Enrollment Exclusions. The following Beneficiaries are excluded from enrollment in the MCO’s program [Minnesota Statutes, §256B.69, subd. 4; Minnesota Rules, Part 9500.1452]:
Enrollment Exclusions. All persons who receive Medical Assistance and reside in the Service Area will participate in managed care, except for Beneficiaries who are members of the following Medical Assistance populations: Beneficiaries receiving Medical Assistance due to blindness or disability as determined by the U.S. Social Security Administration or the State Medical Review Team (SMRT), except if sixty-five (65) years of age or older. Beneficiaries receiving the Refugee Assistance Program pursuant to 8 USC § 1522(e). Beneficiaries who are residents of State institutions, unless the placement has been approved by the MCO. For the purposes of this Contract, approval by the MCO would include a placement which is court-ordered within the terms described in section 6.1.27(E). Beneficiaries who are terminally ill as defined in Minnesota Rules, Part 9505.0297, subpart 2, item N, and who, at the time enrollment in PMAP would occur, have an established relationship with a primary physician who is not a Network Provider in the MCO. Beneficiaries who at the time of notification of mandatory enrollment in managed care, have a communicable disease whose prognosis is terminal and whose primary physician is not a Network Provider in the MCO, and that physician certifies that disruption of the existing physician-patient relationship is likely to result in the patient becoming noncompliant with medication or other health services. Beneficiaries who are Qualified Medicare Beneficiaries (QMB), as defined in § 1905(p) of the Social Security Act, 42 USC § 1396d(p), who are not otherwise receiving Medical Assistance. Beneficiaries who are Specified Low-Income Medicare Beneficiaries (SLMB), as defined in § 1905(p) of the Social Security Act, 42 USC §§ 1396a(a)(10)(E)(iii) and 1396d(p), and who are not otherwise receiving Medical Assistance. Beneficiaries who are eligible while receiving care and services from a non-profit center established to serve victims of torture. Non-citizen Beneficiaries who receive emergency medical assistance under Minnesota Statutes, §256B.06, subd.4. Beneficiaries receiving Medical Assistance on a medical Spenddown basis. Beneficiaries with private health care coverage through a HMO certified under Minnesota Statutes, Chapter 62D. Such Beneficiaries may enroll in PMAP on a voluntary basis if the private HMO is the same as the MCO the person will select under PMAP. Beneficiaries with cost effective employer-sponsored private health care coverage, or who are enrolled in a...
Enrollment Exclusions. The following populations, both SNBC SNP and non-SNP, are excluded from enrollment in the MCO under the SNBC program [Minnesota Statutes, §256B.69, subd. 4; Minnesota Rules, Part 9500.1452]:
Enrollment Exclusions. A. The following persons shall be excluded from enrollment in the managed care program:
Enrollment Exclusions. The following Recipients are excluded from enrollment in the MCO’s program:
Enrollment Exclusions. All persons who receive Medical Assistance and reside in the Service Area will participate in PMAP, except for Recipients who are members of the following Medical Assistance populations:
Enrollment Exclusions. The following populations are excluded from enrollment in the MCO under the SNBC program:
Enrollment Exclusions. All persons who receive Medical Assistance and reside in the Service Area will participate in managed care, except for Recipients who are members of the following Medical Assistance populations:
Enrollment Exclusions. The Contractor shall cover all eligible members, with the exception of excluded members as defined in 12 VAC 00-000-000 B. The Department shall have sole responsibility for determining the program exclusion for these individuals. When individuals no longer meet the exclusion criteria, they shall be required to re-enroll in the Medallion 4.0 program. Members enrolled with a MCO that subsequently meets one or more of these criteria during MCO enrollment shall be excluded from MCO participation as appropriate by the Department. The Department shall, upon new state or federal laws, regulations, or Department policy, exclude other members as appropriate. When a member for whom services have been authorized, but not provided as of the effective date of exclusion or disenrollment is excluded or dis-enrolled from the Contractor’s plan and from Medallion 4.0, the Contractor shall provide to the Department or the relevant PCP the history for that member upon request. This prior authorization history shall be provided to the Department or the relevant PCP within five (5) business days of request. The Department shall exclude members who meet at least one of the following exclusion criteria: • Inpatient Members in State Mental HospitalsMembers who are approved by the Department as inpatients in Long-Stay Hospitals: The Department recognizes two facilities as long-stay hospitals: Lake Xxxxxx [Norfolk] and Hospital for Sick Children [Washington, DC]), nursing facilities, or intermediate care facilities for the intellectually disabled.
Enrollment Exclusions. The following populations are excluded from enrollment in the MCO for MnDHO:
