Voluntary and Involuntary Disenrollment. All MCO enrollees will remain continuously enrolled throughout the term of this Contract, except in situations where clients lose their Medicaid eligibility, are admitted to a skilled nursing facility (SNF) or nursing facility, voluntarily disenroll, or are re-categorized into a Medicaid coverage category not included in the managed care delivery system. BMS will notify the MCO of all disenrollment, by means of a monthly enrollment roster report which explicitly identifies terminations from enrollment and the cause of the disenrollment (e.g. loss of Medicaid eligibility, change in eligibility status to a coverage code not included in the managed care initiative, voluntary switching to another MCO, or other causes). BMS has federal authority to implement an enrollment lock in policy in which enrollees are locked-in to a single MCO for a twelve (12) month period though may request to change their MCO enrollment in accordance with 42 CFR §438.56. Should BMS implement this policy during the Contract year, the MCO will be required to supply all necessary information requested by the enrollment broker regarding BMS’ enrollee lock-in program.
Voluntary and Involuntary Disenrollment. All MCO enrollees will remain continuously enrolled throughout the term of this Contract, except in situations where clients lose their Medicaid eligibility, are admitted to a skilled nursing facility (SNF) or nursing facility, voluntarily disenroll, or are re-categorized into a Medicaid coverage category not included in the managed care delivery system. The Department will notify the MCO of all disenrollment, by means of a monthly enrollment roster report which explicitly identifies terminations from enrollment and the cause of the disenrollment (e.g. loss of Medicaid eligibility, change in eligibility status to a coverage code not included in the managed care initiative, voluntary switching to FFS or other causes).
Voluntary and Involuntary Disenrollment. All MCO enrollees will remain continuously enrolled throughout the term of this contract, except in situations where clients change MCOs or from a MCO to an alternative system (e.g., PAAS) in certain geographic areas of the managed care initiative, lose their Medicaid eligibility, are admitted to a skilled nursing facility (SNF) or nursing facility, or are recategorized into a Medicaid coverage category not included in the managed care initiative. The Department will notify the MCO of all disenrollment, by means of a monthly enrollment roster report which explicitly identifies terminations from enrollment and the cause of the disenrollment (e.g. loss of Medicaid eligibility, change in eligibility status to a coverage code not included in the managed care initiative, voluntary switching to another MCO, or other causes).
Voluntary and Involuntary Disenrollment. 16 4.5 Capitation Payments to Managed Care Organization 17 4.6 Federal Disallowance 18 4.7 Enrollee Eligibility Capitation Adjustments 18 4.8 Enrollee Reinstatement Processing 19 4.9 Ongoing Managed Care Organization Monitoring 19 4.10 Utilization Review and Control 19 4.11 Force Majeure 20 4.12 Time Is of the Essence 20
Voluntary and Involuntary Disenrollment. All MCO enrollees will remain continuously enrolled throughout the term of this Contract, except in situations where clients lose their Medicaid or WVCHIP eligibility, are admitted to a skilled nursing facility (SNF) or nursing facility, voluntarily disenroll, or are re-categorized into a Medicaid coverage category not included in the managed care delivery system. BMS will notify the MCO of all disenrollment, by means of a monthly enrollment roster report which explicitly identifies terminations from enrollment and the cause of the disenrollment (e.g. loss of Medicaid or WVCHIP eligibility, change in eligibility status to a coverage code not included in the managed care initiative, voluntary switching to another MCO, or other causes). BMS has federal authority to implement an enrollment lock in policy in which enrollees are locked-in to a single MCO for a twelve (12) month period though may request to change their MCO enrollment in accordance with 42 CFR §438.56. Should BMS implement this policy during the Contract year, the MCO will be required to supply all necessary information requested by the enrollment broker regarding BMS’ enrollee lock-in program.
Voluntary and Involuntary Disenrollment. All MCO enrollees will remain continuously enrolled throughout the term of this Contract, except in situations where clients change MCOs or from a MCO to an alternative system (e.g., PAAS) in certain geographic areas of the managed care initiative, lose their Medicaid eligibility, are admitted to a skilled nursing facility (SNF) or nursing facility, or are recategorized into a Medicaid coverage category not included in the managed care delivery system. The Department will notify the MCO of all disenrollment, by means of a monthly enrollment roster report which explicitly identifies terminations from enrollment and the cause of the disenrollment (e.g. loss of Medicaid eligibility, change in eligibility status to a coverage code not included in the managed care initiative, voluntary switching to another MCO, or other causes). The MCO must supply all necessary information to the enrollment broker regarding the Department’s enrollee lock-in program implemented in accordance with 42 CFR 438.56.
Voluntary and Involuntary Disenrollment. All MCO enrollees will remain continuously enrolled throughout the term of this Contract, except in situations where clients change MCOs, lose their Medicaid eligibility, are admitted to a skilled nursing facility (SNF) or nursing facility, or are recategorized into a Medicaid coverage category not included in the managed care delivery system. The Department will notify the MCO of all disenrollment, by means of a monthly enrollment roster report which explicitly identifies terminations from enrollment and the cause of the disenrollment (e.g. loss of Medicaid eligibility, change in eligibility status to a coverage code not included in the managed care initiative, voluntary switching to another MCO, or other causes). The MCO must supply all necessary information to the enrollment broker regarding the Department’s enrollee lock-in program implemented in accordance with 42 CFR 438.56.
