Newborns. 4.2.5.1 When a child is born to a mother enrolled in Centennial Care, the hospital or other provider shall complete a Notification of Birth, MAD Form 313, or its successor, prior to or at the time of discharge. HSD shall ensure that upon receipt of the MAD Form 313 the eligibility process is immediately commenced and that upon completion of the eligibility process the newborn is enrolled into his or her mother’s MCO.
4.2.5.2 Medicaid eligible newborns are eligible for a period of thirteen (13) months, starting with the month of birth. The newborn shall be enrolled retroactively to the month of birth with the mother’s MCO.
4.2.5.3 When a Medicaid-eligible child is born to a mother on the New Mexico Health Insurance Exchange and the mother’s Qualified Health Plan is also a Centennial Care MCO, the newborn shall be enrolled retroactively to the month of birth with that Centennial Care MCO.
4.2.5.4 When a Medicaid-eligible child is born to a mother on the New Mexico Health Insurance Exchange and the mother’s Qualified Health Plan is not a Centennial Care MCO, the newborn shall be auto assigned and enrolled in a Centennial Care MCO (in accordance with Section 4.2.4 of this Agreement) retroactively to the month of birth. The mother shall have one (1) opportunity anytime during the three (3) months from the effective date of enrollment to change the newborn’s MCO assignment.
4.2.5.5 Newborns are not considered part of the retroactive reconciliation period if the mother of the newborn is enrolled in Centennial Care at the time of delivery.
Newborns. 4.2.6.1 When a child is born to a mother enrolled in Turquoise Care, the hospital or other Provider shall notify the HCA of the child’s birth. Hospitals or other Providers shall notify HCA by either using the electronic process available through the Baby Bot program (or its successor) or by completing a Notification of Birth, MAD Form 313 (or its successor) prior to or at the time of discharge. Upon receipt of the notification of the child’s birth, HCA shall ensure that the eligibility process is immediately commenced and that upon completion of the eligibility process the newborn is enrolled into their mother’s MCO.
4.2.6.2 Medicaid eligible newborns are eligible for a period of thirteen (13) months, starting with the month of birth. The newborn shall be enrolled retroactively to the month of birth with the mother’s MCO.
4.2.6.3 When a Medicaid-eligible child is born to a mother on the New Mexico Health Insurance Exchange and the mother’s Qualified Health Plan is also a Turquoise Care MCO, the newborn shall be enrolled retroactively to the month of birth with that Turquoise Care MCO.
4.2.6.4 When a Medicaid-eligible child is born to a mother on the New Mexico Health Insurance Exchange and the mother’s Qualified Health Plan is not a Turquoise Care MCO, the newborn shall be auto-assigned and enrolled in a Turquoise Care MCO (in accordance with Section 4.2.5 of this Agreement) retroactively to the month of birth. The mother shall have one (1) opportunity anytime during the three (3) months from the effective date of enrollment to change the newborn’s MCO assignment.
4.2.6.5 Newborns are not considered part of the retroactive reconciliation period if the mother of the newborn is enrolled in Turquoise Care at the time of delivery.
Newborns. For the Traditional Attribution Cohort, children born to an Attributed Member mother after September 30 prior to the Performance Year, will not be attributed to Contractor in the Performance Year. For the Expanded Attribution Cohort, children born to an Attributed Member mother after October 30 prior to the Performance Year will not be attributed to Contractor in the Performance Year.
Newborns. The STATE will pay to the MCO a Capitation Payment for the birth month of an eligible newborn Enrollee if the mother was enrolled in the MCO during the month of the Child’s birth and eligibility is established for the Child. Payment for succeeding months will be determined pursuant to section 3.1.3,
Newborns. 3.2.2.7.1 Newborns born to mothers who are DSHP or DSHP Plus members at the time of the child’s birth will be Enrolled in their mother’s MCO. If the mother is not Enrolled with an MCO but the child is eligible for Medicaid or CHIP, the birth is covered by fee-for-service Medicaid or CHIP, and the child and the mother will be Enrolled in the same MCO.
3.2.2.7.2 The Contractor shall provide Covered Services for eligible newborns retroactive to the date of birth.
3.2.2.7.3 The newborn’s mother or guardian may request the newborn’s Transfer without cause within the first 90 calendar days (see Section
Newborns. Babies born to SCHIP members are not automatically eligible. A separate application must be filed and an eligibility determination must be made by SCDHHS. See the Policy and Procedure Guide.
Newborns. (1) Mother Enrolled with the MCO under this Contract. Eligible newborns born to mothers enrolled in the MCO under this Contract will be enrolled in the same MCO as the mother for the birth month in accordance with STATE policies and procedures, unless the newborn at the time of enrollment meets one of the exclusion reasons listed in section 3.1.1(C).
(2) Mother Enrolled with the MCO under MSHO, MSC+ or SNBC and the MCO has a Program Covered by this Contract in the Same Service Area. If an eligible newborn is born to a mother who is enrolled with the MCO under MSHO, MSC+ or SNBC and the MCO has a program covered by this Contract in that same Service Area, the newborn will be enrolled in the MCO under this Contract in that service area for the birth month in accordance with STATE policies and procedures, unless the newborn at the time of enrollment meets one of the exclusion reasons listed in section 3.1.1(C).
(3) Mother Enrolled with the MCO under MSHO, MSC+ or SNBC and the MCO does not have a Program Covered by this Contract in the Same Service Area. If an eligible newborn is born to a mother enrolled with the MCO under MSHO, MSC+ or SNBC but the MCO does not have a program covered by this Contract in that same Service Area, the newborn will be enrolled in accordance with STATE policies and procedures.
(4) Enrollment within Ninety Days. If a request to enroll a newborn (described in 3.1.3(B)(1) or (2) above) in the MCO is received within ninety (90) days of the birth, the MCO will receive a capitation payment for the birth month and the succeeding months as long as the newborn remains eligible, does not meet an exclusion from enrollment, and there is not a request to change to another MCO. If a request to enroll a newborn described in section (3.1.3(B)(1) or (2) above) in the MCO is not received within ninety (90) days of the birth, the MCO will receive a capitation payment for the birth month only, and the newborn will be enrolled in the MCO for the next available month unless a change of MCOs is requested.
Newborns. (1) Mother Enrolled with the MCO Under This Contract. Eligible newborns born to mothers enrolled in the MCO under a program covered by this Contract will be enrolled in the same MCO as the mother for the birth month in accordance with STATE policies and procedures, unless the newborn meets one of the exclusion reasons listed in section 3.1.1(D).
(2) Mother Enrolled with the MCO Under MSHO, MnDHO or SNBC and the MCO has a Program Covered by this Contract in the Same Service Area. If an eligible newborn is born to a mother who is enrolled with the MCO under MSHO, XxXXX, or SNBC and the MCO has a program covered by this Contract in that same Service Area, the newborn will be enrolled in the MCO under a program covered by this Contract in that service area for the birth month in accordance with STATE policies and procedures, unless the newborn meets one of the exclusion reasons listed in section 3.1.1(D).
(3) Mother Enrolled with the MCO Under MSHO or SNBC and the MCO does not have a Program Covered by this Contract in the Same Service Area. If an eligible newborn is born to a mother enrolled with the MCO under MSHO or SNBC but the MCO does not have a program covered by this Contract in that same Service Area, the newborn will be enrolled in accordance with STATE policies and procedures.
Newborns. A Member's newborn child is automatically enrolled in UnitedHealthcare Community Plan from the date of birth for at least the birth month. UnitedHealthcare Community Plan is required to notify the Department of the birth of the newborn within the time period required under the Healthy Michigan Plan Agreement.
Newborns. PPG shall provide Covered Services to a child born to a Member for the month of birth and the following month. For a child born in the month immediately preceding the mother’s membership. PPG shall provide Covered Services to the child during the mother’s first month of enrollment. No additional Capitation Compensation will be made to PPG for the child for such periods under these circumstances.
