Auto Assignment. 4.2.4.1 Selected Centennial Care 2.0 MCOs that did not participate in the delivery of Covered Services under the Centennial Care program between January 1, 2014 and December 31, 2018 will receive the highest percentage of auto-assignment until a membership threshold of at least fifteen percent (15%) of the total managed care enrollment as of the last day of the month is achieved. If any Centennial Care CONTRACTOR falls below a membership threshold of fifteen percent (15%) of the total managed care enrollment it will receive the highest percentage of auto-assignment until the threshold is maintained for a period of at least one year.
Auto Assignment. 2.4.4.6.1 TENNCARE will auto assign an enrollee to an MCO, in specified circumstances, including but not limited to, the enrollee does not request enrollment in a specified MCO, cannot be enrolled in the requested MCO, or is an adult eligible as a result of receiving SSI benefits.
Auto Assignment. An Eligible Person whose enrollment in a MCO is mandatory and who fails to select a MCO within sixty (60) days of receipt of notice of mandatory enrollment may be assigned by the LDSS to the Contractor's plan pursuant to NYS Social Services Law Section 364-j and in accordance with Appendix H. SECTION 6 (ENROLLMENT) October 1, 2004 6-1
Auto Assignment. Eligible individuals that fail to select a plan will be assigned to an MCOP at the discretion of ODM.
Auto Assignment. 4.2.5.1 HCA will auto-assign a Recipient to a Turquoise Care MCO in specified circumstances, including but not limited to: (i) the Recipient does not select an MCO at the time of eligibility or (ii) the Recipient cannot be enrolled in the requested MCO pursuant to the terms of this Agreement (e.g., the CONTRACTOR is subject to and has reached its enrollment limit).
Auto Assignment. 4.2.4.1 Selected Centennial Care 2.0 MCOs that did not participate in the delivery of Covered Services under the Centennial Care program between January 1, 2014 and December 31, 2018 will receive the highest percentage of auto-assignment until a membership threshold of at least 10% of the total managed care enrollment as of January 1, 2019 is achieved. .
Auto Assignment. The assignment of an Enrollee to a PMG and a PCP, normally at the time the person is Auto-Enrolled in the GHP Program. Auto-Enrollment: The Enrollment of a Potential Enrollee in an MCO by ASES without any action by the Potential Enrollee. Blocked Call: A call that cannot be connected immediately because no circuit is available at the time the call arrives or because the telephone system is programmed to block calls from entering the queue when the queue is backed up beyond a defined threshold. Business Continuity and Disaster Recovery (“BC-DR”) Plan: A documented plan (process) to restore vital and critical Information/health care technology systems in the event of business interruption due to human, technical, or natural causes. The plan focuses mainly on technology systems, encompassing critical hardware, operating and application software, and tertiary elements required to support the operating environment. It must support the process requirement to restore vital business Data inside the defined business requirement, including an emergency mode operation plan as necessary. Business Days: Traditional workdays, including Monday, Tuesday, Wednesday, Thursday, and Friday. Puerto Rico Holidays, as defined in the Law for Compliance with the Fiscal Plan, Act No. 26 of April 29, 2017, or any other law enacted during the duration of this Contract regarding this subject, are excluded. Business Hours: 8:00 a.m. to 6:00 p.m. local Puerto Rico time on Business Days. Calendar Days: All seven (7) days of the week. Call Center: A telephone service facility equipped to handle a large number of inbound and outbound calls and perform all the functions described in this Contract via telephone. Centers for Medicare & Medicaid Services (“CMS”): The agency within the US Department of Health and Human Services with responsibility for the Medicare, Medicaid, and the Children’s Health Insurance Programs (“CHIP”). Children’s Health Insurance Program (“CHIP”): Puerto Rico’s Children’s Health Insurance Program established pursuant to Title XXI of the Social Security Act.
Auto Assignment. The process used by the Division to randomly select a qualified vendor to provide services to a member.
Auto Assignment. The auto-assignment algorithm will be designed by the Agency and comply with the provisions at 42 C.F.R. § 438.54, including striving to preserve existing Provider-beneficiary relationships, inclusive of LTSS Providers. To the extent this is not possible, the algorithm will distribute equitably among qualified Contractors excluding those subject to intermediate sanctions at 42 C.F.R. § 438.702(a)(4). The Agency reserves the right to modify the auto-assignment logic at any time throughout the Contract term. The Agency reserves the right to redistribute membership due to uneven enrollment and cap enrollment by Contractor to ensure an excess of capacity does not impact Quality of services.
Auto Assignment. Upon implementation of the 1115 Waiver, or other applicable waivers of federal requirements, an Eligible Person whose enrollment in a MCO is mandatory and who fails to select a MCO within sixty (60) days of receipt of notice of mandatory enrollment may be assigned by the LDSS to the Contractor's plan pursuant to NYS Social Services Law Section 364-j and in accordance with Appendix H. SECTION 6 (ENROLLMENT) October 1, 1999 6-1
