Common use of State Level Enrollment Operations Requirements Clause in Contracts

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 (▇▇▇▇) 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 Plan’s ability to accept opt-in enrollments, however, is contingent upon successfully passing the Readiness Review. The earliest effective date for Passive Enrollment will be January 1, 2014 as discussed below in d.ii. 1. CMS will provide an initial notice of the Demonstration opt-in enrollment period to all Demonstration eligible beneficiaries no earlier than 90 days prior to the start of the opt-in enrollment period. 2. The effective dates for opt-in and Passive Enrollment are subject to Demonstration Plans meeting CMS and State requirements, including Demonstration Plans’ capacity to accept new Enrollees. ii. The State will conduct monthly Passive Enrollments for those eligible beneficiaries who have not made a Demonstration Plan selection for effective enrollment beginning January 1, 2014 or otherwise opted out of the Demonstration. 1. During October 1, 2013 to December 31, 2013, CMS and the State will monitor each Demonstration Plans’ ability to manage the opt- in enrollments. Dependent on each Demonstration Plan’s capacity, as determined by its ability to manage the opt-in enrollments and the prior month’s Passive Enrollments (once applicable), the State will passively enroll a number of beneficiaries into Demonstration Plans that takes into consideration the number of opt-in Enrollments and the opt-out rate for each Demonstration Plan. Furthermore: a. In the Greater Chicago service area, the Passive Enrollment phase-in will not exceed 5,000 beneficiaries per month per Demonstration Plan and will occur over at least a 6-month period. However, the goal of the Passive Enrollment phase-in is to limit the number of beneficiaries assigned to each Demonstration Plan on a monthly basis without extending the phase-in beyond 6 months unless required to by the 5,000 monthly cap; and b. In the Central Illinois service area, the Passive Enrollment phase-in will occur over a 6 month period and will not exceed 3,000 beneficiaries per month per Demonstration Plan. 2. The State will provide notice of Passive Enrollments at least 60 days and no more than 90 days prior to the effective date of a Passive Enrollment period, and will accept opt-out requests prior to the effective date of enrollment. 3. The 60-day notice will include the name of the Demonstration Plan in which the beneficiary would be enrolled unless he/she selects another Demonstration Plan or indicates the option to opt out of the Demonstration. 4. At least thirty days prior to the enrollment effective dates above, the State will send a second notice to beneficiaries who have not responded to the initial notice or opted in. The CES may choose to call beneficiaries in addition to sending a notice, if appropriate. The State will proceed with Passive Enrollment into the identified Demonstration Plan for beneficiaries who do not make a different choice. iii. Beneficiaries who otherwise are included in Medicare reassignment to a different Medicare Prescription Drug Plan (PDP) effective January 1 of a given year (whether due to their previous year’s PDP’s premium increase or because their current PDP or Medicare Advantage Prescription Drug Plan (MA-PD) is terminating) will be eligible for Passive Enrollment, with an opportunity to opt out, into a Demonstration Plan. For example, those reassigned to a new PDP effective January 1, 2013, will be eligible for Passive Enrollment into a Demonstration Plan effective January 1, 2014, provided the individual meets the requirements of this Demonstration. iv. The State and CMS must agree in writing to any changes to the enrollment effective dates. CMS will provide identifying information to the State about beneficiaries that CMS anticipates will be reassigned for a January 1 of the following year effective date, no later than 120 days prior to the date of the first Passive Enrollment period. v. Beneficiaries who do not opt out of the Demonstration, and who are enrolled in a Medicare Advantage plan that is operated by the same parent organization that operates a Demonstration Plan, will be eligible for Passive Enrollment into the parent organization’s Demonstration Plan effective January 1, 2014. Eligible beneficiaries enrolled in a Medicare Advantage plan that is operated by a parent organization that is not offering a Demonstration Plan may enroll into the Demonstration if they elect to disenroll from their current Medicare Advantage plan. e. Disenrollment Effective Date(s) – Disenrollments are effective the first of the month following the request to opt-out of the Demonstration. The CES will also accept cancellations of opt-in enrollment requests, where the beneficiary submits an enrollment request but then cancels the enrollment prior to the effective date. f. Upon CMS’ or the State’s written determination that the Demonstration will not be renewed, no enrollments will be accepted within six months of the end of the Demonstration. g. Passive Enrollment activity will be coordinated with CMS activities such as Annual Reassignment and daily auto- and facilitated enrollment for individuals with the Medicare Part D LIS. h. The State will develop an “intelligent assignment” algorithm for Passive Enrollment (e.g. that prioritizes continuity of providers and/or services). The algorithm will consider beneficiaries’ previous managed care enrollment and historic provider utilization. i. The State or its Client Enrollment Services (CES) will provide customer service and options counseling, including mechanisms to counsel beneficiaries notified of Passive Enrollment. The CES will also receive and communicate beneficiary choice of opt-outs to CMS’s contractor, who will communicate the choice to CMS via transactions to CMS’ ▇▇▇▇ system. Beneficiaries will also be provided a notice upon completion of the opt-out process. Medicare resources, including 1-800-Medicare, will remain available to Medicare beneficiaries that disenroll from the Demonstration. Beneficiary requests made to 1-800-Medicare for Enrollment, changes among Demonstration Plans, or Disenrollment (when possible) will be referred to the State or its designated CES. j. The State or its vendor will provide notices, as approved by CMS, to ensure complete and accurate information is provided in concert with other Medicare communications, such as Medicare & You and Medicare Plan Finder. CMS may also send a notice to beneficiaries and will coordinate such notice with any State notice(s). k. Enrollment data in State and CMS systems will be reconciled on a timely basis to prevent discrepancies between such systems.

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 enrollments and Disenrollment- disenrollment- related transactions, including transfers between Demonstration Plans, transactions will be processed through the Illinois Client Enrollment Services MassHealth Customer Service Team (CES)CST) vendor. The State MassHealth (or its vendor vendor) will submit enrollment transactions to the CMS Medicare Advantage Prescription Drug (▇▇▇▇) 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 appended to the three-way contract when they are completed and 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 CESCommonwealth. d. Enrollment Effective Date(s) - All enrollment effective dates are prospective. Beneficiary-elected enrollments are effective enrollment is the first day of the month following a receipt of an eligible beneficiary’s request to enroll, so long as or the request is received by the 12th of the month. Enrollment requests, including requests to change among Demonstration Plans, received after the 12th first day of the month will be effectuated the first of the second month following the requestmonth in which the beneficiary is eligible, as applicable for an individual Enrollee. Passive Enrollment 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 ICOs will be required to accept opt-in enrollments no earlier than 90 days prior to the initial 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, and Demonstration Plans must begin providing coverage for those enrolled individuals on October 1, 2013. Each Demonstration Plan’s ability to accept opt-in enrollments, however, is contingent upon successfully passing the Readiness Review. The earliest effective date for Passive Enrollment will be January 1, 2014 as discussed below in d.ii. 1. CMS will provide an initial notice of the Demonstration opt-in enrollment period to all Demonstration eligible beneficiaries no earlier than 90 days prior to the start of the opt-in enrollment period. 2. The effective dates for opt-in and Passive Enrollment are subject to Demonstration Participating Plans meeting CMS and State requirements, Commonwealth requirements including Demonstration Plans’ capacity to accept new Enrollees. ii. The State will conduct monthly Passive Enrollments for those eligible beneficiaries who have not made a Demonstration Plan selection for effective enrollment beginning January 1, 2014 or otherwise opted out of the Demonstration. 1. During October 1, 2013 to December 31, 2013, CMS and the State will monitor each Demonstration Plans’ ability to manage the opt- in enrollments. Dependent on each Demonstration Plan’s capacity, as determined by its ability to manage the opt-in enrollments and the prior month’s Passive Enrollments (once applicable), the State will passively enroll a number of beneficiaries into Demonstration Plans that takes into consideration the number of opt-in Enrollments and the opt-out rate for each Demonstration Plan. Furthermore: a. In the Greater Chicago service area, the Passive Enrollment phase-in will not exceed 5,000 beneficiaries per month per Demonstration Plan and will occur over at least a 6-month period. However, the goal of the Passive Enrollment phase-in is to limit the number of beneficiaries assigned to each Demonstration Plan on a monthly basis without extending the phase-in beyond 6 months unless required to by the 5,000 monthly cap; and b. In the Central Illinois service area, the Passive Enrollment phase-in will occur over a 6 month period and will not exceed 3,000 beneficiaries per month per Demonstration Plan. 2. The State Commonwealth will provide notice of Passive Enrollments passive enrollments at least 60 days and no more than 90 days prior to the effective date of a Passive Enrollment perioddates to eligible individuals, and will accept opt-out requests prior to the effective date of enrollment. 3. The 60-day notice will include the name of the Demonstration Plan in which the beneficiary Individuals who otherwise would be enrolled unless he/she selects another Demonstration Plan or indicates the option to opt out of the Demonstration. 4. At least thirty days prior to the enrollment effective dates above, the State will send a second notice to beneficiaries who have not responded to the initial notice or opted in. The CES may choose to call beneficiaries in addition to sending a notice, if appropriate. The State will proceed with Passive Enrollment into the identified Demonstration Plan eligible for beneficiaries who do not make a different choice. iii. Beneficiaries who otherwise are included in Medicare reassignment to a different in 2013 or 2014 from their current (2012 or 2013, respectively) Medicare Prescription Prescriptions Drug Plan (PDP) effective January 1 of a given year (whether due to their previous year’s PDP’s premium increase or because their current PDP or terminating Medicare Advantage Prescription Drug Plan (MA-PD) is terminating) to another PDP, will be eligible for Passive Enrollmentpassive enrollment, with an opportunity to opt opt-out, into a Demonstration Plan. For example, those reassigned to a new PDP effective January 1, 2013, will be eligible for Passive Enrollment into a Demonstration Plan effective January 1, 2014, provided the individual meets the requirements of this Demonstration. iv. The State Commonwealth and CMS must agree in writing to any changes to the enrollment effective dates. iii. CMS will provide identifying information to Following this start-up period, members who are eligible for the State about beneficiaries that CMS anticipates will be reassigned for Demonstration and who have neither selected a January 1 Plan nor opted out of the following year effective dateDemonstration will receive a notice of passive enrollment into an ICO and an enrollment package that describes their options, no later than 120 days prior to the date including that of opting out of the first Passive Enrollment period. v. Beneficiaries who do not Demonstration. Members will then have 60 days to select a different ICO or opt out of the Demonstration, and who are enrolled in a Medicare Advantage plan that is operated by the same parent organization that operates a Demonstration Plan, . MassHealth will be eligible for Passive Enrollment proceed with passive enrollment into the parent organization’s Demonstration Plan identified ICO for Members who do not make a different choice, with an effective January 1, 2014. Eligible beneficiaries enrolled in a Medicare Advantage plan that is operated by a parent organization that is not offering a Demonstration Plan may enroll into the Demonstration if they elect to disenroll from their current Medicare Advantage plan. e. Disenrollment Effective Date(s) – Disenrollments are effective date of the first day of the month following the request to opt-out end of the Demonstration. The CES will also accept cancellations of opt60-in enrollment requests, where the beneficiary submits an enrollment request but then cancels the enrollment prior to the effective dateday period. f. Upon CMS’ or iv. Requests to disenroll will be accepted at any point after enrollment occurs and are effective on the State’s written determination that first of the Demonstration will not be renewed, no following month. e. No enrollments will be accepted within six 6 months (or less) of the end of the Demonstration. f. Notification of passive enrollment options will be provided by the Commonwealth to each beneficiary not less than 60 calendar days prior to the effective date of the proposed enrollment. g. Passive Enrollment enrollment activity will be coordinated with CMS activities such as Annual Reassignment and daily auto- and facilitated enrollment auto-assignment for individuals with the Medicare Part D LISLow Income Subsidy. h. The State Commonwealth will work to develop an “intelligent assignment” algorithm for Passive Enrollment passive enrollment (e.g. that prioritizes continuity of providers and/or services). The algorithm will consider beneficiaries’ previous managed care enrollment and historic provider utilization, with further details to be provided in the three-way contracts. i. The State or its Client Enrollment Services (CES) Commonwealth will provide customer service and options counselingservice, including mechanisms to counsel beneficiaries notified of Passive Enrollment. The CES will also passive enrollment and to receive and communicate beneficiary choice of opt-outs to CMS’s contractor, who will communicate the choice opt out to CMS via transactions to CMS’ ▇▇▇▇ system. Beneficiaries will also be provided a notice upon the completion of the opt-out process. Medicare resources, including 1-8001800-Medicare, will remain available to a resource for Medicare beneficiaries that disenroll from the Demonstration. Beneficiary requests made to 1-800-Medicare for Enrollment, changes among Demonstration Plans, or Disenrollment (when possible) will be referred to the State or its designated CESbeneficiaries. j. The State or its vendor Commonwealth will provide notices, as approved by CMS, to ensure complete and accurate information is provided in concert with other Medicare communications, such as the Medicare & You and Medicare Plan Finderhandbook. CMS may also send a notice to beneficiaries individuals, and will coordinate such notice with any State notice(s). k. Enrollment data Data in State and CMS systems will be reconciled on a timely basis to prevent discrepancies between such systems.

State Level Enrollment Operations Requirements. a. A. Eligible Populations/Excluded Populations - Populations: As described in the body of the MOU, Section III.C.1. b. B. Enrollment and Disenrollment Processes - All Processes: Enrollment and Disenrollment- related transactions, including transfers between Demonstration Plans, disenrollment transactions will be processed through the Illinois Client State Enrollment Services Counselor, consistent with the enrollment effective date requirements outlined in the Medicare- Medicaid Plan Enrollment and Disenrollment Guidance. RI EOHHS (CES). The State or its vendor vendor) will submit enrollment transactions to the CMS Medicare Advantage Prescription Drug (▇▇▇▇) enrollment system directly or via a third party CMS designates to receive such transactions. CMS will also submit a file to the State RI EOHHS identifying individuals who have elected to enroll in disenroll from a MMP, opt out of passive enrollment, or have enrolled in, or have selected another type of of, available Medicare coveragecoverage that is not an MMP. The State or its designated contractor RI EOHHS will share enrollment enrollment, disenrollment, and disenrollment opt-out transactions with Demonstration Planscontracted MMPs. c. C. Uniform Enrollment / Disenrollment and Disenrollment Opt-Out Letter and Forms - Forms: Letters and forms will be agreed made available to stakeholders 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. D. Enrollment Effective Date(s) - ): All enrollment effective dates are prospective. BeneficiaryEnrollee-elected enrollments are effective the first calendar day of the month following the initial receipt of a beneficiary’s request to enroll, so long as the request is received by the 12th 10th of the month. Enrollment requests, including requests to change among Demonstration Plans, received after the 12th 10th of the month will be effectuated the first day of the second month following the request. . E. Passive Enrollment enrollment is effective not sooner than 60 calendar 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 notification 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 enrollmentright to select an MMP. 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 F. Disenrollment Effective Date(s): Requests to disenroll from an MMP, opt out, or enroll in a different MMP (if applicable) will be effective the first day of the month following receipt of the request. G. Opt-in Enrollments: MMPs will be required to accept opt-in enrollments for eligible individuals no earlier than 90 calendar days prior to the initial first effective date of October 1, 2013enrollment date, and Demonstration Plans must begin providing coverage for those enrolled individuals on October 1, 2013. Each Demonstration Plan’s ability to accept opt-in enrollments, however, is contingent upon successfully passing the Readiness Review. The earliest effective date for Passive Enrollment will be January 1, 2014 as discussed below in d.ii. 1. CMS will provide an initial notice of the Demonstration opt-in enrollment period to all Demonstration eligible beneficiaries Enrollees no earlier than 90 days prior to the start of the opt-in enrollment period. 2. The effective dates for opt-in and Passive Enrollment are subject to Demonstration Plans meeting CMS and State requirements, including Demonstration Plans’ capacity to accept new Enrollees. ii. The State will conduct monthly Passive Enrollments for those eligible beneficiaries who have not made a Demonstration Plan selection for effective enrollment beginning January December 1, 2014 or otherwise opted out of the Demonstration2015. 1. During October 1, 2013 to December 31, 2013, CMS and the State will monitor each Demonstration Plans’ ability to manage the opt- in enrollments. Dependent on each Demonstration Plan’s capacity, as determined by its ability to manage the opt-in enrollments and the prior month’s Passive Enrollments (once applicable), the State will passively enroll a number of beneficiaries into Demonstration Plans that takes into consideration the number of opt-in Enrollments and the opt-out rate for each Demonstration Plan. Furthermore: a. In the Greater Chicago service area, the Passive Enrollment phase-in will not exceed 5,000 beneficiaries per month per Demonstration Plan and will occur over at least a 6-month period. However, the goal of the Passive Enrollment phase-in is to limit the number of beneficiaries assigned to each Demonstration Plan on a monthly basis without extending the phase-in beyond 6 months unless required to by the 5,000 monthly cap; and b. In the Central Illinois service area, the Passive Enrollment phase-in will occur over a 6 month period and will not exceed 3,000 beneficiaries per month per Demonstration Plan. 2. The State will provide notice of Passive Enrollments at least 60 days and no more than 90 days prior to the effective date of a Passive Enrollment period, and will accept opt-out requests prior to the effective date of enrollment. 3. The 60-day notice will include the name of the Demonstration Plan in which the beneficiary would be enrolled unless he/she selects another Demonstration Plan or indicates the option to opt out of the Demonstration. 4. At least thirty days prior to the enrollment effective dates above, the State will send a second notice to beneficiaries who have not responded to the initial notice or opted in. The CES may choose to call beneficiaries in addition to sending a notice, if appropriate. The State will proceed with Passive Enrollment into the identified Demonstration Plan for beneficiaries who do not make a different choice. iii. Beneficiaries who otherwise are included in Medicare reassignment to a different Medicare Prescription Drug Plan (PDP) effective January 1 of a given year (whether due to their previous year’s PDP’s premium increase or because their current PDP or Medicare Advantage Prescription Drug Plan (MA-PD) is terminating) will be eligible for Passive Enrollment, with an opportunity to opt out, into a Demonstration Plan. For example, those reassigned to a new PDP effective January 1, 2013, will be eligible for Passive Enrollment into a Demonstration Plan effective January 1, 2014, provided the individual meets the requirements of this Demonstration. iv. The State and CMS must agree in writing to any changes to the enrollment effective dates. CMS will provide identifying information to the State about beneficiaries that CMS anticipates will be reassigned for a January 1 of the following year effective date, no later than 120 days prior to the date of the first Passive Enrollment period. v. Beneficiaries who do not opt out of the Demonstration, and who are enrolled in a Medicare Advantage plan that is operated by the same parent organization that operates a Demonstration Plan, will be eligible for Passive Enrollment into the parent organization’s Demonstration Plan effective January 1, 2014. Eligible beneficiaries enrolled in a Medicare Advantage plan that is operated by a parent organization that is not offering a Demonstration Plan may enroll into the Demonstration if they elect to disenroll from their current Medicare Advantage plan. e. Disenrollment Effective Date(s) – Disenrollments are effective the first of the month following the request to opt-out of the Demonstration. The CES will also accept cancellations of opt-in enrollment requests, where the beneficiary submits an enrollment request but then cancels the enrollment prior to the effective date. f. Upon CMS’ or the State’s written determination that the Demonstration will not be renewed, no enrollments will be accepted within six months of the end of the Demonstration. g. Passive Enrollment activity will be coordinated with CMS activities such as Annual Reassignment and daily auto- and facilitated enrollment for individuals with the Medicare Part D LIS. h. The State will develop an “intelligent assignment” algorithm for Passive Enrollment (e.g. that prioritizes continuity of providers and/or services). The algorithm will consider beneficiaries’ previous managed care enrollment and historic provider utilization. i. The State or its Client Enrollment Services (CES) will provide customer service and options counseling, including mechanisms to counsel beneficiaries notified of Passive Enrollment. The CES will also receive and communicate beneficiary choice of opt-outs to CMS’s contractor, who will communicate the choice to CMS via transactions to CMS’ ▇▇▇▇ system. Beneficiaries will also be provided a notice upon completion of the opt-out process. Medicare resources, including 1-800-Medicare, will remain available to Medicare beneficiaries that disenroll from the Demonstration. Beneficiary requests made to 1-800-Medicare for Enrollment, changes among Demonstration Plans, or Disenrollment (when possible) will be referred to the State or its designated CES. j. The State or its vendor will provide notices, as approved by CMS, to ensure complete and accurate information is provided in concert with other Medicare communications, such as Medicare & You and Medicare Plan Finder. CMS may also send a notice to beneficiaries and will coordinate such notice with any State notice(s). k. Enrollment data in State and CMS systems will be reconciled on a timely basis to prevent discrepancies between such systems.

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, disenrollment transactions will be processed through the Illinois Client State Enrollment Services Broker. NYSDOH (CES). The State or its vendor vendor) will submit enrollment transactions to the CMS Medicare Advantage Prescription Drug (▇▇▇▇) enrollment system directly or via a third party CMS designates to receive such transactions. CMS will also submit a file to the State NYSDOH identifying individuals who have elected to enroll disenroll from a FIDA Plan, opt out of passive enrollment, or have enrolled in or have selected another type of available Medicare coveragecoverage that is not a FIDA Plan. The State or its designated contractor NYSDOH will share enrollment enrollment, disenrollment, and disenrollment opt-out transactions with Demonstration contracted FIDA Plans. c. Uniform Enrollment / Transfer and Disenrollment Opt-Out Letter and Forms - Letters – Before they are finalized, letters and forms will be agreed made available to stakeholders for comment 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. BeneficiaryParticipant-elected enrollments are enrollment is effective the first day of the month following the initial receipt of a beneficiaryParticipant’s request to enrollenroll or, so long as the request is received by the 12th of the month. Enrollment requestsfor passive enrollment, 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 the month in which the Participant is eligible, as applicable for an individual Participant. Passive enrollment is effective no sooner than 60 days after Participant notification of the right to select a beneficiary’s request FIDA Plan and the option to disenroll from the Demonstrationdecline passive enrollment. i. Demonstration FIDA Plans will be required to accept opt-in enrollments of eligible community-based LTSS individuals no earlier than 90 60-days prior to the initial effective date of October no earlier than July 1, 20132014, and Demonstration Plans must begin providing coverage for those opt-in enrolled individuals on October no earlier than July 1, 20132014. Each Demonstration Plan’s ability FIDA Plans will be required to accept opt-in enrollments, however, is contingent upon successfully passing the Readiness Review. The earliest effective date for Passive Enrollment will be January 1, 2014 as discussed below in d.ii. 1. CMS will provide an initial notice enrollments of the Demonstration opteligible facility-in enrollment period to all Demonstration eligible beneficiaries based LTSS individuals no earlier than 90 60-days prior to the start initial effective date of the no earlier than October 1, 2014, and begin providing coverage for opt-in enrollment periodenrolled individuals no earlier than October 1, 2014. 2ii. No earlier than September 1, 2014, the State will begin to conduct passive enrollment for those eligible community-based LTSS Participants who have not submitted a request to enroll in a FIDA Plan. No earlier than January 1, 2015, the State will begin to conduct passive enrollment for those eligible facility-based LTSS Participants who have not submitted a request to enroll in a FIDA Plan. The effective dates for opt-in and Passive Enrollment above are subject to Demonstration FIDA Plans meeting CMS and State requirements, requirements including Demonstration Plans’ capacity to accept new EnrolleesParticipants. iiiii. The State will conduct monthly Passive Enrollments for those eligible beneficiaries who have not made a Demonstration Plan selection for effective enrollment beginning January 1, 2014 or otherwise opted out of the Demonstration. 1. During October 1, 2013 to December 31, 2013, CMS and the State will monitor each Demonstration Plans’ ability to manage the opt- in enrollments. Dependent on each Demonstration Plan’s capacity, as determined by its ability to manage the optPhase-in enrollments and the prior month’s Passive Enrollments (once applicable), the State will passively enroll a number of beneficiaries into Demonstration Plans that takes into consideration the number of opt-in Enrollments and the opt-out rate Process. Once passive enrollment is initiated for each Demonstration Plan. Furthermore: a. In the Greater Chicago service areagroup per III.d.ii above, the Passive Enrollment phase-it will be phased in will not exceed 5,000 beneficiaries per month per Demonstration Plan and will occur over at least a 6-month period. However, the goal of the Passive Enrollment phase-in is to limit the number of beneficiaries assigned to each Demonstration Plan on a monthly basis without extending the phase-in beyond 6 months unless required to by the 5,000 monthly cap; and b. In the Central Illinois service area, the Passive Enrollment phase-in will occur over a 6 minimum of a four-month period and will not exceed 3,000 beneficiaries per month per Demonstration Plantake into account how close Participants are to their Medicaid redetermination date. 2iv. The State will provide notice of Passive Enrollments the option to select a FIDA Plan at least 60 days and no more than 90 days prior to the effective date of a Passive Enrollment period, passive enrollment and will accept opt-opt- out requests through the last day of the month prior to the effective date of enrollment. This notice will explain the Participant’s options, including the option to decline passive enrollment into the FIDA Plan, or once enrolled, to request prospective disenrollment from the Demonstration. 3v. Thirty days prior to the passive enrollment effective date, a second notice will be provided to Participants who have not responded to the initial notice. The 60-day notice will include the name of the Demonstration FIDA Plan in into which the beneficiary Participant would be enrolled unless he/she selects another Demonstration plan or opts out of the Demonstration. New York will proceed with passive enrollment into the identified FIDA Plan for Participants who do not make a different choice as described in the “Phase-in Process” above. vi. Requests to disenroll from a FIDA Plan or indicates enroll in a different FIDA Plan will be accepted at any point after a Participant’s initial enrollment occurs and is effective on the option first of the month following receipt of the request. Any time an individual requests to opt out of passive enrollment or disenroll from the Demonstration. 4. At least thirty days prior to the enrollment effective dates above, the State will send a second notice to beneficiaries who have not responded letter confirming the opt-out and providing information on the benefits available to the initial notice Participant once they have opted out or opted in. The CES may choose to call beneficiaries in addition to sending a notice, if appropriate. The State will proceed with Passive Enrollment into the identified Demonstration Plan for beneficiaries who do not make a different choicedisenrolled. iiivii. Beneficiaries Participants who otherwise are included in Medicare reassignment to effective January 1 of a different given year or from their current Medicare Prescription Drug Plan (PDP) effective January 1 of a given year (whether due to their previous year’s PDP’s premium increase or because their current PDP or terminating Medicare Advantage Prescription Drug Plan (MA-PD) is terminating) to another PDP, will not be eligible for Passive Enrollment, with an opportunity to opt out, into a Demonstration Planpassive enrollment that same year. For example, those : 1. Those reassigned to a new PDP effective January 1, 20132014, will be eligible for Passive Enrollment passive enrollment into a Demonstration an FIDA Plan effective no earlier than January 1, 2014, provided the individual meets the requirements of this Demonstration. iv2015. The State and CMS must agree in writing to any changes to the enrollment effective dates. CMS will provide identifying information to the State about beneficiaries that CMS anticipates will be reassigned for a January 1 of the following year effective date, eligible Participants no later than 120 days prior to the date of the first Passive Enrollment passive enrollment period. v. Beneficiaries who do not opt out of the Demonstration, and who are enrolled in a Medicare Advantage plan that is operated by the same parent organization that operates a Demonstration Plan, will be eligible for Passive Enrollment into the parent organization’s Demonstration Plan effective January 1, 2014. Eligible beneficiaries enrolled in a Medicare Advantage plan that is operated by a parent organization that is not offering a Demonstration Plan may enroll into the Demonstration if they elect to disenroll from their current Medicare Advantage plan. e. Disenrollment Effective Date(s) – Disenrollments are effective the first of the month following the request to opt-out of the Demonstration. The CES will also accept cancellations of opt-in enrollment requests, where the beneficiary submits an enrollment request but then cancels the enrollment prior to the effective date. f. Upon CMS’ or the State’s written determination that the Demonstration will not be renewed, no No enrollments will be accepted within six 6 months (or less) of the end of the Demonstration. f. Notification of FIDA Plan selection and enrollment options will be provided by the State to each Participant no fewer than 60 calendar days prior to the effective date of the proposed enrollment. g. Passive Enrollment enrollment activity will be coordinated with CMS activities such as Annual Reassignment and daily auto- and facilitated enrollment auto-assignment for individuals with the Medicare Part D LISLow Income Subsidy. h. The State will develop an “intelligent assignment” algorithm for Passive Enrollment passive enrollment (e.g. that prioritizes continuity of providers and/or services). The algorithm will consider beneficiariesParticipants’ previous Medicaid managed care enrollment and historic provider utilization. i. The State or its Client Enrollment Services (CES) will provide customer service and options counselingservice, including mechanisms to counsel beneficiaries Participants notified of Passive Enrollment. The CES will also passive enrollment and to receive and communicate beneficiary Participant choice of opt-outs to CMS’s contractor, who will communicate the choice opt out to CMS via transactions to CMS’ ▇▇▇▇ system. Beneficiaries Participants will also be provided a notice upon the completion of the opt-out process. Medicare resources, including 1-800-Medicare, will remain available a resource for Medicare Participants; calls related to Medicare beneficiaries that disenroll from the Demonstration. Beneficiary requests made to 1-800-Medicare for Enrollment, changes among FIDA Demonstration Plans, or Disenrollment (when possible) enrollment will be referred to the State or its designated CESState’s Enrollment Broker for customer service and enrollment support. j. The CMS and the State or its vendor will provide notices, as approved by CMS, jointly approve all Demonstration notices to ensure complete and accurate information is provided in concert with other Medicare communications, such as the Medicare & You and Medicare Plan Finderhandbook. CMS may also send a jointly-approved notice to beneficiaries individuals, and will coordinate such notice with any State notice(s). k. Enrollment data in State and CMS systems will be reconciled on a timely basis to prevent resolve discrepancies between such systems. ▇. ▇▇▇▇ information – The State will ensure that the PACE program is known to eligible individuals as an integrated program alternative to FIDA Demonstration enrollment. The option of PACE enrollment will be specified in outreach and educational materials about the FIDA Demonstration and will be incorporated into the Enrollment Broker scripts and protocols.