State Level Enrollment and Disenrollment Operations Requirements Sample Clauses

State Level Enrollment and Disenrollment Operations Requirements a) Eligible Populations – All individuals enrolling in or currently enrolled in MSHO will be a part of this Demonstration, as described in the body of the MOU.
View Source
State Level Enrollment and Disenrollment Operations Requirements a. Eligible Populations/Excluded Populations - As described in the body of the MOU. b. Enrollment, and Disenrollment Processes – All enrollment and disenrollment transactions, including enrollments from one ICO to a different ICO, will be processed through the Michigan Enrollment Broker, except those transactions related to non-Demonstration plans participating in Medicare Advantage. Michigan Medicaid (or its vendor) will submit enrollment transactions to the CMS Medicare Advantage Prescription Drug (▇▇▇▇) enrollment system directly or via a third party CMS designates to receive such transactions. CMS will also submit a file to Michigan Medicaid identifying individuals who have elected a Medicare Advantage plan that is not an ICO. CMS will also submit a file to Michigan Medicaid identifying individuals who called ▇-▇▇▇-▇▇▇▇▇▇▇▇ and chose to opt-out. Michigan Medicaid will share enrollment, disenrollment and opt-out transactions with contracted ICOs and Prepaid Inpatient Health Plans (PIHPs). c. Uniform Enrollment/ Disenrollment and Opt-Out Letter and Forms - Letters and forms will be made available to stakeholders by both CMS and MDCH. d. Enrollment Effective Date(s) - All enrollment effective dates are prospective. Beneficiary-elected enrollment is effective the first calendar day of the month following the initial receipt of a beneficiary’s request to enroll, or the first day of the month following the month in which the beneficiary is eligible, as applicable for an individual enrollee. MDCH will conduct phased in periods for opt-in and passive enrollment. i. Opt-in: The State will initially conduct two phased opt-in periods. ICOs will be required to accept opt-in enrollments no earlier than 30-days prior to the initial effective date as outlined below. Opt-in enrollments will be phased in prior to passive enrollment. a) Phase 1: Beneficiaries in Region 1 (Alger, Baraga, Chippewa, Delta, ▇▇▇▇▇▇▇▇▇, Gogebic, Houghton, Iron, Keweenaw, ▇▇▇▇, Mackinac, Marquette, Menominee, Ontonagon, and Schoolcraft counties) and Region 4 (Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, Saint ▇▇▇▇▇▇, and Van Buren counties) will be able to opt in beginning no earlier than October 1, 2014 with an enrollment effective date of January 1, 2015. b) Phase 2: Beneficiaries in Region 7 (▇▇▇▇▇ County) and Region 9 (Macomb County) will be able to opt in no earlier than March 1, 2015 with an enrollment effective date of May 1, 2015. The State or the Michigan Enrollment Broker will p...
View Source
State Level Enrollment and Disenrollment Operations Requirements a. Eligible Populations/Excluded Populations - As described in the body of the MOU. b. Enrollment and Disenrollment Processes – Enrollment and disenrollment transactions will be processed by the State Enrollment Broker, consistent with the enrollment effective date requirements outlined in the Medicare-Medicaid Plan Enrollment and Disenrollment Guidance. The State Enrollment Broker will submit enrollment transactions to the CMS Medicare Advantage Prescription Drug (▇▇▇▇) enrollment system directly or via a third party CMS designates to receive such transactions. CMS will also submit a file to the State Enrollment Broker and the FIDA-IDD Plan identifying individuals who have elected to disenroll from the FIDA-IDD Plan. The State Enrollment Broker and CMS will both share Enrollment and disenrollment transactions with the contracted FIDA-IDD Plan. The contracted FIDA-IDD Plan will have ▇▇▇▇ connectivity and comply with all required Medicare Part C and D Enrollment transaction and reply code timelines and will have connectivity with the State Enrollment Broker. c. Enrollment Notices – Before they are finalized, Enrollment notices will be made available to the public for comment by both CMS and the State. d. Opt-in Enrollment Only - There is no Passive Enrollment for the FIDA-IDD Demonstration. All Enrollment in the FIDA-IDD Demonstration is via Opt-in Enrollment, in which eligible individuals actively choose to enroll in the FIDA-IDD Plan. e. Enrollment and Disenrollment Effective Date(s) – All Enrollment effective dates are prospective. Participant-elected Enrollment is effective the first calendar day of the month following the initial receipt of a Participant’s request to enroll. The FIDA-IDD Plan will be required to accept Opt-in Enrollments of eligible individuals no earlier than 30 calendar days prior to the initial effective date of no earlier than April 1, 2016, and begin providing coverage for enrolled individuals no earlier than April 1, 2016. Participant requests to cancel Enrollment will be accepted any time before the Enrollment Effective Date. Requests to disenroll from the FIDA-IDD Plan will be accepted at any point after a Participant’s initial Enrollment occurs and will be effective on the first of the month following receipt of the request. Any time an individual requests to disenroll from the Demonstration, the State will send a letter confirming the disenrollment and providing information on the benefits available to the Participant once th...
View Source
State Level Enrollment and Disenrollment Operations Requirements 
View Source

Related to State Level Enrollment and Disenrollment Operations Requirements

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • 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.‌

  • 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.

  • Enrollment Requirements You must maintain with Blue Cross and Blue Shield a current and updated listing of covered employees. You will be responsible for all claims costs and expenses associated with failure to maintain an accurate and current listing with Blue Cross and Blue Shield, unless such claims costs and expenses are due to an error on Blue Cross and Blue Shield’s part. In order to maintain health care coverage with Blue Cross and Blue Shield, an employee must meet the written eligibility requirements (such as length of service, active employment and number of hours worked) you impose as long as they do not conflict with Blue Cross and Blue Shield’s eligibility requirements. An eligible employee as defined by Blue Cross and Blue Shield means: • A permanent full-time employee regularly working 30 hours or more each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A permanent part-time employee regularly working at least 20 hours but less than 30 hours each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A disabled permanent full-time or part-time employee who is actively working despite the disability (including one who is engaged in a trial work period) and a disabled employee who is not actively working but whom the employer treats as an employee; or • A former employee (or a former covered dependent of the employee of the group) who qualifies for continued group coverage under federal or state law, but only if the employer maintains Blue Cross and Blue Shield group coverage for permanent full-time employees as defined in (a) above; or • A retired employee of the employer. Newly hired employees who are eligible for group benefits can enroll in the benefits plan according to your eligibility requirements for coverage, provided that your requirements comply with Blue Cross and Blue Shield’s eligibility and enrollment requirements. The effective date of an eligible employee’s (or his or her dependent’s) membership in the benefits plan may be the Member’s initial eligibility date or your subsequent anniversary/renewal date, as long as: (a) Blue Cross and Blue Shield receives your written notice no later than 30 days after the Member’s enrollment notification period applicable to membership modifications (as described in the Subscriber Certificate for your benefits plan); and (b) you pay the applicable premium charges.

  • 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: