Passive Enrollment. An enrollment process through which an eligible individual is enrolled by the EOHHS (or its vendor) into a Contractor’s One Care Plan following a minimum sixty (60) day advance notification that includes the opportunity to make another enrollment decision prior to the effective date.
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 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. 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 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. 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 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.
Passive Enrollment. An Enrollment process through which an Eligible Beneficiary is enrolled by SCDHHS (or its vendor) into a CICO’s MMP, when not electing one, following a minimum sixty (60) day advance notification that includes the plan selection and the opportunity to select a different plan, or decline Enrollment into a CICO, or Opt-Out of the Demonstration prior to the effective date. Patient Liability – The amount an Enrollee must contribute toward the cost of nursing facility services. Patient Liability is required to be calculated for every Enrollee receiving nursing facility services, although not every eligible Enrollee will contribute this amount each month. Automated Case Management System – SCDHHS’s automated Case Management system maintains records of a number of critical functions, including all intake, assessment, and care planning activities. Key features include sections for a home assessment, caregiver supports, and quality indicators. There are also edits to ensure compliance with federal regulations (e.g., waiver admission is within thirty (30) days of the most recent level of care determination) as well as state policies. The system also includes a method to identify waiver participants most at risk for missed in-home visits and those most at risk in the event of natural disasters. Functionality will be expanded for use in the Demonstration, and CICOs will be required to utilize it for specified Demonstration activities. Post-stabilization Care Services - Covered Services related to the Enrollee's underlying condition that are provided after the Enrollee's Emergency Medical Condition has been Stabilized and/or under the circumstances described in 42 C.F.R. § 438.114(e) to improve or resolve the Enrollee's condition. Prevalent Languages —When five (5) percent of the CICO’s enrolled population is non-English speaking and speaks Spanish or another common language other than English. Privacy or Privacy Rules - Requirements established in the Privacy Act of 1974, Health Insurance Portability and Accountability Act of 1996, and implementing regulations, Medicaid regulations, including 42 C.F.R. §§ 431.300 - 431.307, as well as relevant South Carolina Privacy laws. Program of All-Inclusive Care for the Elderly (PACE) — A capitated benefit for frail elderly authorized by the Balanced Budget Act 1997 (BBA) and provided under the State Medicaid Plan that features a comprehensive service delivery system and integrated Medicare and Medicaid financi...
