "PCP Effective From Date" will indicate the first day of the month of birth, as described in 01 OMM/ADM 5 "Automatic Medicaid Enrollment for Newborns." LDSS Responsibilities: 1. Grant Medicaid eligibility for newborns for one (1) year if born to a woman eligible for and receiving MA assistance FHPlus on the date of birth. (SOCIAL SERVICES LAW SECTION Social Services Law Section 366 (4) (1)) 2. LDSS LDSSs must add eligible unborns to all WMS cases insure that include a pregnant woman Medicaid coverage is authorized for the unborn child as soon as the a pregnancy is medically verified. (NYS DSS ADMINISTRATIVE DIRECTIVE 85 ADM-33). 3. In the event that the an LDSS learns of an Enrollee's pregnancy prior to the Contractor, the LDSS is to establish MA Medicaid eligibility and enroll the unborn in the Contractor's planplan of the pregnant woman if that plan participates in Medicaid managed care. If the plan does not participate in Medicaid managed care, the pregnant woman will be asked to select a Medicaid managed care plan for the unborn. If Medicaid managed care is unavailable in the district, or is not chosen by the mother, the newborn will be eligible for Medicaid fee-for-service coverage, and such information will be entered on the WMS. 4. Upon notification of the birth by the Contractor, Enrollee or hospital, the LDSS will update WMS with the demographic data for the newborn. If the MCO participates in Medicaid and enrollment has not already taken place, LDSSs will enroll the newborn in the mother's plan. The LDSS PCP subsystem will automatically be updated and the newborn will appear as Medicaid eligible on the next month's Roster after the update to WMS. In districts where Medicaid managed care is responsible unavailable or is not chosen by the mother, the newborn will be eligible for newborn enrollment should it not be successfully competed under the "SDOH Responsibilities" process as outlined in #2 aboveMedicaid fee-for-service coverage. 5. When a newborn is an unborn has not been pre-enrolled in managed carewith the Contractor, the LDSS must send an Enrollment Confirmation Notice to inform the mother LDSSs, upon receiving notification of the Effective Date of Enrollmentbirth from the Contractor, which is Enrollee or hospital, must retroactively enroll the newborn back to the first (1st) day of the month of birth, and if the mother was enrolled at that time, provided the plan also participates in which Medicaid. If not, the newborn is enrolledwill be covered by fee-for service Medicaid until such time as the mother selects a plan, if available and appropriate. 6. The LDSS Where newborns will be enrolled in the mother's MCO, LDSSs must ensure that the mother is informed that the effective date of enrollment will be the first day of the month of birth. 7. LDSSs may develop a transmittal form to be used for unborn/newborn notification between the Contractor and the LDSS.

NEWBORN ENROLLMENTS. a) The Contractor agrees to enroll and provide coverage for eligible newborn children of Enrollees effective from the time of birth. . b) SDOH Responsibilities: 1. i) The SDOH will update WMS with information on the newborn received from hospitals, consistent with the requirements of Section 366-g of the Social Services Law SSL as amended by Chapter 412 of the Laws of 1999. APPENDIX H October 1, 2004 H-4. 2. ii) Upon notification of the birth by the hospital or birthing center, the SDOH will update WMS with the demographic data for the newborn and enroll the newborn in the mother's MCO if the newborn is not already enrolled, the mother's MCO offers a MMC product, and the newborn is not identified as SSI or SSI-related and therefore Excluded from the MMC Program pursuant to Section 2(b)(xi) of this Appendix. The newborn will be retroactively enrolled back to the first (1st) day of the month of birth. Based on the transaction date of the enrollment Enrollment of the newborn on the PCP subsystem, the newborn will appear on either the next month's roster Roster or the subsequent month's rosterRoster. On plan rosters Rosters for upstate and NYC, the "PCP Effective From Date" will indicate the first day of the month of birth, as described in 01 OMM/ADM 5 "Automatic Medicaid Enrollment for NewbornsNewboms." If the newbom's Enrollment is not completed by this process, the LDSS is responsible for Enrollment (see (c)(iv) below). c) LDSS Responsibilities: 1. i) Grant Medicaid eligibility for newborns newboms for one (1) year if born bom to a woman eligible for and receiving MA assistance Medicaid or FHPlus on the date of the newbom's birth. (SOCIAL SERVICES LAW SECTION 366 (4. ii) (1)) 2. The LDSS must add is responsible for adding eligible unborns unboms to all WMS cases that include a pregnant woman as soon as the pregnancy is medically verified. (NYS DSS ADMINISTRATIVE DIRECTIVE 85 ADM-33). 3. iii) In the event that the LDSS learns leams of an Enrollee's pregnancy prior to the Contractor, the LDSS is to establish MA responsible for establishing Medicaid eligibility and enroll enrolling the unborn in the Contractor's planMMC product. If the Contractor does not offer a MMC product, the pregnant woman will be asked to select a MCO offering a MMC product for the unborn. If a MCO offering a MMC product is unavailable, or if Enrollment is voluntary in the LDSS jurisdiction and an MCO is not chosen by the mother, the newborn will be eligible for Medicaid fee-for-service coverage, and such information will be entered on the WMS. 4. iv) The LDSS is responsible for newborn Enrollment if enrollment should it is not be successfully competed completed under the "SDOH Responsibilities" process as outlined in #2 2(b)(ii) above. October 1, 2005 d) Contractor Responsibilities: i) The Contractor must notify the LDSS in writing of any Enrollee that is pregnant within thirty (30) days of knowledge of the pregnancy. Notifications should be transmitted to the LDSS at least monthly. The notifications should contain the pregnant woman's name, Client ID Number (CIN), and the expected date of confinement (EDC). ii) The Contractor must send verifications of infant's demographic data to the LDSS, within five (5) days after knowledge of the birth. When a newborn is enrolled in managed careThe demographic data must include: the mother's name and CIN, the LDSS must send newborn's name and CIN (if newborn has a CIN), sex and the date of birth. iii) In districts that use an Enrollment Confirmation Notice Broker, the Contractor shall not submit electronic Enrollments of newborns to inform the mother Enrollment Broker, because this will interfere with the retroactive Enrollment of the Effective Date of Enrollment, which is newborn back to the first (1st) day of the month of birth. For newborns whose mothers are not enrolled in the Contractor's MMC or FHPlus product and who were not pre-enrolled into the Contractor's MMC product as unborns, the Contractor may submit electronic Enrollment of the newborns to the Enrollment Broker. In such cases, the Effective Date of Enrollment will be prospective. iv) In voluntary MMC counties, the Contractor will accept Enrollment applications for unborns if that is the mothers' intent, even if the mothers are not and/or will not be enrolled in the Contractor's MMC or FHPlus product. In all counties, when a mother is ineligible for Enrollment or chooses not to enroll, the Contractor will accept Enrollment applications for pre-enrollment of unborns who are eligible. v) The Contractor is responsible for provision of services to a newborn and payment of the plan hospital or birthing center bill if the mother is an Enrollee at the time of the newborn's birth, even if the newborn is not yet on the Roster, unless the Contractor does not offer a MMC product in the mother's county of fiscal responsibility or the newborn is Excluded from the MMC Program pursuant to Section 2(b)(xi) of this Appendix. vi) Within fourteen (14) days of the date on which the Contractor becomes aware of the birth, the Contractor will issue a letter, informing parents) about the newborn's Enrollment and how to access care, or a member identification card. vii) In those cases in which the Contractor is aware of the pregnancy, the Contractor will ensure that enrolled pregnant women select a PCP for their infants prior to birth. viii) The Contractor will ensure that the newborn is enrolled. 6. The LDSS may develop linked with a transmittal form PCP prior to be used for unborn/newborn notification between discharge from the hospital or birthing center, in those instances in which the Contractor and the LDSS.has received appropriate notification of birth prior to discharge. October 1, 2005