Common use of Enrollment and Disenrollment Processes Clause in Contracts

Enrollment and Disenrollment Processes. The Demonstration will use an integrated enrollment system to simplify the enrollment experience for Beneficiaries and improve the accuracy of the enrollment process. i. Integrated enrollment system: a. Currently the State serves as a third-party administrator (TPA) for some MSHO Plans to facilitate coordinated enrollment. This mechanism will be maintained, and enhanced, as necessary. b. Uniform Enrollment and Disenrollment Letters and Forms - Beneficiaries will enroll and disenroll from Medicare and Medicaid managed care simultaneously through an integrated form, notices, and process. The State will test new, simplified language on enrollment forms and notices, subject to CMS approval. ii. Accuracy of the Enrollment Process: a. Data in State and CMS systems will be reconciled on a timely basis to prevent discrepancies between the systems. For example, for the purpose of sending forms and notices, the Demonstration will use updated State mailing addresses where the State addresses are more likely to be more accurate than the addresses from CMS. b. Enrollment Effective Date(s) – D-SNPs are typically required to submit beneficiary enrollment requests to CMS within 7 days of verification. However, MSHO SNPs are currently exempted from requirements related to timely reporting of enrollments to allow time for Medicaid enrollments to be verified and finalized. In the demonstration, they will continue to be exempt from 7 day timeliness reporting requirements. This process allows for the completion of the Medicaid eligibility process prior to enrollment in the plan and enables the MSHO Plans and the State to promote overall integration of the enrollment process.