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 Medi-Cal Eligibility Data System (MEDS), except those transactions related to non- Demonstration plans participating in Medicare Advantage. Medi-Cal operates a Health Care Options program via an enrollment broker contract for Two-Plan and Geographic Managed Care counties (see Appendix 3). This supports the enrollment process. California will submit enrollment transactions to the CMS Medicare Advantage Prescription Drug (▇▇▇▇) enrollment system via a third party CMS designates to receive such transactions. Medi-Cal will share enrollment, disenrollment, and opt-out transactions with Participating Plans. i. In San Mateo and Orange counties, the Participating Plans will submit enrollment transactions directly to CMS or via the third party processor that CMS designates, consistent with how Medi-Cal enrollment is processed today. c. Uniform Enrollment and Disenrollment Letter and Forms - Letters and forms will be made available to stakeholders when they are completed and agreed to by both CMS and California. 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 not sooner than 60 days after beneficiary notification of the right to select a Participating Plan. i. Participating Plans will be required to accept enrollments beginning no earlier than August 1, 2013 for an effective date of no sooner than October 1, 2013 and begin providing coverage for enrolled individuals on the effective date. ii. Beneficiaries who are eligible for passive enrollment into the Demonstration will receive an informational notice about the Demonstration and process of passive enrollment 90 days prior to the effective date of enrollment. iii. Sixty (60) days prior to the effective date of enrollment, beneficiaries will receive a notice that identifies the Participating Plan in which the beneficiary would be enrolled unless he/she selects another plan or the option to opt out of the Demonstration. The notice will include an enrollment packet with information about other health plan choices in their county. iv. A third notice sent 30 days prior to effective enrollment date will remind beneficiaries of their options and the assigned Participating Plan for individuals who do not select a plan or do not opt out. California will proceed with passive enrollment into the identified plan for beneficiaries who do not make a different choice or opt out. CMS communication on the Demonstration will be coordinated with the State. 1. Enrollment materials will be written at no more than a sixth-grade reading level in the threshold languages and available upon request in alternative formats. 2. This information will include, at a minimum: how the beneficiary’s system of care would change, when the changes will occur, how to contact the State’s enrollment broker for questions or assistance with choosing a Participating Plan, and how to opt out of the Demonstration. v. Requests to change Participating Plans, opt out, or enroll with a Participating Plan will be accepted at any point after the notification of passive enrollment has been provided and are effective on the first of the following month. Any time an individual requests to opt out of the Demonstration, the State will send a letter confirming the opt-out and providing information on the benefits available to the beneficiary once they have opted out. 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 beneficiary once they have disenrolled from the Participating Plan. vi. The State will conduct passive enrollment periods specific to each county for those beneficiaries who have not made a plan selection as described below. Beneficiaries included in Medicare reassignment or currently enrolled in a Medicare Advantage Plan will be eligible for passive enrollment as detailed in Appendix 7, section II.D.vii and Appendix 7, section II.D.viii, immediately following this section. The enrollment periods below are only applicable to beneficiaries in Medicare fee-for- service. 1. Alameda County: Beneficiaries that have enrolled in Medi-Cal managed care will have an enrollment effective date of no sooner than October 1, 2013. Beneficiaries in FFS Medi-Cal will have an enrollment effective date on the 1st of the month of birth, beginning no sooner than October 1, 2013 and ending after twelve months. Beneficiaries with a birth month of January 2014 will be enrolled into the plans on February 1, 2014.