Enrollment Limits. In accordance with 42 CFR 438.206, BMS may establish a maximum Medicaid enrollment level for Medicaid beneficiaries for the MCO on a county-specific basis dependent on BMS’ evaluation of the capacity of the MCO’s network. Subsequent to the establishment of this limit, if the MCO wishes to change its maximum enrollment level, it must gain BMS’ approval. The MCO must notify BMS 45 days prior to the desired effective date of the change. BMS will issue its approval or disapproval in thirty (30) days, subject to BMS’ timely receipt of all necessary information from the MCO to make the determination. If the change is an increase, the MCO must demonstrate its capability to serve additional enrollees. An increase will be effective the first of the month after BMS confirms additional capacity exists. If capacity is decreased because of a reduction in the number of participating providers available to Medicaid enrollees, then BMS will give the patients of those providers leaving the network the option to voluntarily disenroll from the plan.
Appears in 3 contracts
Sources: Purchase of Service Provider Agreement, Purchase of Service Provider Agreement, Purchase of Service Provider Agreement
Enrollment Limits. In accordance with 42 CFR 438.206, BMS may establish a maximum Medicaid enrollment level for Medicaid beneficiaries for the MCO on a county-specific basis dependent on BMS’ evaluation of the capacity of the MCO’s network. Subsequent to the establishment of this limit, if the MCO wishes to change its maximum enrollment level, it must gain BMS’ approval. The MCO must notify BMS 45 forty-five (45) calendar days prior to the desired effective date of the change. BMS will issue its approval or disapproval in thirty (30) calendar days, subject to BMS’ timely receipt of all necessary information from the MCO to make the determination. If the change is an increase, the MCO must demonstrate its capability to serve additional enrollees. An increase will be effective the first of the month after BMS confirms additional capacity exists. If capacity is decreased because of a reduction in the number of participating providers available to Medicaid enrollees, then BMS will give the patients of those providers leaving the network the option to voluntarily disenroll from the plan.
Appears in 2 contracts
Sources: Purchase of Service Provider Agreement, Purchase of Service Provider Agreement
Enrollment Limits. In accordance with 42 CFR 438.206, BMS may establish a maximum Medicaid enrollment level for Medicaid beneficiaries for the MCO on a county-specific basis dependent on BMS’ evaluation of the capacity of the MCO’s network. Subsequent to the establishment of this limit, if the MCO wishes to change its maximum enrollment level, it must gain BMS’ approval. The MCO must notify BMS 45 days prior to the desired effective date of the change. BMS will issue its approval or disapproval in thirty (30) 30 days, subject to BMS’ timely receipt of all necessary information from the MCO to make the determination. If the change is an increase, the MCO must demonstrate its capability to serve additional enrollees. An increase will be effective the first of the month after BMS confirms additional capacity exists. If capacity is decreased because of a reduction in the number of participating providers available to Medicaid enrollees, then BMS will give the patients of those providers leaving the network the option to voluntarily disenroll from the plan.
Appears in 1 contract