State Level Enrollment and Disenrollment Operations Requirements Sample Clauses

State Level Enrollment and Disenrollment Operations Requirements a. Eligible Populations/Excluded Populations - As described in the body of the MOU. b. Enrollment and Disenrollment Processes – Enrollment and disenrollment transactions will be processed by the State Enrollment Broker, consistent with the enrollment effective date requirements outlined in the Medicare-Medicaid Plan Enrollment and Disenrollment Guidance. The State Enrollment Broker will submit enrollment transactions to the CMS Medicare Advantage Prescription Drug (XXXx) enrollment system directly or via a third party CMS designates to receive such transactions. CMS will also submit a file to the State Enrollment Broker and the FIDA-IDD Plan identifying individuals who have elected to disenroll from the FIDA-IDD Plan. The State Enrollment Broker and CMS will both share Enrollment and disenrollment transactions with the contracted FIDA-IDD Plan. The contracted FIDA-IDD Plan will have XXXx connectivity and comply with all required Medicare Part C and D Enrollment transaction and reply code timelines and will have connectivity with the State Enrollment Broker. c. Enrollment Notices – Before they are finalized, Enrollment notices will be made available to the public for comment by both CMS and the State. d. Opt-in Enrollment Only - There is no Passive Enrollment for the FIDA-IDD Demonstration. All Enrollment in the FIDA-IDD Demonstration is via Opt-in Enrollment, in which eligible individuals actively choose to enroll in the FIDA-IDD Plan. e. Enrollment and Disenrollment Effective Date(s) – All Enrollment effective dates are prospective. Participant-elected Enrollment is effective the first calendar day of the month following the initial receipt of a Participant’s request to enroll. The FIDA-IDD Plan will be required to accept Opt-in Enrollments of eligible individuals no earlier than 30 calendar days prior to the initial effective date of no earlier than April 1, 2016, and begin providing coverage for enrolled individuals no earlier than April 1, 2016. Participant requests to cancel Enrollment will be accepted any time before the Enrollment Effective Date. Requests to disenroll from the FIDA-IDD Plan will be accepted at any point after a Participant’s initial Enrollment occurs and will be effective on the first of the month following receipt of the request. Any time an individual requests to disenroll from the Demonstration, the State will send a letter confirming the disenrollment and providing information on the benefits available to the Participant once th...
Sample 1
AutoNDA by SimpleDocs
State Level Enrollment and Disenrollment Operations Requirements a) Eligible Populations – All individuals enrolling in or currently enrolled in MSHO will be a part of this Demonstration, as described in the body of the MOU.
Sample 1
State Level Enrollment and Disenrollment Operations Requirements a. Eligible Populations/Excluded Populations - As described in the body of the MOU. b. Enrollment, and Disenrollment Processes – All enrollment and disenrollment transactions, including enrollments from one ICO to a different ICO, will be processed through the Michigan Enrollment Broker, except those transactions related to non-Demonstration plans participating in Medicare Advantage. Michigan Medicaid (or its vendor) will submit enrollment transactions to the CMS Medicare Advantage Prescription Drug (XXXx) enrollment system directly or via a third party CMS designates to receive such transactions. CMS will also submit a file to Michigan Medicaid identifying individuals who have elected a Medicare Advantage plan that is not an ICO. CMS will also submit a file to Michigan Medicaid identifying individuals who called 0-000-XXXXXXXX and chose to opt-out. Michigan Medicaid will share enrollment, disenrollment and opt-out transactions with contracted ICOs and Prepaid Inpatient Health Plans (PIHPs). c. Uniform Enrollment/ Disenrollment and Opt-Out Letter and Forms - Letters and forms will be made available to stakeholders by both CMS and MDCH. d. Enrollment Effective Date(s) - All enrollment effective dates are prospective. Beneficiary-elected enrollment is effective the first calendar day of the month following the initial receipt of a beneficiary’s request to enroll, or the first day of the month following the month in which the beneficiary is eligible, as applicable for an individual enrollee. MDCH will conduct phased in periods for opt-in and passive enrollment. i. Opt-in: The State will initially conduct two phased opt-in periods. ICOs will be required to accept opt-in enrollments no earlier than 30-days prior to the initial effective date as outlined below. Opt-in enrollments will be phased in prior to passive enrollment. a) Phase 1: Beneficiaries in Region 1 (Alger, Baraga, Chippewa, Delta, Xxxxxxxxx, Gogebic, Houghton, Iron, Keweenaw, Xxxx, Mackinac, Marquette, Menominee, Ontonagon, and Schoolcraft counties) and Region 4 (Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, Saint Xxxxxx, and Van Buren counties) will be able to opt in beginning no earlier than October 1, 2014 with an enrollment effective date of January 1, 2015. b) Phase 2: Beneficiaries in Region 7 (Xxxxx County) and Region 9 (Macomb County) will be able to opt in no earlier than March 1, 2015 with an enrollment effective date of May 1, 2015. The State or the Michigan Enrollment Broker will p...
Sample 1
State Level Enrollment and Disenrollment Operations Requirements 
Sample 1

Related to State Level Enrollment and Disenrollment Operations Requirements

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • Disenrollment An Enrollee must be disenrolled from the Plan if the Beneficiary: a. No longer resides in the State of Mississippi; b. Is deceased; c. No longer qualifies for medical assistance under one of the Medicaid eligibility categories in the targeted population. The Contractor must notify the Division within three (3) days of their request that an Enrollee is disenrolled for a reason listed above and provide written documentation of disenrollment. Disenrollment shall be effective on the first day of the calendar month for which the disenrollment appears on the Enrollee Listing Report. The Contractor shall not disenroll an Enrollee because of an adverse change in the Enrollee’s health status, or because of the Enrollee’s utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from Enrollee’s special needs (except when Enrollee’s continued enrollment in the CCO seriously impairs the Contractor’s ability to furnish services to either this particular Enrollee or other Enrollees.) The Contractor must file a request to disenroll an Enrollee with the Division in writing stating specifically the reasons for the request if the reasons are for other than those specified above. An Enrollee may request disenrollment without cause during the ninety (90) days following the date the Division sends the Enrollee notice of enrollment or the date of the Enrollee’s initial enrollment, whichever is later, during the annual open enrollment period, upon automatic reenrollment if the temporary loss of Medicaid eligibility has caused the Enrollee to miss the annual disenrollment opportunity, or when the Division imposes an intermediate sanction on the Contractor as specified in this Contract. An Enrollee may request disenrollment from the CCO for cause if the CCO does not, because of moral or religious objections, cover the service the Enrollee seeks, the Enrollee needs related services to be performed at the same time, not all related services are available within the network, the Enrollee’s primary care provider or another provider determines receiving the services separately would subject Enrollee to unnecessary risk, poor quality of care, lack of access to services covered under the Plan, or lack of access to providers experienced in dealing with the Enrollee’s health care needs. Enrollee requests for disenrollment must be directed to the Division either orally or in writing. The effective date of any approved disenrollment will be no later than the first day of the second month following the month in which the Enrollee or the Plan files the request with the Division.

  • Enrollment Process The Department may, at any time, revise the enrollment procedures. The Department will advise the Contractor of the anticipated changes in advance whenever possible. The Contractor shall have the opportunity to make comments and provide input on the changes. The Contractor will be bound by the changes in enrollment procedures.

  • Enrollment Requirements You must maintain with Blue Cross and Blue Shield a current and updated listing of covered employees. You will be responsible for all claims costs and expenses associated with failure to maintain an accurate and current listing with Blue Cross and Blue Shield, unless such claims costs and expenses are due to an error on Blue Cross and Blue Shield’s part. In order to maintain health care coverage with Blue Cross and Blue Shield, an employee must meet the written eligibility requirements (such as length of service, active employment and number of hours worked) you impose as long as they do not conflict with Blue Cross and Blue Shield’s eligibility requirements. An eligible employee as defined by Blue Cross and Blue Shield means: • A permanent full-time employee regularly working 30 hours or more each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A permanent part-time employee regularly working at least 20 hours but less than 30 hours each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A disabled permanent full-time or part-time employee who is actively working despite the disability (including one who is engaged in a trial work period) and a disabled employee who is not actively working but whom the employer treats as an employee; or • A former employee (or a former covered dependent of the employee of the group) who qualifies for continued group coverage under federal or state law, but only if the employer maintains Blue Cross and Blue Shield group coverage for permanent full-time employees as defined in (a) above; or • A retired employee of the employer. Newly hired employees who are eligible for group benefits can enroll in the benefits plan according to your eligibility requirements for coverage, provided that your requirements comply with Blue Cross and Blue Shield’s eligibility and enrollment requirements. The effective date of an eligible employee’s (or his or her dependent’s) membership in the benefits plan may be the Member’s initial eligibility date or your subsequent anniversary/renewal date, as long as: (a) Blue Cross and Blue Shield receives your written notice no later than 30 days after the Member’s enrollment notification period applicable to membership modifications (as described in the Subscriber Certificate for your benefits plan); and (b) you pay the applicable premium charges.

  • Technical Objections to Grievances It is the intent of both Parties of this Agreement that no grievance shall be defeated merely because of a technical error, other than time limitations in processing the grievance through the grievance procedure. To this end, an arbitration board shall have the power to allow all necessary amendments to the grievance and the power to waive formal procedural irregularities in the processing of a grievance, in order to determine the real matter in dispute and to render a decision according to equitable principles and the justice of the case.

  • Credentialing Requirements Registry Operator, through the facilitation of the CZDA Provider, will request each user to provide it with information sufficient to correctly identify and locate the user. Such user information will include, without limitation, company name, contact name, address, telephone number, facsimile number, email address and IP address.

  • Claims Review Population A description of the Population subject to the Claims Review.

  • Staffing Plan The Board and the Association agree that optimum class size is an important aspect of the effective educational program. The Polk County School Staffing Plan shall be constructed each year according to the procedures set forth in Board Policy and, upon adoption, shall become Board Policy.

  • Money Market Fund Compliance Testing and Reporting Services Subject to the authorization and direction of the Trust and, in each case where appropriate, the review and comment by the Trust’s independent accountants and legal counsel, and in accordance with procedures that may be established from time to time between the Trust and the Administrator, the Administrator will:

  • Open Enrollment KFHPWA will allow enrollment of Subscribers and Dependents who did not enroll when newly eligible as described above during a limited period of time specified by the Group and KFHPWA.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!