Passive Enrollment. An Enrollment process through which an Eligible Individual is enrolled by EOHHS (or its vendor) with a Contractor following a minimum 60-day advance notification period during which the Eligible Individual may elect to make a different enrollment decision (including Opting-Out or enrolling with a different Senior Care Organization).
Passive Enrollment. An Enrollment process through which an eligible individual is enrolled by the MDCH (or its vendor) into an ICO’s plan, following a minimum 60 calendar day advance notification that includes the plan selection and the opportunity to select a different plan, make another Enrollment decision, or decline Enrollment into an ICO, or opt-out of the Demonstration prior to the effective date.
Passive Enrollment. An enrollment process through which an eligible individual is enrolled by DHCS into a Contractor’s plan following a minimum sixty (60) day advance notification that includes the opportunity for the Enrollee to choose another plan or opt out prior to the effective date.
Passive Enrollment. An Enrollment process through which an Eligible Beneficiary is enrolled by the state (or its vendor) into a STAR+PLUS MMP, when not affirmatively electing one, following a minimum sixty (60)-day advance notification that identifies the STAR+PLUS MMP the state has selected and the opportunity to select a different plan, make another Enrollment decision, or decline Enrollment into a STAR+PLUS MMP and Opt-Out of the Demonstration prior to the effective date of coverage.
Passive Enrollment. 2.3.5.1. MDCH will initially conduct two Passive Enrollment phase-in periods for those Potential Enrollees who have not made a plan selection and are not excluded from Passive Enrollment.
Passive Enrollment. An Enrollment process through which an eligible individual is enrolled by RI EOHHS (or its vendor) into the Contractor, following a minimum sixty
Passive Enrollment. Passive Enrollment is effective no sooner than sixty (60) Days after beneficiary notification of the right to select the Contractor’s MMP. RI EOHHS may passively enroll into the Demonstration only Medicaid fee- for-service beneficiaries, or other Eligible Beneficiaries who are not enrolled in a Medicare Advantage plan or otherwise ineligible for Passive Enrollment. All other Eligible Beneficiaries who are not passively enrolled into the Demonstration will be provided the option to opt-in. Individuals currently enrolled in PACE may not be passively enrolled into the Contractor’s MMP. As part of the Enrollment process, RI EOHHS will exclude individuals identified as at-risk or potentially at-risk for abuse or overuse of specified prescription drugs per 42 C.F.R. §§ 423.100 and 423.153(f). CMS and RI EOHHS may stop Passive Enrollment to Contractor’s MMP if the Contractor does not meet reporting requirements necessary to maintain Passive Enrollment as set forth by CMS and RI EOHHS. Enrollees who otherwise are included in Medicare reassignment effective January 1 of a given year either from their current Medicare Prescription Drug Plan (PDP) or terminating Medicare Advantage Prescription Drug Plan (MA-PD) to another PDP, will not be eligible for Passive Enrollment that same year. For example: those reassigned to a new PDP effective January 1, 2016, will be eligible for Passive Enrollment into the Contractor’s MMP effective no earlier than January 1, 2017. Passive Enrollment activity will be coordinated with CMS activities such as annual reassignment and daily auto-assignment for individuals with the Part D Low Income Subsidy.
Passive Enrollment. An Enrollment process through which an eligible individual is enrolled by RI EOHHS (or its vendor) into the Contractor, following a minimum sixty (60) Day advance notification from the Enrollment effective date that includes the plan selection and the opportunity to cancel the Passive Enrollment into the Demonstration prior to the effective date. The individual may Opt-Out of Passive Enrollment in the Demonstration at any time.
Passive Enrollment. An enrollment process through which an eligible individual is enrolled by the State (or its vendor) into an ICO, when not otherwise affirmatively electing one, following a minimum 60-day notice that includes the plan selection and the opportunity to select a different ICO, decline enrollment into an ICO, or opt out of the Demonstration prior to the effective date. Person-Centered Planning Process – A process for planning and supporting a person receiving services that builds on the individual’s desire to engage in activities that promote community life and that honor the person’s preferences, choices, and abilities. The person-centered planning process is led by the person and involves families, friends, legal representative, and professionals as he/she desires or requires. Pre-paid Inpatient Health Plan (PIHP) – PIHPs manage the Medicaid specialty services under the 1915(b)(c) Waiver Program, consistent with the requirements of 42 C.F.R. Part 401. This benefit plan covers mental health and substance use services for people eligible for Medicaid who have a need for behavioral health, intellectual/developmental disabilities services and supports, or substance use services. Privacy – Requirements established in the Health Insurance Portability and Accountability Act of 1996, and implementing regulations, Medicaid regulations, including 42 C.F.R. 431.300 through 431.307, as well as relevant Michigan privacy laws. Quality Improvement Organization (QIO) – A statewide organization that contracts with CMS to evaluate the appropriateness, effectiveness, and quality of care provided to Medicare beneficiaries. Readiness Review – Prior to entering into a three-way agreement with MDCH and CMS, each ICO selected to participate in the Demonstration will undergo a readiness review. The readiness review will evaluate each ICO’s ability to comply with the Demonstration requirements, including but not limited to, the ability to quickly and accurately process claims and enrollment information, accept and transition new members, and provide adequate access to all Medicare- and Medicaid‐covered medically necessary services. CMS and MDCH will use the results to inform their decision of whether the ICO is ready to participate in the Demonstration. At a minimum, each readiness review will include a desk review and potentially a site visit to the ICO’s headquarters. Reassessment – A detailed assessment of the enrollee at specified intervals and/or after a change in health status. ...
Passive Enrollment. An enrollment process through which an eligible individual is enrolled by DMAS (or its authorized agent) into a Contractor’s plan, when not otherwise affirmatively electing one, following a minimum 60-day advance notification that includes the opportunity to make another enrollment decision, or opt out of the Demonstration, prior to the effective date.
