Default Enrollment Process Clause Samples

Default Enrollment Process. On behalf of currently enrolled AHCCCS categorically eligible members who receive full medical assistance benefits, and who become newly Medicare eligible either by age or disability, and that such Medicare eligibility results in Full Benefit Dual Eligible status for such members , MAO shall perform the default enrollment process as provided by 42 CFR 422.66 and 422.68. Through this Agreement, in conformance with 42 CFR 422.66(c)(2)(i)(B) and 42 CFR 422.107, AHCCCS approves MAO’s implementation of the default enrollment process subject to CMS’ prior approval as per the requirements of 42 CFR 422.66(c)(2)(i)(E), (F), and (G) inclusive; 422.66(c)(2)(ii); and other CMS-published regulatory guidance as applicable. MAO shall be responsible for timely obtaining initial default enrollment process approval from CMS no later than 120 calendar days prior to the Effective Date of this Agreement as specified in paragraph 3.1: Term of Agreement. MAO shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS prior approval. MAO shall forward to AHCCCS a copy of CMS’ default enrollment process prior approval notification or correspondence to the MAO within 10 calendar days of receipt, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall also be responsible for coordinating those necessary activities to renew any existing default enrollment process approval(s) with CMS, as per the requirements of 42 CFR 422.66(c)(2)(ii), so that any such subsequent CMS approval(s)/renewal(s) of an existing approved default enrollment process shall be effective no later than 120 calendar days prior to the expiration of the existing CMS approval requested to be renewed. MAO shall coordinate with AHCCCS regarding those activities necessary to obtain such CMS renewal approval(s) of an existing default enrollment process. MAO shall forward to AHCCCS copies of its default enrollment process renewal notification and materials to CMS, and CMS’ renewal approval(s) notification or correspondence to the MAO, within 10 calendar days of receipt, in accordance with the requirements of Attachment 1: Chart of Deliverables. MAO shall maintain a minimum 3.0 overall plan Star rating as assigned by CMS to implement the default enrollment process. MAO implementation of the default enrollment process shall be revoked by CMS if a minimum 3.0 overall plan Star rating is not maintained, and default enrollment cannot be re-applied for with CMS until the MA...
View SourceView Similar (14)
Default Enrollment Process a. On behalf of Members who receive full medical assistance benefits, and who become newly Medicare eligible either by age or disability, and such Medicare eligibility results in full benefit Dual Eligible Beneficiary status for such Members, Health Plan shall perform the default enrollment process as provided by 42 CFR §§ 422.66 & 422.68. b. Through this Agreement, and in conformance with 42 CFR § 422.66(c)(2)(i)(B) and 42 CFR § 422.107, SDOH approves Health Plan’s implementation of the default enrollment process for its D-SNP subject to CMS’ prior approval as per the requirements of 42 CFR §§ 422.66(c)(2)(i)(E), (F), & (G) inclusive; 42 CFR § 422.66(c)(2)(ii); and other CMS- published regulatory guidance as applicable. c. Health Plan shall be responsible for timely obtaining initial default enrollment process approval from CMS. Health Plan shall coordinate with SDOH regarding those activities necessary to obtain such CMS prior approval. Health Plan shall forward to SDOH a copy of CMS’ default enrollment process prior approval notification or correspondence to Health Plan within 10 calendar days of receipt. d. Health Plan shall be responsible for coordination and continuity of care to ensure that, for each Member enrolled in Health Plan’s D-SNP through the default enrollment process (and who is thus also enrolled in a managed care organization operated by the Health Plan), Health Plan shall be responsible for continuing to provide covered services authorized by the Member’s managed care organization, without regard to whether such services are being provided by participating or non-participating providers for at least sixty (60) days, which shall be extended as necessary to ensure continuity of care pending the provider’s contracting with the Health Plan’s D-SNP plan or the Member’s transition to a participating provider and any needed actions to mitigate potential negative consequences related to transition of providers. e. Health Plan shall be responsible for coordinating those activities necessary to renew any existing default enrollment process approval(s) with CMS, as per the requirements of 42 CFR § 422.66(c)(2)(ii), so that any such subsequent CMS approval(s)/renewal(s) of an existing approved default enrollment process shall be effective no later than 120 calendar days prior to the expiration of the existing CMS approval requested to be renewed. Health Plan shall coordinate with SDOH regarding those activities necessary to obtain such CMS renewal ...
View SourceView Similar (5)

Related to Default Enrollment Process

  • Enrollment Process The Department may, at any time, revise the enrollment procedures. The Department shall advise the Contractor of the anticipated changes in advance whenever possible. The Contractor shall have the opportunity to make comments and provide input on the changes. The Contractor shall be bound by the changes in enrollment procedures.

  • Payment Process Subject to the terms and conditions established by the Agreement, the pricing per deliverable established by the Grant Work Plan, and the billing procedures established by Department, Department agrees to pay Grantee for services rendered in accordance with Section 215.422, Florida Statutes (F.S.).

  • Contractor Selection Justification Form Customers shall complete this Contractor Selection Justification Form for each candidate selected and attach all completed forms to the purchase order. Date: Contractor’s Name: _ Contractor’s Contact Information: Address: _ Phone: _ Email: Candidate’s Name: _ Date Candidate will be available: _ Hourly rate of candidate: $ Position candidate recommended for: _ Justification for selection of candidate: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Agency: Division/Section/Unit: _ Printed Name: _ Title: _ Signature _ Date: Contractor's Name: Quarter: Purchase Order (PO) Number: PO Total $ Amount: PO Starting Date Ending Date Please review the attached Rating Definitions and provide your opinion by rating the following:

  • Selection Process The Mortgage Loans were selected from among the outstanding one- to four-family mortgage loans in the Seller's portfolio at the related Closing Date as to which the representations and warranties set forth in Subsection 9.02 could be made and such selection was not made in a manner so as to affect adversely the interests of the Purchaser;

  • Disenrollment 12.1 ADFMs shall be disenrolled from TOP Prime/TOP Prime Remote, TOP Select when: • The enrollee loses eligibility for TOP enrolled coverage, • The enrollee has not requested enrollment transfer/disenrollment of TOP Prime/TOP Prime Remote within 60 calendar days following the end of the overseas tour. 12.2 ADSMs shall be disenrolled from TOP Prime/TOP Prime Remote when: 12.3 ADFMs who are enrolled in TOP Prime/TOP Prime Remote may disenroll at any time. They will not be permitted to make another enrollment until after a 12-month period if they have already changed their enrollment status from enrolled to disenrolled twice during the enrollment year (October 1 to September 30) for any reason. ADFMs with sponsors E-1 through E-4 are exempt from these enrollment lock-out provisions. See Chapter 6, Section 1 for guidance regarding enrollment lock-outs. Effective January 1, 2018, see TPM, Chapter 10, Section 2.1 for QLE information and Chapter 6, Sections 1 and 2, for enrollment eligibility and time frames. 12.4 ADSMs cannot voluntarily disenroll from TOP Prime or TOP Prime Remote if they remain on permanent assignment in an overseas location where these programs are offered. ADSM enrollment in TOP Prime or TOP Prime Remote continues until they transfer enrollment to another TRICARE region/program or lose eligibility for TOP/TRICARE. 12.5 TOP Prime/TOP Prime Remote enrollees must either transfer enrollment or disenroll within 60 calendar days of the end of the overseas tour when the ADSM departs to a new area of assignment. The TOP contractor shall provide continuing coverage until (1) the enrollment has been transferred to the new location, (2) the enrollee disenrolls, or (3) when enrollment transfer or disenrollment has not been requested by the TOP Prime/TPR enrollee by the 60th day the TOP contractor will automatically disenroll the beneficiary on the 61st calendar day following the end date of the overseas tour from TOP Prime or TOP TPR. Until December 31, 2017, the disenrolled ADFM TOP Prime or TOP TPR beneficiary will revert to TRICARE Standard. Effective January 1, 2018, ADFMs disenrolled from TOP Prime or TOP TPR will be only eligible for space available care at military treatment facilities.‌