Common use of Enrollment Exclusions Clause in Contracts

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 non-Medicare individual health plan determined to be cost-effective according to Minnesota Statutes, § 256B.69, subd. 4 (b)(9). Women receiving Medical Assistance through the Breast and Cervical Cancer Control Program. Persons eligible for the Minnesota Family Planning Program (MFPP) in accordance with Minnesota Statutes, § 256B.78. Persons participating in the Navigator Pilot in Minnesota Statutes, § 254B.13. Persons participating in the Continuum of Care Pilot in Minnesota Statutes,‌ § 254B.14.