Enrollment and Disenrollment. The Division or its Agent shall send written notification to the Member to inform the Member of Enrollment into CHIP and to select a Contractor and Primary Care Provider (PCP).
Enrollment and Disenrollment. The Division or its Agent shall send written notification to the Member to inform the Member of Enrollment into the MississippiCAN Program and to select a CCO and PCP.
Enrollment and Disenrollment. 1.5.1 Non-Discrimination Consistent with 42 C.F.R. § 438.3(d), the Contractor may not refuse an assignment or seek to disenroll a Dental Health Plan Enrollee or otherwise discriminate against individuals eligible to enroll on the basis of race, color, national origin, sex, sexual orientation, gender identity, or disability and may not use any policy or practice that has the effect of discriminating on the basis of race, color or national origin, sex, sexual orientation, gender identity, or disability. The Contractor also may not discriminate against a Dental Health Plan Enrollee on the basis of expectations that the Dental Health Plan Enrollee will require frequent or high-cost care, or on the basis of health status or need for health care services or due to an adverse change in the Dental Health Plan Enrollee’s health in Enrollment, Disenrollment, or re-enrollment. The Contractor shall accept individuals eligible for enrollment in the order in which they are enrolled (unless otherwise authorized by CMS) up to the limits set under the Contract. The Contractor shall not request Disenrollment because of a change in the Dental Health Plan Enrollee’s health status, or because of the Dental Health Plan Enrollee’s utilization of dental services, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs, except when his or her continued enrollment with the Contractor seriously impairs the Contractor’s ability to furnish services to either this particular Dental Health Plan Enrollee or other Dental Health Plan Enrollees. The Contractor may only request Disenrollment of the Dental Health Plan Enrollee in accordance with the provisions outlined in Section 0.0.0.0: “Contractor Request” of this Contract.
Enrollment and Disenrollment. In accordance with A.R.S. §8-512, CMDP provides comprehensive medical and dental care for each child who is: a) placed in a xxxxxx home; b) in the custody of DES and placed with a relative, in a certified adoptive home prior to the final order of adoption, or in an independent living program as provided in A.R.S. §8-512; and c) in the custody of the Arizona Department of Juvenile Corrections (ADJC) or the Administrative Office of the Courts/Juvenile Probation Office (AOC/JPO) and placed in xxxxxx care. Children who are enrolled with CMDP when placed temporarily in detention may remain Title XIX or Title XXI eligible. When it is determined that the child does not meet the “inmate of a public institution” status as determined by the Children in Detention Policy, AHCCCS enrollment will remain with CMDP. The Division of Children, Youth and Families (DCYF) is responsible for determining Title XIX eligibility for the children entitled to CMDP coverage. Upon notification from DCYF that a CMDP covered child qualifies for Title XIX, AHCCCS, will enroll the child with CMDP as the Title XIX health plan. AHCCCS shall in turn notify CMDP of the child’s AHCCCS enrollment, and CMDP shall ensure that the member is enrolled in CMDP’s Title XIX line of business. DCYF is responsible for timely notification to AHCCCS that a member is no longer eligible for Title XIX or that member no longer meets the criteria for CMDP coverage as set forth in A.R.S. §8-512. As a result of the DCYF notification that a member no longer qualifies for CMDP, AHCCCS shall notify CMDP of a member’s termination from CMDP. CMDP shall timely disenroll the member from CMDP’s Title XIX line of business. AHCCCS is responsible for determining Title XXI eligibility. AHCCCS shall notify CMDP when a child qualifies for Title XXI and CMDP coverage. CMDP shall ensure that the member is enrolled in CMDP’s Title XXI line of business. AHCCCS shall notify CMDP if a Title XXI child no longer meets the criteria for Title XXI eligibility, and CMDP shall disenroll such child from the Title XXI line of business. If a Title XXI eligible child no longer meets the criteria for CMDP coverage as set forth in A.R.S. §8.512, CMDP shall notify AHCCCS, and the child shall be disenrolled from CMDP, by AHCCCS and CMDP. CMDP may not disenroll because of an adverse change in the member’s health status, or because of the member’s utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resu...
Enrollment and Disenrollment. A. Enrollment
Enrollment and Disenrollment. Procedures
Enrollment and Disenrollment. DOM or its Agent shall send written notification to the Member to inform the Member of Enrollment into CHIP and to select a CCO and Primary Care Provider (PCP).
Enrollment and Disenrollment. A. Enrollment Discrimination Prohibited
Enrollment and Disenrollment. 2.1.1.1 Enrollment Procedures (1) The Contractor will receive a complete referral package from CARES. (2) Upon receipt, the Contractor will log in and date stamp the CARES referral package. (3) The Contractor must check monthly Medicaid eligibility through the FMMIS Web Portal or other valid system. (4) Upon receipt of the referral package, the Contractor will confirm through FMMIS’s Web Portal or other valid system the following: a. Medicaid eligibility program codes are MS, MMS, or MWA. b. The recipient resides in the Contractor’s service area. c. The recipient has Medicare Parts A and B. d. At the time of enrollment: 1) The recipient is not residing in a nursing home. 2) The recipient is not currently enrolled in a Medicaid HMO. 3) The recipient is not currently enrolled in the MediPass program. 4) The recipient is not currently enrolled in a Medicaid waiver program. (5) The Contractor must accept individuals eligible for enrollment in the order in which they are received from CARES. The Contractor will not discriminate against individuals eligible to enroll on the basis of race, color, or national origin, and will not use any policy or practice that has the effect of discriminating on any basis including but not limited to race, color, or national origin. (6) A dispute between the CARES assessment and the Contractor’s assessment as to the appropriateness of the enrollment shall be referred by the Contractor to the Contract Manager if resolution with CARES is unsuccessful within 48 hours of the Contractor’s face-to-face project orientation. The Department will review the dispute within one (1) business day of receipt and issue a final determination in writing in no more than five (5) business days to the Contractor and the CARES office. (7) The CARES referral package shall include a copy of the disenrollment form for enrollees transferring to a new Contractor.
Enrollment and Disenrollment. Because premium payments are based on the number of Members enrolled, the Group must notify Coventry of the enrollment or disenrollment of a Member by submitting an enrollment/change form to Coventry within thirty-one (31) days of the enrollment or thirty-one (31) days of the disenrollment. If the enrollment or disenrollment is not submitted within the allotted window, the maximum retroactive enrollment and disenrollment is thirty-one (31) days prior to the date Coventry was notified of the change. Coventry will make an appropriate adjustment of premiums for any retroactive enrollment or disenrollment. Coventry also reserves the right to make adjustments to offset any premium adjustment by any expenses for claims and administration costs incurred by Coventry with respect to such Member after the date the Coverage should have been terminated under the Agreement. Retroactive disenrollments of all or the majority of Members will not be allowed to effectuate retroactive termination of the Group’s coverage or a specific segment of the Group’s coverage. Eligibility for coverage under the Agreement shall be in accordance with the requirements stated in the Evidence of Coverage, unless additional requirements are provided in the Coverage and Premium Rate Addendum.
