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).
Appears in 4 contracts
Sources: Primary Care Accountable Care Organization Contract, Primary Care Accountable Care Organization Contract, Primary Care Accountable Care Organization Contract
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 PCPsPCCs, including but not limited to if the Member has an existing relationship with one of the Contractor’s Participating PCPs PCCs 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)(3508.004(C)(3); and
2. Without cause, at any time during a plan selection period as set forth in 130 CMR 508.003(C)(1).508.004(C)(1).
Appears in 3 contracts
Sources: Contract, Contract for Primary Care Accountable Care Organization Services, Contract for Primary Care Accountable Care Organization Services
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).508.003(C)(1).
Appears in 1 contract
Sources: Primary Care Accountable Care Organization Contract