Common use of STATE and CMS MSHO Enrollment Clause in Contracts

STATE and CMS MSHO Enrollment. Integrated Enrollment Procedures; Enrollment TPA Services. Enrollment in MSHO for Medicaid in MMIS will be performed by the STATE or MCO. The STATE and MCO agree that coordination of enrollment processes for Medicare SNP and Medicaid benefits will be consistent with the requirements of 42 CFR § 422.107(c)(6), regarding verification of the Enrollee’s eligibility for both Medicare and Medicaid. MCO agrees to use the real-time data exchange and enrollment processes further described in sections 3.1.2 (Enrollment), 3.3 (Capability to Receive Enrollment Data Electronically), 3.5 (LTCC Screening Document and Health Risk Assessment Entry.), and the timeframes in 3.6.6. Assignment of Rate Cell Categories will be done by the STATE, based on information in MMIS at the time of capitation. Integrated enrollments for both Medicare and Medicaid will be conducted by a joint process between the MCO and the STATE. The MCO or the STATE will perform each duty according to the terms and conditions of a separate integrated enrollment Third Party Administrator (TPA) contract, or if the MCO chooses not to enter into a TPA contract with the STATE, by following the integrated enrollment processes posted on the DHS managed care website. The STATE will continue to be available to provide integrated enrollment TPA services to the MSHO MCOs. The charge and scope of duties for this service will be negotiated between the MCO and the State in an additional contract. These duties will include but not be limited to the submission of Medicare SNP enrollment to CMS on a monthly basis. If a TPA contract does not exist between the MCO and the STATE, the STATE may propose to contract with the MCO for processes performed by the STATE that are required to maintain integrated enrollment, and may charge for these processes, as an alternative to the TPA contract in section 3.1.4(D). If the STATE determines such a contract is necessary, the STATE will provide one hundred and fifty (150) days’ notice to the MCO.