Common use of Enrollment Discrimination Clause in Contracts

Enrollment Discrimination. ‌ The Contractor must accept individuals eligible for enrollment in the order in which they apply without restriction (unless authorized by CMS), up to the limits set under the Contract. Contractor must not discriminate against individuals eligible to enroll on the basis of health status or need for health care services. The Contractor must not discriminate against individuals eligible to enroll on the basis of race, color, religion, sex, sexual orientation, gender identity, disability, national origin, limited English proficiency, marital status, political affiliation, or level of income, and must not use any policy or practice that has the effect of discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, disability, limited English proficiency, marital status, political affiliation, or level of income. The Contractor must not disenroll a Member because of an adverse change in the Member’s health status, or because of the Member’s utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from Member’s special needs (except when Member’s continued Enrollment in the Contractor seriously impairs the Contractor’s ability to furnish services to either this particular Member or other Members). 3.3 Disenrollment‌ 3.3.1 Disenrollment from MississippiCAN‌ A Member must be disenrolled from the Contractor if the Member: 1. No longer resides in the State of Mississippi; 2. Is deceased; 3. No longer qualifies for medical assistance under one of the Medicaid eligibility categories in the eligible population; 4. Becomes a nursing home resident. For the purposes of determining eligibility for MississippiCAN, PRTFs shall not be considered a long-term care facility; 5. ▇▇▇▇▇▇▇ enrolled in a waiver program; 6. Becomes eligible for Medicare coverage; or 7. Is diagnosed with hemophilia and receives clotting factor products and other treatments.