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 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 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. MassHealth will proceed with passive enrollment into the identified ICO for Members who do not make a different choice, with an effective date of the first day of the month following the end of the 60-day period. iv. Requests to disenroll will be accepted at any point after enrollment occurs and are effective on the first of the following month. e. No enrollments will be accepted within 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 activity will be coordinated with CMS activities such as Annual Reassignment and daily auto-assignment for individuals with the Part D Low Income Subsidy. h. The Commonwealth will work to develop an “intelligent assignment” algorithm for passive enrollment (e.g. that prioritizes continuity of providers and/or services), with further details to be provided in the three-way contracts. i. The Commonwealth will provide customer service, including mechanisms to counsel beneficiaries notified of passive enrollment and to receive and communicate beneficiary choice of opt out to CMS via transactions to CMS’ XXXx system. Beneficiaries will also be provided a notice upon the completion of the opt-out process. Medicare resources, including 1800-Medicare, will remain a resource for Medicare beneficiaries. j. The 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 handbook. CMS may also send a notice to individuals, and will coordinate such notice with any State notice(s). k. 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 enrollments – Enrollment and disenrollment- related disenrollment transactions will be processed through the MassHealth Customer Service Team (CST) vendorState Enrollment Broker. MassHealth NYSDOH (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 NYSDOH identifying individuals who have elected to disenroll from a FIDA Plan, opt out of passive enrollment, or have enrolled in or have selected another type of available Medicare coverage that is not a FIDA Plan. NYSDOH will share enrollment, disenrollment, and opt-out transactions with contracted FIDA Plans. c. Uniform Enrollment / Transfer and Disenrollment Opt-Out Letter and Forms - Letters – Before they are finalized, letters and forms will be appended made available to the three-way contract when they are completed and agreed to stakeholders for comment by both CMS and the CommonwealthState. d. Enrollment Effective Date(s) - – All enrollment effective dates are prospective. BeneficiaryParticipant-elected enrollment is effective the first day of the month following the initial receipt of an eligible beneficiarya Participant’s request to enrollenroll or, or for passive enrollment, the first day of the month following the month in which the beneficiary Participant is eligible, as applicable for an individual EnrolleeParticipant. Passive enrollment is effective not no sooner than 60 days after beneficiary notificationParticipant notification of the right to select a FIDA Plan and the option to decline passive enrollment. i. ICOs FIDA Plans will be required to accept opt-in enrollments of eligible community-based LTSS individuals no earlier than 60-days prior to the initial effective date of no earlier than July 1, 2014, and begin providing coverage for opt-in enrolled individuals no earlier than July 1, 2014. FIDA Plans will be required to accept opt-in enrollments of eligible facility-based LTSS individuals no earlier than 60-days prior to the initial effective date of no earlier than October 1, 2014, and begin providing coverage for opt-in enrolled individuals no earlier than October 1, 2014. ii. 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, 2013 for an effective date of April 12015, 2013 and the State will begin providing coverage for enrolled individuals on April 1, 2013. ii. The Commonwealth will initially to conduct two passive enrollment periodsfor those eligible facility-based LTSS Participants who have not submitted a request to enroll in a FIDA Plan. The effective dates for the two periods above are tentatively July 1, 2013 and October 1, 2013, subject to Participating FIDA Plans meeting CMS and Commonwealth State requirements including Plans’ capacity to accept new EnrolleesParticipants. iii. Phase-in Process. Once passive enrollment is initiated for each group per III.d.ii above, it will be phased in over a minimum of a four-month period and will take into account how close Participants are to their Medicaid redetermination date. iv. The Commonwealth State will provide notice of passive enrollments the option to select a FIDA Plan at least 60 days prior to the effective dates to eligible individuals, date of passive enrollment and will accept opt-opt- out requests through the last day of the month prior to the effective date of enrollment. Individuals 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. v. 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 notice will include the name of the FIDA Plan into which the Participant would be enrolled unless he/she selects another 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 enroll in a different FIDA Plan will be accepted at any point after a Participant’s initial enrollment occurs and is effective on the 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, the State will send a letter confirming the opt-out and providing information on the benefits available to the Participant once they have opted out or disenrolled. vii. Participants who otherwise would be eligible for are included in Medicare reassignment in 2013 effective January 1 of a given year or 2014 from their current (2012 or 2013, respectively) Medicare Prescriptions Prescription Drug Plan (PDP) or terminating Medicare Advantage Prescription Drug Plan (MA-PD) to another PDP, will not be eligible for passive enrollment, with an opportunity enrollment that same year. For example: 1. Those reassigned to opt-out, into a Demonstration Plan new PDP effective January 1, 2014, will be eligible for passive enrollment into an FIDA Plan effective no earlier than January 1, 2015. The Commonwealth State and CMS must agree in writing to any changes to the enrollment effective dates. iii. Following this start-up period, members who are CMS will provide identifying information to the State about eligible for Participants no later than 120 days prior to 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. MassHealth will proceed with passive enrollment into the identified ICO for Members who do not make a different choice, with an effective date of the first day of the month following the end of the 60-day passive enrollment period. iv. Requests to disenroll will be accepted at any point after enrollment occurs and are effective on the first of the following month. e. No enrollments will be accepted within 6 months (or less) of the end of the Demonstration. f. Notification of passive FIDA Plan selection and enrollment options will be provided by the Commonwealth State to each beneficiary not less Participant no fewer than 60 calendar days prior to the effective date of the proposed enrollment. g. Passive enrollment activity will be coordinated with CMS activities such as Annual Reassignment and daily auto-assignment for individuals with the Part D Low Income Subsidy. h. The Commonwealth State will work to develop an “intelligent assignment” algorithm for passive enrollment (e.g. that prioritizes continuity of providers and/or services), with further details to be provided in the three-way contracts. The algorithm will consider Participants’ previous Medicaid managed care enrollment and historic provider utilization. i. The Commonwealth State will provide customer service, including mechanisms to counsel beneficiaries Participants notified of passive enrollment and to receive and communicate beneficiary Participant choice of opt out to CMS via transactions to CMS’ XXXx system. Beneficiaries Participants will also be provided a notice upon the completion of the opt-out process. Medicare resources, including 18001-800-Medicare, will remain a resource for Medicare beneficiariesParticipants; calls related to FIDA Demonstration enrollment will be referred to the State’s Enrollment Broker for customer service and enrollment support. j. The Commonwealth CMS and the State 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 handbook. CMS may also send a jointly-approved notice to individuals, and will coordinate such notice with any State notice(s). k. Data in State and CMS systems will be reconciled on a timely basis to prevent resolve discrepancies between such systems. x. XXXX 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.

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 enrollments Processes: Enrollment and disenrollment- related disenrollment transactions will be processed through the MassHealth Customer Service Team (CST) vendorState Enrollment Counselor, consistent with the enrollment effective date requirements outlined in the Medicare- Medicaid Plan Enrollment and Disenrollment Guidance. MassHealth RI EOHHS (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 RI EOHHS identifying individuals who have elected to disenroll from a MMP, opt out of passive enrollment, or have enrolled in, or have selected another type of, available Medicare coverage that is not an MMP. RI EOHHS will share enrollment, disenrollment, and opt-out transactions with contracted MMPs. c. C. Uniform Enrollment / Disenrollment and Disenrollment Opt-Out Letter and Forms - Forms: Letters and forms will be appended made available to the three-way contract when they are completed and agreed to stakeholders by both CMS and the CommonwealthState. 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 10th of the month. Enrollment requests received after the 10th of the month will be effectuated the first day of the second month following the request. E. Passive enrollment is effective not sooner than 60 calendar days after beneficiary notification of the right 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. 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 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 notificationrequest. i. ICOs G. Opt-in Enrollments: MMPs will be required to accept opt-in enrollments for eligible individuals no earlier than January 190 calendar days prior to the first effective enrollment date, 2013 for an effective date of April 1, 2013 and begin providing coverage for enrolled individuals on April opt-in Enrollees no earlier than December 1, 20132015. 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 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. MassHealth will proceed with passive enrollment into the identified ICO for Members who do not make a different choice, with an effective date of the first day of the month following the end of the 60-day period. iv. Requests to disenroll will be accepted at any point after enrollment occurs and are effective on the first of the following month. e. No enrollments will be accepted within 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 activity will be coordinated with CMS activities such as Annual Reassignment and daily auto-assignment for individuals with the Part D Low Income Subsidy. h. The Commonwealth will work to develop an “intelligent assignment” algorithm for passive enrollment (e.g. that prioritizes continuity of providers and/or services), with further details to be provided in the three-way contracts. i. The Commonwealth will provide customer service, including mechanisms to counsel beneficiaries notified of passive enrollment and to receive and communicate beneficiary choice of opt out to CMS via transactions to CMS’ XXXx system. Beneficiaries will also be provided a notice upon the completion of the opt-out process. Medicare resources, including 1800-Medicare, will remain a resource for Medicare beneficiaries. j. The 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 handbook. CMS may also send a notice to individuals, and will coordinate such notice with any State notice(s). k. Data in State and CMS systems will be reconciled on a timely basis to prevent discrepancies between such systems.