Common use of Redetermination Assistance Clause in Contracts

Redetermination Assistance. The Contractor may assist its members in the eligibility redetermination process. Permitted assistance includes:  Conducting outreach calls or sending letters to members reminding them to renew their eligibility and reviewing redetermination requirements with the member;  Answering questions about the redetermination process; and  Helping the member obtain required documentation and collateral verification needed to process the application. In providing assistance during redetermination, Contractor shall not do any of the following:  Discriminate against members, including particularly high-cost members or members that have indicated a desire to change MCEs;  Talk to members about changing MCEs;  All requests to change MCEs shall be referred to the Enrollment Broker. However, if during the outreach process the member raises a concern and would like to change MCEs due to the concern, the Contractor shall attempt to resolve the member’s concern. If the member remains dissatisfied with the outcome, the Contractor shall refer him or her to the Enrollment Broker;  Provide any indication as to whether the member will be eligible (this decision must be made by DFR);  Engage in or support fraudulent activity in association with helping the member complete the redetermination process;  Sign the member’s redetermination form; or  Complete or send redetermination materials to DFR on behalf of the member. Contractors must provide redetermination assistance equally across the membership and be able to demonstrate to FSSA that their redetermination-related procedures are applied consistently for each member. In accordance with the State’s status as a 1634 state, SSI members are automatically enrolled in Medicaid without a separate application required to Medicaid. Eligibility in Medicaid for SSI recipients is maintained without the need for an annual Medicaid redetermination. Therefore, the Contractor shall ensure redetermination assistance activities are not provided to SSI members.

Redetermination Assistance. The Contractor may shall assist its members in the eligibility redetermination process. Permitted assistance includes:  ▪ Conducting outreach calls or sending letters to members reminding them to renew their eligibility and reviewing redetermination requirements with the member;  ▪ Answering questions about the redetermination process; and  ▪ Helping the member obtain required documentation and collateral verification needed to process the application. In providing assistance during redetermination, Contractor shall not do any of the following:  ▪ Discriminate against members, including particularly high-cost members or members that have indicated a desire to change MCEs;  ▪ Talk to members about changing MCEs;  ▪ All requests to change MCEs shall be referred to the Enrollment Broker. However, if during the outreach process the member raises a concern and would like to change MCEs due to the concern, the Contractor shall attempt to resolve the member’s concern. If the member remains dissatisfied with the outcome, the Contractor shall refer him or her to the Enrollment Broker;  ▪ Provide any indication as to whether the member will be eligible (this decision must be made by DFRDFR employees);  ▪ Engage in or support fraudulent activity in association with helping the member complete the redetermination process;  ▪ Sign the member’s redetermination form; or  ▪ Complete or send redetermination materials to DFR on behalf of the member. Contractors must shall provide redetermination assistance equally across the membership and be able to demonstrate to FSSA that their redetermination-related procedures are applied consistently for each member. In accordance with the State’s status as a 1634 state, SSI members are automatically enrolled in Medicaid without a separate application required to Medicaid. Eligibility in Medicaid for SSI recipients is maintained without the need for an annual Medicaid redetermination. Therefore, the Contractor shall ensure redetermination assistance activities are not provided to SSI members.

Redetermination Assistance. The Contractor may shall assist its members in the eligibility redetermination process. Permitted assistance includes:  ▪ Conducting outreach calls or sending letters to members reminding them to renew their eligibility and reviewing redetermination requirements with the member;  ▪ Answering questions about the redetermination process; and  ▪ Helping the member obtain required documentation and collateral verification needed to process the application. ▪ Referring eligibility related questions to the DFR. In providing assistance during redetermination, Contractor shall not do any of the following:  ▪ Discriminate against members, including particularly high-cost members or members that have indicated a desire to change MCEs;  ▪ Talk to members about changing MCEs;  ▪ All requests to change MCEs shall be referred to the Enrollment Broker. However, if during the outreach process the member raises a concern and would like to change MCEs due to the concern, the Contractor shall attempt to resolve the member’s concern. If the member remains dissatisfied with the outcome, the Contractor shall refer him or her to the Enrollment Broker;  ▪ Provide any indication as to whether the member will be eligible (this decision must be made by DFRDFR employees);  ▪ Engage in or support fraudulent activity in association with helping the member complete the redetermination process;  ▪ Sign the member’s redetermination form; or  ▪ Complete or send redetermination materials to DFR on behalf of the member. Contractors must shall provide redetermination assistance equally across the membership and be able to demonstrate to FSSA that their redetermination-related procedures are applied consistently for each member. In accordance with the State’s status as a 1634 state, SSI members are automatically enrolled in Medicaid without a separate application required to Medicaid. Eligibility in Medicaid for SSI recipients is maintained without the need for an annual Medicaid redetermination. Therefore, the Contractor shall ensure redetermination assistance activities are not provided to SSI members.

Redetermination Assistance. The Contractor may shall assist its members in the eligibility redetermination process. Permitted assistance includes:  • Conducting outreach calls or sending letters to members reminding them to renew their eligibility and reviewing redetermination requirements with the member;  • Answering questions about the redetermination process; and  • Helping the member obtain required documentation and collateral verification needed to process the application. In providing assistance during redetermination, Contractor shall not do any of the following:  • Discriminate against members, including particularly high-cost members or members that have indicated a desire to change MCEs;  • Talk to members about changing MCEs;  • All requests to change MCEs shall be referred to the Enrollment Broker. However, if during the outreach process the member raises a concern and would like to change MCEs due to the concern, the Contractor shall attempt to resolve the member’s concern. If the member remains dissatisfied with the outcome, the Contractor shall refer him or her to the Enrollment Broker;  • Provide any indication as to whether the member will be eligible (this decision must be made by DFRDFR employees);  • Engage in or support fraudulent activity in association with helping the member complete the redetermination process;  • Sign the member’s redetermination form; or  • Complete or send redetermination materials to DFR on behalf of the member. Contractors must shall provide redetermination assistance equally across the membership and be able to demonstrate to FSSA that their redetermination-related procedures are applied consistently for each member. In accordance with the State’s status as a 1634 state, SSI members are automatically enrolled in Medicaid without a separate application required to Medicaid. Eligibility in Medicaid for SSI recipients is maintained without the need for an annual Medicaid redetermination. Therefore, the Contractor shall ensure redetermination assistance activities are not provided to SSI members.

Redetermination Assistance. The Contractor may assist its members in the eligibility redetermination process. Permitted assistance includes:  Conducting outreach calls or sending letters to members reminding them to renew their eligibility and reviewing redetermination requirements with the member;  Answering questions about the redetermination process; and  Helping the member obtain required documentation and collateral verification needed to process the application. In providing assistance during redetermination, Contractor shall not do any of the following:  Discriminate against members, including particularly high-cost members or members that have indicated a desire to change MCEs;  Talk to members about changing MCEs;  All requests to change MCEs shall be referred to the Enrollment Broker. However, if during the outreach process the member raises a concern and would like to change MCEs due to the concern, the Contractor shall attempt to resolve the member’s concern. If the member remains dissatisfied with the outcome, the Contractor shall refer him or her to the Enrollment Broker;  Provide any indication as to whether the member will be eligible (this decision must be made by DFR);  Engage in or support fraudulent activity in association with helping the member complete the redetermination process;  Sign the member’s redetermination form; or  Complete or send redetermination materials to DFR on behalf of the member. Contractors must provide redetermination assistance equally across the membership and be able to demonstrate to FSSA that their redetermination-related procedures are applied consistently for each member. In accordance with the State’s status as a 1634 state, SSI members are automatically enrolled in Medicaid without a separate application required to Medicaid. Eligibility in Medicaid for SSI recipients is maintained without the need for an annual Medicaid redetermination. Therefore, the Contractor shall ensure redetermination assistance activities are not provided to SSI members.

Redetermination Assistance. The Contractor may assist its members in the eligibility redetermination process. Permitted assistance includes:  Conducting outreach calls or sending letters to members reminding them to renew their eligibility and reviewing redetermination requirements with the member;  Answering questions about the redetermination process; and  Helping the member obtain required documentation and collateral verification needed to process the application. In providing assistance during redetermination, Contractor shall not do any of the following:  Discriminate against members, including particularly high-cost members or members that have indicated a desire to change MCEs;  Talk to members about changing MCEs;  All requests to change MCEs shall be referred to the Enrollment Broker. However, if EXHIBIT 1.M SCOPE OF WORK during the outreach process the member raises a concern and would like to change MCEs due to the concern, the Contractor shall attempt to resolve the member’s concern. If the member remains dissatisfied with the outcome, the Contractor shall refer him or her to the Enrollment Broker;  Provide any indication as to whether the member will be eligible (this decision must be made by DFR);  Engage in or support fraudulent activity in association with helping the member complete the redetermination process;  Sign the member’s redetermination form; or  Complete or send redetermination materials to DFR on behalf of the member. Contractors must provide redetermination assistance equally across the membership and be able to demonstrate to FSSA that their redetermination-related procedures are applied consistently for each member. In accordance with the State’s status as a 1634 state, SSI members are automatically enrolled in Medicaid without a separate application required to Medicaid. Eligibility in Medicaid for SSI recipients is maintained without the need for an annual Medicaid redetermination. Therefore, the Contractor shall ensure redetermination assistance activities are not provided to SSI members.

Redetermination Assistance. The Contractor may shall assist its members in the eligibility redetermination process. Permitted assistance includes:  • Conducting outreach calls or sending letters to members reminding them to renew their eligibility and reviewing redetermination requirements with the member;  • Answering questions about the redetermination process; and  • Helping the member obtain required documentation and collateral verification needed to process the application. • Referring eligibility related questions to the DFR. • In providing assistance during redetermination, Contractor shall not do any of the following:  • Discriminate against members, including particularly high-cost members or members that have indicated a desire to change MCEs;  • Talk to members about changing MCEs;  • All requests to change MCEs shall be referred to the Enrollment Broker. However, if during the outreach process the member raises a concern and would like to change MCEs due to the concern, the Contractor shall attempt to resolve the member’s concern. If the member remains dissatisfied with the outcome, the Contractor shall refer him or her to the Enrollment Broker;  • Provide any indication as to whether the member will be eligible (this decision must be made by DFRDFR employees);  • Engage in or support fraudulent activity in association with helping the member complete the redetermination process;  • Sign the member’s redetermination form; or  • Complete or send redetermination materials to DFR on behalf of the member. Contractors must shall provide redetermination assistance equally across the membership and be able to demonstrate to FSSA that their redetermination-related procedures are applied consistently for each member. In accordance with the State’s status as a 1634 state, SSI members are automatically enrolled in Medicaid without a separate application required to Medicaid. Eligibility in Medicaid for SSI recipients is maintained without the need for an annual Medicaid redetermination. Therefore, the Contractor shall ensure redetermination assistance activities are not provided to SSI members.

Redetermination Assistance. The Contractor may shall assist its members in the eligibility redetermination process. Permitted assistance includes:  • Conducting outreach calls or sending letters to members reminding them to renew their eligibility and reviewing redetermination requirements with the member;  • Answering questions about the redetermination process; and  • Helping the member obtain required documentation and collateral verification needed to process the application. In providing assistance during redetermination, Contractor shall not do any of the following:  • Discriminate against members, including particularly high-cost members or members that have indicated a desire to change MCEs;  • Talk to members about changing MCEs;  • All requests to change MCEs shall be referred to the Enrollment Broker. However, if during the outreach process the member raises a concern and would like to change MCEs due to the concern, the Contractor shall attempt to resolve the member’s concern. If the member remains dissatisfied with the outcome, the Contractor shall refer him or her to the Enrollment Broker;  • Provide any indication as to whether the member will be eligible (this decision must be made by DFRDFR employees);  • Engage in or support fraudulent activity in association with helping the member EXHIBIT 1 SCOPE OF WORK complete the redetermination process;  • Sign the member’s redetermination form; or  • Complete or send redetermination materials to DFR on behalf of the member. Contractors must shall provide redetermination assistance equally across the membership and be able to demonstrate to FSSA that their redetermination-related procedures are applied consistently for each member. In accordance with the State’s status as a 1634 state, SSI members are automatically enrolled in Medicaid without a separate application required to Medicaid. Eligibility in Medicaid for SSI recipients is maintained without the need for an annual Medicaid redetermination. Therefore, the Contractor shall ensure redetermination assistance activities are not provided to SSI members.

Redetermination Assistance. The Contractor may shall assist its members in the eligibility redetermination process. Permitted assistance includes:  • Conducting outreach calls or sending letters to members reminding them to renew their eligibility and reviewing redetermination requirements with the member;  • Answering questions about the redetermination process; and  • Helping the member obtain required documentation and collateral verification needed to process the application. • Referring eligibility related questions to the DFR. In providing assistance during redetermination, Contractor shall not do any of the following:  • Discriminate against members, including particularly high-cost members or members that have indicated a desire to change MCEs;  • Talk to members about changing MCEs;  • All requests to change MCEs shall be referred to the Enrollment Broker. However, if during the outreach process the member raises a concern and would like to change MCEs due to the concern, the Contractor shall attempt to resolve the member’s concern. If the member remains dissatisfied with the outcome, the Contractor shall refer him or her to the Enrollment Broker;  • Provide any indication as to whether the member will be eligible (this decision must be made by DFRDFR employees);  • Engage in or support fraudulent activity in association with helping the member complete the redetermination process;  • Sign the member’s redetermination form; or  • Complete or send redetermination materials to DFR on behalf of the member. Contractors must shall provide redetermination assistance equally across the membership and be able to demonstrate to FSSA that their redetermination-related procedures are applied consistently for each member. In accordance with the State’s status as a 1634 state, SSI members are automatically enrolled in Medicaid without a separate application required to Medicaid. Eligibility in Medicaid for SSI recipients is maintained without the need for an annual Medicaid redetermination. Therefore, the Contractor shall ensure redetermination assistance activities are not provided to SSI members.

Redetermination Assistance. The Contractor may assist its members in the eligibility redetermination process. Permitted assistance includes:  Conducting outreach calls or sending letters to members reminding them to renew their eligibility and reviewing redetermination requirements with the member;  Answering questions about the redetermination process; and and EXHIBIT 1. M SCOPE OF WORK  Helping the member obtain required documentation and collateral verification needed to process the application. In providing assistance during redetermination, Contractor shall not do any of the following:  Discriminate against members, including particularly high-cost members or members that have indicated a desire to change MCEs;  Talk to members about changing MCEs;  All requests to change MCEs shall be referred to the Enrollment Broker. However, if during the outreach process the member raises a concern and would like to change MCEs due to the concern, the Contractor shall attempt to resolve the member’s concern. If the member remains dissatisfied with the outcome, the Contractor shall refer him or her to the Enrollment Broker;  Provide any indication as to whether the member will be eligible (this decision must be made by DFR);  Engage in or support fraudulent activity in association with helping the member complete the redetermination process;  Sign the member’s redetermination form; or  Complete or send redetermination materials to DFR on behalf of the member. Contractors must provide redetermination assistance equally across the membership and be able to demonstrate to FSSA that their redetermination-related procedures are applied consistently for each member. In accordance with the State’s status as a 1634 state, SSI members are automatically enrolled in Medicaid without a separate application required to Medicaid. Eligibility in Medicaid for SSI recipients is maintained without the need for an annual Medicaid redetermination. Therefore, the Contractor shall ensure redetermination assistance activities are not provided to SSI members.