Passive Enrollment. An enrollment process through which an eligible individual is enrolled by the EOHHS (or its vendor) into a Contractor‘s One Care Plan following a minimum sixty (60) day advance notification that includes the opportunity to make another enrollment decision prior to the effective date.
Passive Enrollment. An Enrollment process through which an eligible individual is enrolled by the MDHHS (or its vendor) into an ICO’s plan, following a minimum 60 calendar day advance notification that includes the plan selection and the opportunity to select a different plan, make another Enrollment decision, or decline Enrollment into an ICO, or opt-out of the Demonstration prior to the effective date.
Passive Enrollment. An enrollment process through which an eligible individual is enrolled by DHCS into a Contractor’s plan following a minimum sixty (60) day advance notification that includes the opportunity for the Enrollee to choose another plan or opt out prior to the effective date.
Passive Enrollment. Passive Enrollment is effective no sooner than sixty (60) Days after beneficiary notification of the right to select the Contractor’s MMP. RI EOHHS may passively enroll into the Demonstration only Medicaid fee- for-service beneficiaries, or other Eligible Beneficiaries who are not enrolled in a Medicare Advantage plan or otherwise ineligible for Passive Enrollment. All other Eligible Beneficiaries who are not passively enrolled into the Demonstration will be provided the option to opt-in. Individuals currently enrolled in PACE may not be passively enrolled into the Contractor’s MMP. As part of the Enrollment process, RI EOHHS will exclude individuals identified as at-risk or potentially at-risk for abuse or overuse of specified prescription drugs per 42 C.F.R. §§ 423.100 and 423.153(f). CMS and RI EOHHS may stop Passive Enrollment to Contractor’s MMP if the Contractor does not meet reporting requirements necessary to maintain Passive Enrollment as set forth by CMS and RI EOHHS. Enrollees who otherwise are included in Medicare reassignment effective January 1 of a given year either from their current Medicare Prescription Drug Plan (PDP) or terminating Medicare Advantage Prescription Drug Plan (MA-PD) to another PDP, will not be eligible for Passive Enrollment that same year. For example: those reassigned to a new PDP effective January 1, 2016, will be eligible for Passive Enrollment into the Contractor’s MMP effective no earlier than January 1, 2017. Passive Enrollment activity will be coordinated with CMS activities such as annual reassignment and daily auto-assignment for individuals with the Part D Low Income Subsidy.
Passive Enrollment. An Enrollment process through which an eligible individual is enrolled by RI EOHHS (or its vendor) into the Contractor, following a minimum sixty
Passive Enrollment. An Enrollment process through which an Eligible Beneficiary is enrolled by the state (or its vendor) into a STAR+PLUS MMP, when not affirmatively electing one, following a minimum sixty (60)-day advance notification that identifies the STAR+PLUS MMP the state has selected and the opportunity to select a different plan, make another Enrollment decision, or decline Enrollment into a STAR+PLUS MMP and Opt-Out of the Demonstration prior to the effective date of coverage.
Passive Enrollment. MDCH will initially conduct two Passive Enrollment phase-in periods for those Potential Enrollees who have not made a plan selection and are not excluded from Passive Enrollment.
Passive Enrollment. An Enrollment process through which an eligible individual is enrolled by RI EOHHS (or its vendor) into the Contractor, following a minimum sixty (60) Day advance notification from the Enrollment effective date that includes the plan selection and the opportunity to cancel the Passive Enrollment into the Demonstration prior to the effective date. The individual may Opt-Out of Passive Enrollment in the Demonstration at any time.
Passive Enrollment. An Enrollment process through which an eligible individual is enrolled by RI EOHHS (or its vendor) into the Contractor, following a minimum sixty (60) day advance notification from the enrollment effective date that includes the plan selection and the opportunity to cancel the passive enrollment into the Demonstration prior to the effective date. The individual may Opt-Out of passive enrollment in the Demonstration at any time.
1. 100. Patient Centered Medical Home (PCMH) – A PCMH provides and coordinates the provision of comprehensive and continuous medical care and required support services to patients with the goals of improving access to needed care and maximizing outcomes. PCMHs are certified by National Committee for Quality Insurance (NCQA) and RI EOHHS requires the inclusion of PCMH as PCPs in this procurement.
Passive Enrollment. An enrollment process through which an eligible individual is enrolled by DMAS (or its authorized agent) into a Contractor’s plan, when not otherwise affirmatively electing one, following a minimum 60-day advance notification that includes the opportunity to make another enrollment decision, or opt out of the Demonstration, prior to the effective date.
