Enrollment and Attribution Clause Samples
The Enrollment and Attribution clause defines how individuals or entities are officially included in a program, service, or agreement and how their participation or outcomes are assigned or credited. Typically, this clause outlines the criteria and process for enrollment, such as eligibility requirements and necessary documentation, and specifies how participants are linked to particular benefits, responsibilities, or results. Its core function is to ensure clarity and fairness in determining who is covered by the agreement and how their actions or outcomes are tracked, thereby preventing disputes over participation or credit.
Enrollment and Attribution.
A. EOHHS shall inform Eligible Members of their enrollment options in an unbiased manner, including the option of becoming Enrollees for the Contractor or another ACO in the MassHealth ACO program, and shall inform each Member at the time of enrollment of their right to change enrollment without cause within 90 days and at other times in accordance with applicable rules and regulations.
B. EOHHS may assign Members that fail to make a selection prior to the Operational Start Date to the Contractor and one of the Contractor’s Participating PCPs, including but not limited to if the Member has an existing relationship with one of the Contractor’s Participating PCPs in EOHHS’ determination.
C. EOHHS shall provide the Contractor with a list of its Enrollees and periodic updates to such a list.
D. Except as otherwise provided under federal law or waiver, an Enrollee may disenroll voluntarily:
1. For cause, at any time, in accordance with 42 CFR 438.56(d)(2) and 130 CMR 508.003(C)(3); and
2. Without cause, at any time during a plan selection period as set forth in 130 CMR 508.003(C)(1).
Enrollment and Attribution. A. EOHHS shall inform Eligible Members of their enrollment options in an unbiased manner, including the option of becoming Attributed Members for the Contractor or another ACO in the MassHealth ACO program, and shall inform each Member at the time of enrollment of their right to change enrollment without cause within 90 days and at other times in accordance with applicable rules and regulations; and
B. EOHHS may assign certain Members that fail to make a selection to a Contracting MCO, including but not limited to if the Member has an existing relationship with one of the Contractor’s Participating PCPs in EOHHS’ determination. The Contracting MCO may assign such Members to the Contractor’s PCPs at the Contracting MCO’s discretion.