Common use of Special Temporary STAR Default Process Clause in Contracts

Special Temporary STAR Default Process. (a) STAR HMOs that did not contract with HHSC prior to the Effective Date of the Contract to provide Medicaid Health Care Services will be assigned a limited number of Medicaid-eligibles, who have not actively made a STAR HMO choice, for a finite period. The number will vary by Service Area as set forth below. To the extent possible, the special default assignment will be based on each eligible’s prior history with a PCP and geographic proximity to a PCP. (b) For the Bexar, Dallas, El Paso, Harris, Tarrant, and Xxxxxx Service Areas, the special default process will begin with the Operational Start Date and conclude when the HMO has achieved an enrollment of 15,000 mandatory STAR members, or at the end of six months, whichever comes first. (c) For the Lubbock Service Area, the special default process will begin with the Operational Start Date and conclude when the HMO has achieved an enrollment of 5,000 mandatory STAR members, or at the end of six months, whichever comes first. (d) Special default periods may be extended for one or more Service Areas if consistent with HHSC administrative rules. (e) This Section does not apply to the Nueces Service Area.

Special Temporary STAR Default Process. (a) STAR HMOs that did not contract with HHSC prior to the Effective Date of the Contract to provide Medicaid Health Care Services will be assigned a limited number of Medicaid-eligibles, who have not actively made a STAR HMO choice, for a finite period. The number will vary by Service Area as set forth below. To the extent possible, the special default assignment will be based on each eligible’s prior history with a PCP and geographic proximity to a PCP. (b) For the Bexar, Dallas, El Paso, HarrisXxxxxx, Tarrant, and Xxxxxx Service Areas, the special default process will begin with the Operational Start Date and conclude when the HMO has achieved an enrollment of 15,000 mandatory STAR members, or at the end of six months, whichever comes first. (c) For the Lubbock Service Area, the special default process will begin with the Operational Start Date and conclude when the HMO has achieved an enrollment of 5,000 mandatory STAR members, or at the end of six months, whichever comes first. (d) Special default periods may be extended for one or more Service Areas if consistent with HHSC administrative rules. (e) This Section does not apply to the Nueces Service Area.