Common use of At enrollment Clause in Contracts

At enrollment. 2.5.1.1.1.1. The Contractor shall complete a Comprehensive Assessment within thirty (30) calendar days of each Enrollee’s Effective Enrollment Date. 2.5.1.1.1.2. The Contractor shall make subsequent attempts beyond the thirty (30) days if the initial attempt to contact the Enrollee is unsuccessful. The Contractor shall incorporate the following into their policies and procedures for unreachable Enrollees: 2.5.1.1.1.2.1. The Contractor shall submit a weekly no contact list to EOHHS outlining frequency and type of outreach efforts, 2.5.1.1.1.2.2. The Contractor’s Medical Director or designee shall review past and/or current claims utilization to find provider(s) and/or pharmacies connected to the Enrollee, and 2.5.1.1.1.2.3. The Contractor shall notify EOHHS of Enrollees who remain unreachable after 180 days, have not actively participated in Care Coordination, Assessment and Care Planning, and who have no claims for physical and/or behavioral health treatment. 2.5.1.1.1.3. With the Member’s consent, the Contractor may complete the assessment in advance of the Effective Enrollment Date for new SCO program Enrollees. 2.5.1.1.1.4. For Enrollees participating in the Frail Elder Waiver, the assessment at the time of enrollment is completed by an ASAP RN. 2.5.1.1.1.5. The Contractor is not required to conduct a new Comprehensive Assessment for individuals who were enrolled in the Contractor’s SCO Plan prior to January 1, 2026, and for whom that Comprehensive Assessment is still current.

Appears in 1 contract

Sources: Senior Care Options Contract

At enrollment. 2.5.1.1.1.1. The Contractor shall complete a Comprehensive Assessment within thirty (30) calendar days of each Enrollee’s Effective Enrollment Date. 2.5.1.1.1.2. The Contractor shall make subsequent attempts beyond the thirty (30) days if the initial attempt to contact the Enrollee is unsuccessful. The Contractor shall incorporate the following into their policies and procedures for unreachable Enrollees: 2.5.1.1.1.2.1. The Contractor shall submit a weekly no contact list to EOHHS outlining frequency and type of outreach efforts, 2.5.1.1.1.2.2. The Contractor’s Medical Director or designee shall review past and/or current claims utilization to find provider(s) and/or pharmacies connected to the Enrollee, and 2.5.1.1.1.2.3. The Contractor shall notify EOHHS of Enrollees who remain unreachable after 180 days, have not actively participated in Care Coordination, Assessment and Care Planning, and who have no claims for physical and/or behavioral health treatment. 2.5.1.1.1.3. With the Member’s consent, the Contractor may complete the assessment in advance of the Effective Enrollment Date for new SCO program Enrollees. 2.5.1.1.1.4. For Enrollees participating in the Frail Elder Waiver, the assessment at the time of enrollment is completed by an ASAP RN. 2.5.1.1.1.5. The Contractor is not required to conduct a new Comprehensive Assessment for individuals who were enrolled in the Contractor’s SCO Plan prior to January 1, 2026, and for whom that Comprehensive Assessment is still currentcurrent in accordance with Section 2.5.1.1.2.1. 2.5.1.1.2. Ongoing 2.5.1.1.2.1. The Contractor shall complete Comprehensive Assessments for all Enrollees to identify all of an Enrollee’s needs, and to evaluate and identify Complex Care needs: 2.5.1.1.2.1.1. For all Enrollees, at least once every six months; 2.5.

Appears in 1 contract

Sources: Contract for Senior Care Options Plans