Common use of Pregnant Members and Infants Clause in Contracts

Pregnant Members and Infants. (1) The HHSC Administrative Contractor will refer pregnant CHIP Members, with the exception of Legal Permanent Residents and other legally qualified aliens barred from Medicaid due to federal eligibility restrictions, to Medicaid for eligibility determinations. Those CHIP Members who are determined to be Medicaid Eligible will be disenrolled from HMO’s CHIP plan. Medicaid coverage will be coordinated to begin after CHIP eligibility ends to avoid gaps in health care coverage. (2) In the event the HMO remains unaware of a Member’s pregnancy until delivery, the delivery will be covered by CHIP. Babies are automatically enrolled in the mother’s CHIP health plan at birth with CHIP eligibility and re-enrollment following the timeframe as that of the mother. The HHSC Administrative Services Contractor will then set the Member’s eligibility expiration date at the later of (1) the end of the second month following the month of the baby’s birth or (2) the Member’s original eligibility expiration date. Section 5.04.1 CHIP Perinatal eligibility, enrollment, and disenrollment (a) The HHSC Administrative Contractor will electronically transmit to the HMO new CHIP Perinate Member information based on the appropriate CHIP Perinate or CHIP Perinate Newborn Rate Cell. There is no waiting period for CHIP Perinatal Program Members. (b) CHIP Perinate Newborns are eligible for 12 months continuous enrollment, beginning with the month of enrollment as a CHIP Perinate (month of enrollment plus 11 months). A CHIP Perinate Newborn will maintain coverage in his or her CHIP Perinatal health plan.

Pregnant Members and Infants. (1) The HHSC Administrative Contractor will refer pregnant CHIP Members, with the exception of Legal Permanent Residents and other legally qualified aliens barred from Medicaid due to federal eligibility restrictions, to Medicaid for eligibility determinations. Those CHIP Members who are determined to be Medicaid Eligible will be disenrolled from HMOMCO’s CHIP plan. Medicaid coverage will be coordinated to begin after CHIP eligibility ends to avoid gaps in health care coverage. (2) In the event the HMO MCO remains unaware of a CHIP Member’s pregnancy until delivery, the facility and professional costs associated with the delivery will be covered by CHIP. Babies are automatically enrolled CHIP in accordance with Attachment B-1.1, “CHIP Covered Services.” This includes the post-delivery costs for the newborn’s care while in the mother’s facility, as described in Attachment B-1.1, “CHIP health plan at birth with CHIP eligibility and re-enrollment following the timeframe as that of the mother. Covered Services.,” The HHSC Administrative Services Contractor will then set the Membera pregnant CHIP mother’s eligibility expiration date at the later of (1) the end of the second month following the month of the baby’s birth pregnancy delivery or the pregnancy termination or (2) the Member’s original eligibility expiration date. Section 5.04.1 CHIP Perinatal eligibility, enrollment. The Administrative Services Contractor will screen the newborn’s eligibility for Medicaid, and disenrollment then CHIP (a) The HHSC if the newborn is not eligible for Medicaid). If the newborn is eligible for CHIP, the Administrative Services Contractor will electronically transmit to enroll the HMO new newborn in the mother’s CHIP Perinate Member information based on plan prospectively, following standard cut-off rules. The newborn’s CHIP eligibility ends when the appropriate mother’s CHIP Perinate or CHIP Perinate Newborn Rate Cell. There is no waiting period for CHIP Perinatal Program Memberseligibility expires, as described above. (b) CHIP Perinate Newborns are eligible for 12 months continuous enrollment, beginning with the month of enrollment as a CHIP Perinate (month of enrollment plus 11 months). A CHIP Perinate Newborn will maintain coverage in his or her CHIP Perinatal health plan.

Pregnant Members and Infants. (1) The If notified of a CHIP Member's pregnancy prior to birth, the HHSC Administrative Contractor will refer pregnant CHIP Members, Member to Medicaid for eligibility determination (with the exception of Legal Permanent Residents and other legally qualified aliens barred from Medicaid due to federal eligibility restrictions, to Medicaid for eligibility determinations). Those CHIP Members who are determined to be Medicaid Eligible will be disenrolled from HMO’s CHIP plan. Medicaid coverage will be coordinated to begin after CHIP eligibility ends to avoid gaps in health care coverage. (2) In the event the HMO remains unaware of a A pregnant CHIP Member’s pregnancy until delivery, 's facility and professional costs associated with the delivery will be covered by CHIP. Babies are automatically enrolled CHIP in accordance with Attachment B-2, "CHIP Covered Services." This includes the post-delivery costs for the newborn's care while in the mother’s facility , as described in Attachment B-2, "CHIP health plan at birth with CHIP eligibility and re-enrollment following the timeframe as that of the mother. Covered Services." The HHSC Administrative Adminstrative Services Contractor will then set the pregnant CHIP Member’s eligibility 's eligibilty expiration date at the later of (1) the end of the second month following the month of the pregnancy termination or the baby’s birth or (2) the Member’s original eligibility expiration date. Section 5.04.1 CHIP Perinatal eligibility, enrollment. The Administrative Services Contractor will screen the newborn's eligibility for Medicaid, and disenrollment then CHIP (a) The HHSC Administrative if the newborn is not eligible for Medicaid). If the newborn is eligible for CHIP, the Adminstrative Services Contractor will electronically transmit to enroll the HMO new newborn in the mother's CHIP Perinate Member information based on plan prospectively, following standard cut-off rules. The newborn's CHIP eligibility ends when the appropriate mother's CHIP Perinate or CHIP Perinate Newborn Rate Cell. There is no waiting period for CHIP Perinatal Program Memberseligibility expires, as described above. (b) CHIP Perinate Newborns are eligible for 12 months continuous enrollment, beginning with the month of enrollment as a CHIP Perinate (month of enrollment plus 11 months). A CHIP Perinate Newborn will maintain coverage in his or her CHIP Perinatal health plan.