State Level Enrollment Operations Requirements a. Eligible Populations/Excluded Populations - As described in the body of the MOU.
b. Enrollment and Disenrollment Processes - All Enrollment and Disenrollment- related transactions, including transfers between Demonstration Plans, will be processed through the Illinois Client Enrollment Services (CES). The State 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 the State identifying individuals who have elected to enroll in another type of available Medicare coverage. The State or its designated contractor will share enrollment and disenrollment transactions with Demonstration Plans.
c. Uniform Enrollment and Disenrollment Letter and Forms - Letters and forms will be agreed to by both CMS and the State. Over-the-phone Enrollment through the CES is the primary method of Enrollment. Beneficiaries may only receive a paper Enrollment form by requesting one from the CES.
d. Enrollment Effective Date(s) - All enrollment effective dates are prospective. Beneficiary-elected enrollments are effective the first day of the month following a beneficiary’s request to enroll, so long as the request is received by the 12th of the month. Enrollment requests, including requests to change among Demonstration Plans, received after the 12th of the month will be effectuated the first of the second month following the request. Passive Enrollment is effective not sooner than 60 days after beneficiary notification. CMS and the State will monitor input received by the Ombudsman and Demonstration Plans about the time between the beneficiary’s Enrollment request and the effective date of Enrollment. After the first year of the Demonstration, or when the State updates its eligibility systems, the State and CMS will also revisit the timeline for processing enrollments and, if necessary, will shorten the time period between the beneficiary’s Enrollment request and the effective date of enrollment. All disenrollment requests will be effective the first day of the month following a beneficiary’s request to disenroll from the Demonstration.
i. Demonstration Plans will be required to accept opt-in enrollments no earlier than 90 days prior to the initial effective date of October 1, 2013, and Demonstration Plans must begin providing coverage for those enrolled individuals on October 1, 2013. Each Demonstration Pl...
State Level Enrollment Operations Requirements a. Eligible Populations/Excluded Populations - As described in the body of the MOU.
b. Enrollment and Disenrollment Processes - All enrollments and disenrollment- related transactions will be processed through the MassHealth Customer Service Team (CST) vendor. MassHealth (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.
c. Uniform Enrollment and Disenrollment Letter and Forms - Letters and forms will be appended to the three-way contract when they are completed and agreed to by both CMS and the Commonwealth.
d. Enrollment Effective Date(s) - All enrollment effective dates are prospective. Beneficiary-elected enrollment is the first day of the month following receipt of an eligible 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. Passive enrollment is effective not sooner than 60 days after beneficiary notification.
i. ICOs will be required to accept enrollments no earlier than January 1, 2013 for an effective date of April 1, 2013 and begin providing coverage for enrolled individuals on April 1, 2013.
ii. The Commonwealth will initially conduct two passive enrollment periods. The effective dates for the two periods are tentatively July 1, 2013 and October 1, 2013, subject to Participating Plans meeting CMS and Commonwealth requirements including Plans’ capacity to accept new Enrollees. The Commonwealth will provide notice of passive enrollments at least 60 days prior to the effective dates to eligible individuals, and will accept opt-out requests prior to the effective date of enrollment. Individuals who otherwise would be eligible for Medicare reassignment in 2013 or 2014 from their current (2012 or 2013, respectively) Medicare Prescriptions Drug Plan (PDP) or terminating Medicare Advantage Prescription Drug Plan (MA-PD) to another PDP, will be eligible for passive enrollment, with an opportunity to opt-out, into a Demonstration Plan effective January 1, 2014. The Commonwealth and CMS must agree in writing to any changes to the enrollment effective dates.
iii. Following this start-up period, members who are eligible for the Demonstration and who have neither selected a Plan nor opted out of the Demonstration will receive a notice of passive enrollment into an ICO and an enrollment package that de...
State Level Enrollment Operations Requirements. A. Eligible Populations/Excluded Populations: As described in the body of the MOU.
State Level Enrollment Operations Requirements. A. Eligible Populations/Excluded Populations - As described in the body of the MOU.
B. Enrollment and Disenrollment Processes - All enrollments and disenrollment- related transactions will be processed through DMAS’s contracted Enrollment Facilitator, except those transactions related to non-Demonstration plans participating in Medicare Advantage. DMAS (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 DMAS identifying individuals who have elected to disenroll from a Participating Plan, opt-out of passive enrollment, or enroll in another type of available Medicare coverage. DMAS will share enrollment, disenrollment and opt-out transactions with contracted Participating Plans.
C. Uniform Enrollment and Disenrollment Letter and Forms - Letters and forms will be made available to stakeholders by both CMS and DMAS.
D. Enrollment Effective Date(s) - All enrollment effective dates are prospective. Beneficiary-elected enrollment is the first day of the month following a beneficiary’s request to enroll, so long as the request is received by the 25th of the month. Enrollment requests, including requests to change among Participating Plans, received after the 25th of the month will be effectuated the first of the second month following the request. Passive Enrollment is effective not sooner than 60 days after beneficiary notification. All disenrollment requests will be effective the first day of the month following a beneficiary’s request to disenroll from the Demonstration. Passive enrollment is effective no sooner than 60 days after beneficiary notification of the right to select a Participating Plan.
1. Under the Demonstration, DMAS will conduct a regional phase-in. Phase I will impact Central Virginia and Tidewater. Phase II will impact Western/Charlottesville, Northern Virginia, and Roanoke.
2. Each regional phase-in will consist of an opt-in and a passive enrollment period for those beneficiaries who have not made a plan selection.
3. Phase I will take place in Central Virginia and Tidewater. Participating Plans will begin marketing for opt-in enrollment for Phase I no sooner than January 1, 2014, with those opting into the Demonstration being able to receive services the following month (e.g., an individuals who opts in January 5, 2014 will begin receiving services on February 1, 20...
State Level Enrollment Operations Requirements a. Eligible Populations/Excluded Populations - As described in the body of the MOU.
b. Enrollment and Disenrollment Processes - All enrollments and disenrollment- related transactions will be processed through Wisconsin’s interChange system. DHS (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.
c. Uniform Enrollment and Disenrollment Letter and Forms - Letters and forms will be appended to the three-way contract when they are completed and agreed to by both CMS and the State.
d. Enrollment Effective Date(s) - All enrollment effective dates are prospective. Beneficiary-elected enrollment is the first day of the month following receipt of an eligible 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. Passive enrollment is effective not sooner than 60 days after beneficiary notification.
i. ICOs will be required to accept enrollments two months prior to the date on which they begin providing coverage .
ii. The State will initially conduct a passive enrollment period effective the first date of the month in which the demonstration begins in a given county, subject to Participating Plans meeting CMS and State requirements including Plans’ capacity to accept new Enrollees. The State will provide notice of passive enrollments at least 60 days prior to the effective dates to eligible individuals, and will accept opt-out requests prior to the effective date of enrollment. Individuals who otherwise would be in the voluntary enrollment eligible group due to enrollment in another plan or program who subsequently disenroll from the other plan or program will be eligible for passive enrollment, with an opportunity to opt-out, into a Demonstration Plan upon their disenrollment from the other plan or program.. The State and CMS must agree in writing to any changes to the enrollment effective dates.
iii. Following this start-up period, members who are eligible for the Demonstration and who have neither selected a Plan nor opted out of the Demonstration will receive a notice of passive enrollment into an ICO and an enrollment package that describes their options, including that of opting out of the Demonstration. Members will then have 60 days to select a different ICO or opt out of the Demonstration. DHS will procee...
State Level Enrollment 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 will be processed through the Ohio Enrollment vendor, except those transactions related to non-Demonstration plans participating in Medicare Advantage. Ohio 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 Ohio Medicaid identifying individuals who have elected a Medicare Advantage plan that is not an ICDS Plan. Ohio Medicaid will share enrollment, disenrollment and opt-out transactions with contracted ICDS Plans.
c. Uniform Enrollment/ Transfer and Opt-Out Letter and Forms - Letters and forms will be made available to stakeholders by both CMS and the State.
d. Enrollment Effective Date(s) - All enrollment effective dates are prospective. Beneficiary-elected enrollment is the first day of the month following 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. Passive enrollment is effective no sooner than 60 days after beneficiary notification of the right to select an ICDS Plan. 1 The selections are posted at the following web address: xxxx://xxx.xxxxxxxxxxxxxxxxxxxx.xxxx.xxx/LinkClick.aspx?fileticket=CEnFHbwxoYg%3d&tabid=105
i. ICDS Plans will be required to accept opt-in enrollments no earlier than 90-days prior to the initial effective date of September 1, 2013, and begin providing coverage for enrolled individuals on September 1, 2013.
ii. The State will initially conduct three passive enrollment periods for those beneficiaries who have not made a plan selection. The effective dates for the first three of these periods are tentatively as follows:
1. Beneficiaries in the Northeast region will have an enrollment effective date of October 1, 2013.
2. Beneficiaries in the Northwest, Northeast Central and Southwest regions will have an enrollment effective date of November 1, 2013.
3. Beneficiaries in the East Central, Central and West Central regions will have an enrollment effective date of December 1, 2013. The effective dates above are subject to ICDS Plans meeting CMS and State requirements including Plans’ capacity to accept new Enrollees. Effective September 1, 2013, beneficiaries...
