gsa18

Auto-enrollment process

AZ | CA | CO | CT | DE | DC | FLMH | HI | HIBH | IA | KS | ME | MD | MA
MI | MN | MO | MT | NE | NEBH | NV | NH | NM | NY | NC | ND | OH
OK | OR | ORMH | PA | PABH | RI | TN | TX | UTMH | VA | WA | WV | WI

"6. ENROLLMENT AND DISENROLLMENT…
Health Plan Choice...
Members who do not choose prior to AHCCCSA's being notified of their eligibility are automatically assigned to a health plan based on family continuity or the auto-assignment algorithm...

When a member is transferred from Title XIX to Title XXI and has not made a health plan choice for Title XXI, the member will remain with the Title XIX health plan and a choice notice will be sent to the member...

Exceptions to the above enrollment policies for Title XIX and state only members include: previously enrolled members who have been disenrolled for less than 90 days will be automatically enrolled with the same contractor, if that contractor is still available. Also, women whose SOBRA eligibility have terminated and have become enrolled in the Family Planning Services Extension Programs will automatically remain assigned to the same health plan. The Family Planning Services Extension Program provides a maximum of 24 months of Family planning Services." Arizona Contract, page 19.

"4.42 Definitions
For purposes of Section 4.4, Enrollment Processing, the following definitions shall apply:

A. Fully Converted County means a county in which the following circumstances exist, except for those Medi-Cal beneficiaries covered by Title 22, CCR, Section 53887:

1. Eligible Beneficiaries who meet the mandatory enrollment criteria contained in Title 22, CCR, Section 53845(a) may no longer choose to receive Covered Services on a Fee-for-Service basis; and

2. All new Eligible Beneficiaries who meet the mandatory enrollment criteria contained in Title 22, CCR, Section 53845(a) must now choose a managed care plan or they will be assigned to a managed care plan; and

3. All Eligible Beneficiaries listed in MEDS as meeting the mandatory enrollment criteria contained in Title 22, CCR, Section 53845(a) on the last date that both 1. and 2. above occur:
(i) have been notified of the requirement to choose a managed care plan and informed that if they fail to choose a plan they will be assigned to a managed care plan; and
(ii) those beneficiaries still eligible for Medi-Cal and enrollment into a managed care plan at the time their plan enrollment is processed in MEDS have been enrolled into a managed care plan...

4.4.3 DHS Enrollment Obligations
A. DHS shall receive applications for enrollment from its enrollment contractor and shall verify the current eligibility of applicants for enrollment in Contractor’s plan under this Contract. If the Contractor has the capacity to accept new enrollees, DHS or its enrollment contractor shall enroll or assign eligible applicants in Contractor’s plan when selected by the applicant or when the applicant fails to timely select a plan. Of those to be enrolled or assigned in Contractor’s plan, DHS will ensure that in a Fully Converted County a Mandatory Plan Beneficiary will receive an effective date of plan enrollment that is no later than 90 days from the date that MEDS lists such an individual as meeting the enrollment criteria contained in Title 22, CCR, Section 53845(a), if all changes to MEDS have been made to allow for the enrollment of the individual and all changes necessary to this Contract to accommodate such enrollment...

B. DHS or its enrollment contractor shall assign Eligible Beneficiaries meeting the enrollment criteria contained in Title 22, CCR, Section 53845(a) to plans in accordance with Title 22, CCR, Section 53884." California Contract, pages 53-54.

"II. ELIGIBILITY AND ENROLLMENT…
B. Enrollment
1. Voluntary Enrollment and Assignment...
a. If a Client has not selected one of the Department's managed health care programs within at least sixty five (65) days of determination or redetermination of eligibility for Medicaid, the Client may be assigned to the Contractor, as specified in 10 CCR 2050-10, § 8.209.29...

3. Open Enrollment
The Contractor shall maintain open enrollment as specified at 10 CCR 2050-10, §8.207.28, unless the Contractor informs the Department in writing that it is unwilling to accept additional Medicaid Enrollment. In such cases, with the exception of newborns, further Enrollment shall cease entirely until the Contractor informs the Department in writing that it will again accept additional Medicaid Enrollment...

4. Contractor Enrollment
The Contractor shall agree to serve a population broadly representative of the various age, social, and income groups within the categories of aid as defined in Exhibit B. Notwithstanding any other provision of this Contract, the right of the Contractor to limit Client Enrollment in an aid category to a percentage of total Enrollment which reflects the distribution of Clients by eligibility category in the Service Area is acknowledged and affirmed…

7. Restricted Disenrollment (Lock-In)
Upon voluntary enrollment in a managed care organization or, if voluntary choice is not made by the Client, upon assignment to the Contractor’s Plan, Clients eligible for Medicaid managed care shall remain assigned to the Contractor’s Plan for a period of six (6) months. Disenrollment shall be for Good Cause only, except for the first thirty 30 days of enrollment in the Contractor’s Plan." Colorado Contract, pages 13-16.

"4. FUNCTIONS AND DUTIES OF THE DEPARTMENT...
4.3 Enrollment/Disenrollment
Enrollment… will be handled by the DEPARTMENT through a contract with a central enrollment broker…

4.4 Default Enrollment…
The DEPARTMENT shall, on a rotating basis among all of the participating MCO's and as the MCO's enrollment capacity allows, assign default enrollees of the MCO.

The default assignment methodology is structured to evenly distribute families among all the participating MCOs. However, due to variability in MCO service area and enrollment capacity, family size and loss of Medicaid eligibility, the outcome of the default assignment may not result in an even net default distribution among all the MCOs…" Connecticut Contract, pages 55-56.

"2.1.3.2 MCO Enrollment Materials
During the enrollment phase for January 1, 1999, The HBM will mail enrollment materials no later than five (5) business days after the mailing of advance notice materials. During the ongoing enrollment phase no advanced notice by the HBM will occur. The HBM will mail enrollment materials no later than three (3) business days after receipt of the eligibility roster from the DSS…

Individuals will be asked to complete a managed care enrollment application, indicating the MCO of his or her choice and will be made aware of the auto-assigned MCO choice should they not choose. Members may either return a pre-addressed and stamped document marked with their choice of MCO or call a toll-free telephone number manned by HBM employees. All members of a family will be encouraged (but not required) to select the same MCO.

2.1.3.3 HBM Follow Up Process
If a member's choice information has not been received by the HBM within twenty (20) calendar days after the mailing of the enrollment materials, the HBM will contact the member to remind them about the pending enrollment choice. If a member/family does not select a MCO within thirty (30) calendar days from the postmark date of the initial HBM enrollment mailing, the default assignment choice will become effective. When information regarding MCO selection is received (by mail, through telephone contact or face-to-face contact), the HBM will enter the member's information into the automated system which interfaces with the State's Medicaid Management Information System (MMIS). Enrollment rosters will be sent directly from the MMIS to the MCO. MCOs must have electronic systems that will interface with and accept enrollment information from the HBM." Delaware RFP, pages II.4-II.5.

"2. Voluntary Enrollment and Default Providers
a. Individuals participating in the Medicaid Managed Care Program will select MCOs at their discretion. Enrollment by a person eligible under section '1' of this section with Provider shall be voluntary except for those persons who are automatically enrolled with Provider under paragraph 'b' of this section.

b. Persons who do not voluntarily select a Managed Care Organization as required under the conditions of the Medicaid Managed Care Program shall be automatically enrolled with a participating Managed Care Organization." District of Columbia Contract, page 16.

FLMH

"2.14 Enrollment...
A. Agency's Enrollment Rules and Procedures
1. The agency will enroll all eligible Medicaid recipients. Enrollment will be mandatory for all recipients with the appropriate program codes as indicated in section 2.13, and in the eligibility categories specified by the agency in Attachment 4." Florida Mental Health RFP, page 35.

“35.000 Provision of Services- QUEST-NET...
35.300 Assignment To Health Plans
Recipients who are currently enrolled in QUEST will be assigned to the same medical, dental, and behavioral health plans. New recipients shall select their respective plans or be assigned by MQD.” Hawaii RFP, pages 40-41.

“40.420 QUEST Enrollment
Upon determination of eligibility for coverage under QUEST, the recipient shall be enrolled in an available health plan at the earliest possible date. To the extent possible, all members of a family unit shall be enrolled in the same plan...

DHS has implemented an auto-assignment algorithm to distribute recipients who do not choose a health plan, in manner that is predictable and consistent with QUEST goals. The assignment process shall provide preferential treatment to the plan with the lowest capitated rates in the service area, if more than one plan meets the needs of the recipient. The preferential treatment will provide the plan with the lowest capitated rate increased enrollment among the recipients who do not select a plan.” Hawaii RFP, page 46.

“40.430 QUEST-Net Enrollment
Recipients enrolled into QUEST-Net from QUEST shall be enrolled in the same plans that they had in QUEST. Recipients entering QUEST-Net from the ABD FFS program shall select their plans or shall be assigned to the plans by DHS.” Hawaii RFP, page 47.

HIBH

"40.400 Responsibilities of the BHMC Plan
DHS shall be the sole authority to enroll members into the selected BHMC plan. DHS shall transmit the necessary enrollment information to the BHMC plan on a daily basis via electronic media and shall be formatted in the manner prescribed by DHS...

Upon receipt of the information from DHS, the plan shall enroll the member and perform the necessary procedures to ensure that the member is provided access to care…" Hawaii Behavioral Health RFP, page 39.

"8.1.1. General Enrollment...
If an eligible Medicaid recipient fails to choose a Managed Care Entity, the Department shall default enroll those recipient in an HMO if one is available in a county of recipient residence. If two or more HMOs are available in a county, and recipients in that county fail to choose a Managed Care Entity, the Department shall enroll such recipients to each HMO equally however the Department shall default enroll members of the same family with the same HMO...

8.1.2. Open Enrollment
The HMO shall accept Enrollees eligible for coverage under this Contract… in the order in which the HMO is notified by the Department of their enrollment.

The Department and the HMO may mutually agree in writing to establish a maximum enrollment level of Enrollees. If the HMO wishes to subsequently decrease its maximum enrollment level, the HMO shall notify the Department in writing sixty (60) days prior to the desired effective date of the request...

Any Enrollee disenrolled from the HMO as a result of the loss of Medicaid eligibility shall be automatically re-enrolled with the same HMO upon reinstatement of Medicaid eligibility if reinstated occurs within 60 days." Iowa Contract, page 48.

"A. ENROLLMENT PROCESS
Enrollment of Medicaid beneficiaries in managed care will include the following components:
• Enrollment of newly eligible beneficiaries in the primary care case management program, HealthConnect Kansas, or a capitated managed care program, PrimeCare Kansas, in those counties which include both choices:
o Application for Medicaid eligibility is approved…
o Beneficiaries can mail in the enrollment application or call the toll-free number with their choice of managed care plan...
o The beneficiary has twenty (20) days to choose an HMO or PCP. If the beneficiary fails to choose either a PCP or HMO, the fiscal agent will assign the beneficiary to a PCP or HMO...
o After enrollment into the HMO, all new members will be sent an HMO welcome packet requesting that members choose a Primary Care Provider (PCP)…
o The HMO may choose to assign new members to a PCP immediately, notify the member of that assignment in writing and allow the member not less than 10 days to change this assignment if it is not acceptable…
• Annual enrollment process for those beneficiaries currently enrolled in a managed care program:
o The Medicaid fiscal agent will facilitate the annual enrollment of beneficiaries. An enrollment packet will be mailed to all identified beneficiaries qualified to participate in managed care, informing them they have 30 days to change their assignment without cause…
o SRS and the fiscal agent will conduct educational workshops for eligible beneficiaries to educate them about the HMO programs and provide a face-to-face contact for beneficiaries at the local level. These workshops will occur during the open enrollment process." Kansas Contract, pages 44-45.

"E. SELECTION OF CONTRACTOR...
Because the state was unable, however, to successfully procure the services of two HMOs during the bidding process, it cannot at this time, under federal law, implement the Initiative as a mandatory program. This contract, therefore, is designed to implement a program in which eligible persons are given the opportunity to enroll voluntarily." Maine Contract, page 2.

"C. ENROLLMENT
1. Enrollment Process. The Contractor shall:
   a. accept all eligible persons who select or are assigned to the Health Plan pursuant to the enrollment process administered by the Department and the HBA;
   b. maintain a continuous open enrollment period and provide coverage to recipients immediately upon the effective date of enrollment into the Health Plan;
   c. not exclude recipients from enrollment or otherwise reject any recipient based on pre-existing conditions or expected health status; and
d. inform the Department within fifteen (15) calendar days if the Contractor determines that an Enrollee may be an excluded or exempt recipient, and provide any documentation to assist the Department in its review and determination." Maine Contract, page 10.

"10.09.63.02...
C. The Department shall enroll waiver-eligible recipients as follows:
(1) Except as provided in §C(2), (3), and (4) of this regulation, 1/5 of the waiver-eligible recipients shall be selected on a random basis and enrolled each month beginning with the first month of the Maryland Medicaid Managed Care Program;
(2) Recipients who, during the first 6 months of the Waiver Program, are receiving case management services under a voluntary program administered by the Program for individuals at risk of high medical expenses shall be enrolled during the sixth month of the Maryland Medicaid Managed Care Program;
(3) A waiver-eligible recipient may volunteer to be enrolled before the recipient's mandatory enrollment date, beginning with the first month of the Maryland Medicaid Managed Care Program; and
(4) Individuals who are new waiver-eligible recipients shall be enrolled in an MCO within 1 month of the Department's receipt of notice of the individual's Medical Assistance eligibility." Maryland COMAR 10.09.63.02.

"10.09.63.02...
H. Automatic Assignment Criteria.
(1) Children in Foster and Kinship Care. An eligible recipient who is a child in foster care or kinship care, and who fails to elect an MCO within 60 days of the Department's mailing of eligibility notification shall be assigned to an MCO with available capacity in accordance with the procedures specified in §H(2) of this regulation.
(2) Except as provided in §H(1) of this regulation, an eligible recipient who fails to elect an MCO within 21 days of the Department's mailing of eligibility notification shall be assigned to a MCO with available capacity as follows:
(a) If the recipient has a current preestablished relationship with a PMP pursuant to the Medicaid program that participates in more than one MCO in the local access area, the recipient shall be randomly assigned to an MCO in the local access area whose provider panel includes that provider and that provides adult dental benefits, or, if there are none, then randomly to any MCO in the local access area whose provider panel includes that provider;
(b) If the recipient has a current preestablished relationship with a PMP pursuant to the Medicaid program who participates in one MCO in the recipient's local access area, the recipient shall be assigned to the MCO in the local access area whose provider panel includes that provider;
(c) If the recipient has a current preestablished relationship with a FQHC and is enrolled in a Medicaid HMO, assuming the HMO has qualified as an MCO;
(d) If the recipient has a current preestablished relationship with a FQHC and is enrolled in a Medicaid HMO that has not qualified as an MCO, the recipient shall be assigned to an MCO in the local access area whose provider panel includes the FQHC;
(e) Unless inconsistent with assigning household members to the same MCO pursuant to §H(2)(f) of this regulation, if the recipient meets none of the conditions specified in §H(2)(a)--(d) of this regulation, the Department shall randomly assign the recipient to an MCO in the local access area that provides adult dental benefits, or, if there are none, then randomly to any MCO in the local access area; or
(f) If the recipient meets none of the conditions specified in §H(2)(a)--(d) of this regulation, the Department shall, in addition to assigning the recipient to an MCO pursuant to §H(2)(e) of this regulation, assign to the same MCO all the recipient's family members who:
   (i) Are eligible for enrollment in the Maryland Medicaid Managed Care Program,
   (ii) Live in the same household as the recipient, and
   (iii) Meet none of the conditions specified in §H(2)(a)--(d) of this regulation." Maryland COMAR 10.09.63.02.

"10.09.63.05...
C. If the enrollee fails to respond timely to the Department's notice of opportunity to change MCOs, the Department shall reassign the enrollee in the same MCO in which the enrollee is currently enrolled.

D. The Department shall reassign into the same MCO from which the recipient was last enrolled any recipient disenrolled from an MCO who, within 3 months of disenrollment, regains:
(1) Eligibility for Medicaid; or
(2) Maryland Medicaid Managed Care Program eligibility lost for any of the reasons listed in Regulation .06B of this chapter." Maryland COMAR 10.09.63.05.

"Section 3.2 Enrollment, Assignment, and Disenrollment Processes...
D. Assignment
The Division shall make its best efforts to provide the Contractor with information described in Section 3.2.B.4 of this section required to (1) contact an Enrollee assigned to the Contractor's Plan and, (2) to determine if the assigned Enrollee has a pre-existing relationship with a Provider who participates in the Contractor's Plan…" Massachusetts Contract, pages 97-99.

"II-G ENROLLMENT IN THE CHCP...
2. Initial Enrollment...
Beneficiaries must decide on the Contractor they wish to enroll in within 30 days from the date of approval of Medicaid eligibility. If they do not voluntarily choose a Contractor within 30 days of approval, DCH will automatically assign the Beneficiaries to Contractors within their county of residence.

Under the automatic enrollment process, Beneficiaries will be automatically assigned to Contractors based on performance of the Contractor in areas specified by DCH. DCH will automatically assign a larger proportion of Beneficiaries to Contractors with a higher performance ranking. The capacity of the Contractor to accept new Enrollees and to provide reasonable accessibility for the Enrollees also will be taken into consideration in automatic Beneficiary enrollment. Individuals in a family unit will be assigned together whenever possible. DCH has the sole authority for determining the methodology and criteria to be used for automatic enrollment." Michigan Contract, page 17.

"Section 3.1.2. Enrollment.
B. Order of Enrollment. The HEALTH PLAN shall enroll Recipients in the order in which they apply or are assigned. Recipients who do not choose a health plan within the allotted time will be assigned to a health plan by the Local Agency or the STATE. The STATE may limit the number of Enrollees in the HEALTH PLAN if in the STATE's judgment, the HEALTH PLAN is unable to demonstrate a capacity to serve additional Enrollees.

C. Timing of Enrollment. Recipients may enroll with the HEALTH PLAN at any time during the duration of this contract, subject to the limitations under Article 3.

D. Period of Enrollment. Each Recipient enrolled in the HEALTH PLAN pursuant to this Contract shall be enrolled for twelve (12) months following the effective date of coverage, subject to the exceptions in this Section.

F. Open Enrollment. The HEALTH PLAN shall enroll any eligible Recipients during any open enrollment period required by the STATE." Minnesota Contract, page 20.

"2.4.5 Automatic Assignment Into Health Plans: The state agency will employ an algorithm to assign to health plans, on a prorated basis, any eligibles who do not make a voluntary selection of a health plan during enrollment. The algorithm will be based on a total evaluation score determined by the State of Missouri…" Missouri RFP, page 35.

"2.2.3 Open Enrollment
Conduct a continuous open enrollment period during which the CONTRACTOR shall accept all eligible RECIPIENTS in the order in which they apply without regard to health status of the RECIPIENT or any other factor(s) up to the limit described in Appendix 2.2(A) of Attachment 1.

2.2.4 Enrollment Changes Due to a Federal Waiver
The conditions of enrollment described in the contract, including but not limited to enrollment and the right to disenrollment, are subject to change as provided in any waiver under Section 1915(b) or Section 1115 of the Social Security Act (as amended) obtained by the DEPARTMENT." Montana Contract, page 33.

"2.2 Scope: ...
Under the provisions for auto-assignment, the Department shall attempt (based on the auto-assignment algorithm) but shall not guarantee a fair distribution of clients to the available plans. The Department will not change the auto-assignment process without first discussing such changes with plans." Nebraska Contract, page 3.

"9.3.3 Forty-Five Day Enrollment Process: ...
After forty-five calendar days, if a choice has not been made, automatic assignment pursuant to 9.14 of this contract shall be completed by the Department and shall occur the first month possible, given the system cutoff. Enrollment activities may be completed via face-to-face contact, telephone calls, or the mail...

9.4 Reenrollment for the Basic Benefits Package
9.4.1 Reenrollment Rules Within Two Months of Disenrollment: If the client is re-enrolling in the NHC within two (2) months of the disenrollment, the client shall automatically be enrolled with the previous PCP/plan, effective with the first month possible given system cutoff…" Nebraska Contract, page 34.

"9.14 Auto-Assignment for the Basic Benefits Package
9.14.1 Auto-Assignment Rules: All enrollment activities shall be concluded within forty-five (45) calendar days. If a choice of PCP/plan is not made, automatic assignment shall occur. The client will be automatically assigned to a PCP/plan, based on criteria established by the Department pursuant to this contract.

9.14.2 EBS Report of Auto-Assignments: The Department shall provide a report to the EBS prior to the effective date of the auto-assignment enrollment…" Nebraska Contract, page 39.

NEBH

"3.2 Background Information: ...
Enrollment into the MH/SA Package is ‘automatic’, i.e., the client is not required to make a choice of PCP/plan, but is required to access MH/SA services through the contracted PHP." Nebraska Behavioral Health Contract, page 4.

"4.1 Applicable Definitions: The following definitions apply under this contract: ...
4.1.15 The term ‘Enrollment’ means the automatic process by which a client begins participation into the Mental Health/Substance Abuse component of the Nebraska Health Connection. The interface between the Enrollment Broker Services (EBS) and the Mental Health/Substance Abuse component of the Nebraska Health Connection will be identified in this contract…" Nebraska Behavioral Health Contract, pages 6-7.

"9.1 Introduction: The Department maintains responsibility for the enrollment of clients into managed care, through various departmental and contractual arrangements.

Enrollment into the Mental Health/Substance Abuse (MH/SA) Package is ‘automatic’. In the MH/SA component of the NHC, the client is not required to select a Primary Care Physician, and there is only one Prepaid Health Plan (PHP) providing the MH/SA Package on a statewide basis." Nebraska Behavioral Health Contract, page 32.

"9.3 Enrollment for the NHC Mental Health/Substance Abuse (MH/SA) Package...
9.3.1 Process at Initial Eligibility Interview: HHS local office staff shall provide the client with written information about the NHC when the individual applies for assistance.

At the time of the initial eligibility interview, HHS local office staff shall inform the client of the requirement to participate in the NHC...

9.3.3 Enrollment for the MH/SA Package: Clients are enrolled for the MH/SA Package by virtue of their ‘mandatory status’ and eligibility for Medicaid in the categories pursuant to Section 9.2 of this contract. There isn’t a separate enrollment process for the MH/SA Package.

9.3.4 Order of Enrollment: The PHP shall accept Medicaid clients in the order in which they are enrolled." Nebraska Behavioral Health Contract, page 34.

"M. Auto Assignment Process. For participants who do not select a Contractor, DHCFP will assign the individual to a Contractor based upon federally required enrollment default criteria which includes:
1. The maintenance of existing provider, individual relationships or relationships with traditional Medicaid providers; and
2. Where maintaining such relationships is not possible, equitably distributing the participants among the Contractors.

The algorithm used will give a weighted preference to the Contractors based on the number of contracts with the FQHC, the University Medical Center, the University of Nevada School of Medicine and essential community providers as designated by DHCFP, as one method of meeting the criteria to maintain relationship with traditional Medicaid providers." Nevada Contract, page 30.

"Article II
Functions and Duties of Contractor
In consideration of the Agreement of the State contained in Article III, Contractor Agrees: ...

2.4 OPEN ENROLLMENT-----To conduct a continuous open enrollment period during which Contractor shall enroll beneficiaries eligible for coverage under this Agreement in the order in which they apply without regard to health status of the beneficiary or any other factor(s) unless to enroll such a beneficiary would cause Contractor to exceed the limits set forth in this Agreement." New Hampshire General Service Agreement, page 7.

"Article III
Functions and Duties of the State
In consideration of the Agreements of Contractor contained in Article II. the State agrees: ...

3.2 ENROLLMENT-----The State shall be responsible for completing all enrollments and voluntary disenrollments and shall notify Contractor in writing of each person to be enrolled under this Agreement. Enrollment shall be voluntary…" New Hampshire General Service Agreement, page 5.

"Article VI
Enrollment and Disenrollment...

6.1 TERM OF ENROLLMENT-----Each beneficiary enrolled in Contractor at any time under this Agreement shall be enrolled through the end of the Agreement period, unless Contractor is notified by the State, in writing of termination of enrollment. Each Enrollee shall be automatically reenrolled on the anniversary date, and at the beginning of the new Agreement at the new Capitation Payment rate unless Contractor is notified of an intent not to enroll by the State in writing." New Hampshire General Service Agreement, page 23.

"2.B.2.a Minimum Selection Period:
The client shall have a minimum of fourteen (14) calendar days to select an MCO from the provided information. If a selection is not made during this selection period. HSD shall assign the client to an MCO." New Mexico Contract, page 24.

"2.B.3 Enrollment Requirements
As required by 42 C.F.R. §434.25. the CONTRACTOR shall:
2.B3.a Accept eligible individuals
(I) in the order in which they apply;
(ii) without restriction. unless authorized by the HCFA Regional Administrator; and
(iii) up to the limits established pursuant to the Agreement..
(iv) The CONTRACTOR shall assume responsibility for all covered medical conditions of each member inclusive of pre-existing conditions as of the effective date of enrollment." New Mexico Contract, pages 17-18.

"1. DEFNITIONS...
'Auto-assignment' means a process by which an Eligible Person, who is mandated to enroll in managed care, but who has not chosen to enroll within sixty (60) days of receipt of the mandatory notice, is assigned to a MCO …" New York Contract, page 1-1.

"6. ENROLLMENT...
6.4 Auto Assignment
Upon implementation of the 1115 Waiver, or other applicable waivers of federal requirements, an Eligible Person whose enrollment in a MCO is mandatory and who fails to select a MCO within sixty (60) days of receipt of notice of mandatory enrollment may be assigned by the LDSS to the Contractor's plan pursuant to NYS Social Services Law § 364-j and in accordance with Appendix H…" New York Contract, page 6-1.

"APPENDIX H
New York Department of Health Guidelines for the Processing of Enrollments and Disenrollments…

C. Auto-Assignment Process (Mandatory Program Only):
This section only applies to a LDSS where HCFA has given approval and the LDSS has begun mandatory enrollment. The details of the auto-assignment process are contained in Section 12 of the State’s Operational Protocol.

SDOH Responsibilities: ...
1. SDOH will provide information to LDSS on a daily basis of those individuals who have been added to the tickler file (Potential Auto-Assign List).
2. SDOH, LDSS or Enrollment Broker will assign individuals who do not choose an MCO in the required time period to an MCO using an algorithm as specified in State Law SSL 364-j(4)(d).
3. SDOH will ensure the auto-assignment process automatically updates the PCP Subsystem.
4. SDOH will notify the LDSS electronically on a daily basis of those individuals for whom the State has selected a health plan…" New York Contract, Appendix H, pages H-1-H-5.

"4.1 Plan Selection...
The Plan…shall enroll all eligible Recipients without restriction...
Eligible Recipients who do not voluntarily select a Plan…will be assigned to a Plan according to an algorithm approved by the Division." North Carolina Contract, page 5.

"4.6 Automatic Re-Enrollment
A Recipient whose membership in the Plan is terminated due to ineligibility…shall be automatically re-enrolled in the Plan if eligibility is resumed within two months…" North Carolina Contract, page 6.

"3.5 Enrollment, Disenrollment
The Department shall process recipient enrollments and disenrollments and offer recipients a choice of managed care plans. If the Department obtains a federal waiver, the Department may mandatorily assign newborns born to a mother who is an enrollee or a recipient who fails to choose a managed car program to the Contractor. When mandatory assigning a recipient to the Contractor, the Department shall not exceed the maximum enrollment level per Section 2.10." North Dakota Contract, Attachment C, page 28.

"Background...
Program Characteristics…
Enrollment: ...
ODHS supports and encourages all eligible individuals to actively select an MCP; however, when individuals in mandatory enrollment counties do not make a choice within thirty days of notification, assignments to plans are made. Assignment are made at the assistance group level, which means all eligibles within the same case, category, and sequence are assigned to the same MCP. Currently, assignments are made on a rotating basis among available MCPs.

Beginning July 2000, assignments will be made based first on existing provider-patient relationships and second on the geographic accessibility of MCP provider networks. ODHS will use fee-for-service claims history to determine the most recent, regularly visited primary care physician (PCP). Individuals who have not made a timely selection will be assigned to the MCP that has this PCP on their provider panel. If more than one MCP has the identified PCP on their panel, the individual will be assigned to the MCP who both has the PCP and the most accessible provider panel. If a PCP cannot be determined, the individual will be assigned to the MCP with the provider panel most accessible to the majority of the eligible population. The accessibility assessment will be based on the distance between PCPs and the eligible population as well as each PCP's enrollment capacity. If more than one MCP is equally accessible, assignments will be made on a rotating basis among equally accessible MCPs." Ohio RFP, pages 4-5.

"APPENDIX C...
Enrollment Change Opportunities
Open Enrollment Change Effective Dates
Open enrollment change requests are processed the month following the open enrollment month with an effective date of the next succeeding month…" Ohio RFP, Appendix C, page 1.

"5101:3-26-02 Managed care plan: Eligibility, enrollment and automatic enrollment...
(B) Enrollment…
(1) The following applies to enrollment in MCPs...
(f) The MCO must accept eligible individuals in the order in which they apply and without restriction, except as otherwise provided in this rule. Enrollment opportunities must remain open and available as long as the enrollment maximums determined by ODHS and found in the provider agreement are not exceeded. If the maximum Medicaid enrollment is reached, further enrollment is prohibited except to fill vacancies caused by disenrollment, to enroll newborns or other additions within enrolled assistance groups, or to reenroll in accordance with paragraph (B)(1)(i) of this rule, unless the MCP's enrollment maximum is renegotiated and amended in the provider agreement. Commercial enrollment may be considered in amending enrollment maximums...

(3) In addition to the provisions of paragraph (B)(1) of this rule, the following applies to enrollment in MCPs participating in the mandatory program…
(d) Enrollment procedures for the mandatory program…
(ii) An eligible assistance group which is unable to or does not make a choice as identified in paragraph (B)(3)(d)(i) of this rule will be assigned to an MCP by ODHS or an ODHS-approved entity. No eligible assistance group will be assigned until at least one written notification has been issued to the assistance group by the ODHS or an ODHS-approved entity. In such instances, ODHS or an ODHS-approved entity will complete and forward the initial enrollment form to the ODHS-approved entity to be processed. The MCP must contact the assigned assistance group NO LATER THAN THE TENTH WORKING DAY FOLLOWING confirmation of enrollment from ODHS to obtain the assistance group's selection of a PCP for each enrollee. If no selection is made within twenty working days of confirmation of enrollment, the MCP MUST assign a PCP. The MCP must notify the assistance group of such assignment, in writing, within five working days, as well as provide information as to how the assistance group can change PCPs." Ohio RFP, Appendix E, OAC 5101:3-26-02, pages 1-6.

"2.4 Member Enrollment and Disenrollment
2.4.1 Eligibility Determination and Enrollment...
Recipients will enroll in a Health Plan in one of two ways: ...by being assigned to a Plan by the Authority...
If recipients do not voluntarily select a Plan, the State will assign recipients to a Plan on the basis of a pre-determined algorithm...

2.4.2 Open Enrollment...
Other eligibles will be informed that if they do not select a Health Plan, they will be assigned to one. New eligibles living in households in which some members are already enrolled in a Health Plan will be informed that they must join the same Plan as the other members of the family...If they do not select a Health Plan, they will be auto-assigned…" Oklahoma RFP, pages 15-16.

"2.5.3 EPSDT Services...
The Authority may reduce a Plans' auto-assignment percentage if a Plan fails to perform an EPSDT screening of 80% of all members under the age of 21." Oklahoma RFP, pages 26-27.

"Enrollment...
DHR shall sign on such individuals with the contractor selected by the individual unless, pursuant to OAR 410-141-0060, DHR assigns the person to a contractor because the individual failed to select a contractor…" Oregon Contract, page 28.

ORMH

"IV. Enrollment and Disenrollment
A. Enrollment
1 ...If an eligible individual does not select a contractor, DHS may, pursuant to OAR 410-141-0060, Oregon Health Plan Managed Care Enrollment Requirements, elect to assign the person to a contractor selected by DHS…" Oregon Mental Health Contract, page 4.

"C. HealthChoices Program
10. Automatic Assignment into HMOs
The department will employ an algorithm to assign to HMOs any program eligibles who do not make a voluntary selection. The automatic assignment will be done on a random basis; however; individuals in a family unit will be assigned together. The number of individuals assigned to a specific HMO will be based on the HMO's ranking in the total RFP scoring process. Any individuals not selecting an HMO and mandated in to the program will go through the automatic assignment process. Exception: All MA recipients who do not make a selection of an HMO during the pre-enrollment period and who are currently enrolled in a voluntary HMO or the HealthPASS plan, will remain in that HMO providing the HMO receives a contract to operate under the HealthChoices Program. These individuals will be assigned back to that HMO through the automatic assignment process. The assignment will count towards the HMO's targeted percentage using the algorithm…" Pennsylvania RFP, pages 6-10.

PABH

"1. Pre-Enrollment...
b) Behavioral Health
All persons whose enrollment is mandatory for November 1, 1996, will be notified that they will be assigned to the MCO for their county…

3. Phase-in
Contracts to operate the HealthChoices Program will become effective in accordance with the following schedule.

Mandatory recipient enrollment for the first phase of program eligible groups:

November 1, 1996: AFDC and Health Beginnings (Exception: Foster children categorized as AFDC-FC are not mandated for inclusion until July 1, 1997)

Mandatory recipient enrollment for the second phase of program eligible groups:

July 1, 1997: Supplemental Security Income (SSI) (with and without Medicare), General Assistance (GA) (state and federal), Healthy Horizons, children and adolescents in substitute care (Note: This does not include children receiving adoption assistance. They will be mandatory enrollees on November 1, 1996), ICF/MRs, migrant workers (Exception: An individual who is determined eligible for cost sharing coverage only (categories PG and PL) will not be enrolled in the HealthChoices Program.)...

a. Phase-In of HealthPASS Members...
For currently enrolled members who express no preference and whose existing plan is not selected as a HealthChoices managed care plan the member will be assigned automatically to a HealthChoices plan..." Pennsylvania Behavioral Health RFP, pages 42-44.

"2.04.08 Voluntary Selection Of Health Plan...
If a family does not select a Health Plan within the 14 day window, it shall automatically be assigned to a Health Plan… If Rite Care eligibles do not attend an enrollment counseling session, they will be given the opportunity to enroll by mail. They will have a thirty (30) day window from the date of the mailing to select a health plan. If a family does not select a health Plan within the 30-day window, it shall automatically be assigned to a Health Plan…

2.04.09 Automatic Assignment Into Health Plans
The State will employ a formula, or algorithm, to assign to Health Plans any Rite Care eligibles who do not make a voluntary selection…

2.04.10 Automatic Re-Assignment Following Resumption Of Eligibility
Rite Care members who are disenrolled from a Health Plan due to loss of eligibility, shall automatically be re-enrolled, or assigned, into the same plan should they regain eligibility within ninety (90) calendar days…" Rhode Island RFP, page 12.

"2-3 Benefit/Service Requirements and Limitations...
m. Out of Area or Out of Plan Use
3...The parties to this Agreement recognize that in accordance with TennCare policies and procedures, if an enrollee requests enrollment in a specified MCO, the enrollee may be assigned to an MCO other than the one that he/she requested. Examples of circumstances when an enrollee would not be enrolled in the requested MCO include, but are not limited to, such factors as the enrollee does not reside in a community service area covered by the requested MCO, the enrollee has other family members already enrolled in a different MCO, the MCO is closed to new TennCare enrollment, etc. If an enrollee did not request enrollment in a specified MCO, the enrollee will be assigned to an MCO in accordance with TennCare policies and procedures…" Tennessee Contract, pages 7-23.

"14.2 ENROLLMENT
14.2.1 TDH has the right and responsibility to enroll and disenroll eligible individuals into the STAR program. TDH will conduct continuous open enrollment for Medicaid recipients and HMO must accept all persons who chose to enroll as Members in HMO or who are assigned as Members in HMO by TDH, without regard to the Member’s health status or any other factor.

14.2.2 All enrollments are subject to the accessibility and availability limitations and restrictions contained in the §1915(b) waiver obtained by TDH. TDH has the authority to limit enrollment into HMO if the number and distance limitations are exceeded.

14.2.3 TDH makes no guarantees or representations to HMO regarding the number of eligible Medicaid recipients who will ultimately be enrolled as STAR Members of HMO.

14.2.4 HMO must cooperate and participate in all TDH sponsored and announced enrollment activities. HMO must have a representative at all TDH enrollment activities unless an exception is given by TDH. The representative must comply with HMO’s cultural and linguistic competency plan…" Texas Contract, pages 115-116.

UTMH

"Article II
ENROLLMENT

A. Enrolled Persons
Since the authorization for the Contract is based on a freedom of choice waiver of section 1915(b)(4) of the Social Security Act which restricts Medicaid Enrollees living in specific counties to obtain mental health services from a mental health center under contract with the DEPARTMENT, the DEPARTMENT will automatically enroll any Medicaid eligible person who is determined by PACMIS to reside in the catchment area covered by the CONTRACTOR. The CONTRACTOR will cover Medicaid Enrollees in the following counties: ...

D. Enrollment Process
1. Monthly, DHCF will provide the CONTRACTOR with a computer tape or diskette of all Enrollees for the current month, including Enrollees who were given retroactive eligibility during the current month. The tape will include the Enrollee's case number, case name, PACMIS identification, Enrollee name, date of birth, sex, county, aid category grouping, month(s) of eligibility, and third party liability coverage.

2. Monthly, DHCF will provide the CONTRACTOR with the 'Mental Health Enrollment' report that lists the aggregate number of Enrollees by category of eligibility, including retroactive eligible persons.

3. DHCF will provide the CONTRACTOR access to the DEPARTMENT's touch tone telephone eligibility line and a direct connection to the Medicaid computer system, subject to the CONTRACTOR's compliance with federal and state requirements for access to such data. Both systems provide information on Medicaid client eligibility, enrollment in a managed care plan, and other insurance coverage. Since Medicaid eligibility can be determined on a daily basis, the information provided through these systems reflects eligibility based on the date of inquiry. The CONTRACTOR may use this information to verify PACMIS identification numbers, eligibility of person seeking services, date of birth and third party coverage." Utah Mental Health Contract, pages 2-3.

"ARTICLE I - DEFINITIONS...
Enrollment Broker - An independent broker who enrolls recipients in the Contractor plan, and who is responsible for the operation and documentation of toll-free recipient service helpline. The responsibilities of the enrollment broker include, but are not limited to, recipient education and enrollment and may include recipient marketing and outreach." Virginia Contract, pages 7-8.

"3. Pre-assignment to HMOs
Clients will be pre-assigned to HMOs in accordance with 12 VAC 30-120-370 (E) as follows:
a. MEDALLION primary care physicians will be asked to select the HMO in which their MEDALLION clients will be assigned (only during initial implementation of the Medallion II program in a specific geographic area).
b. Clients currently enrolled in Options shall be assigned to the HMO in which they participated under Options if that HMO contracts with DMAS for Medallion II (only during initial implementation).
c. Clients not pre-assigned pursuant to subsection a. or b. above will be pre-assigned to the HMO of another family member, if applicable.
d. All other clients will be randomly pre-assigned to an HMO on a basis of approximately equal numbers by HMO in each locality." Virginia Contract, page 24.

"7. Automatic Assignment
The Contractor will accept automatic assignment for any Medallion II eligible Medicaid or CMSIP recipient.

8. Automatic Re-Enrollment
Recipients who have been previously enrolled with the Contractor who regain eligibility for Medallion II enrollment within sixty (60) calendar days of the effective date exclusion or disenrollment and who do not select another HMO will be reassigned to the Contractor, as appropriate, provided sufficient enrollee slots are available under this Contract and without going through the selection or pre-assignment process." Virginia Contract, page 27.

"ARTICLE III - FUNCTIONS AND DUTIES OF THE DEPARTMENT...
A. DETERMINATION OF MEDICAID ELIGIBILITY AND OPTIONS ENROLLMENT
The Department shall have sole responsibility for determining the eligibility of an individual for Medicaid and CMSIP funded services. The Department shall have sole responsibility for determining enrollment in the Contractor's plan.

B. PRE-ASSIGNMENT
The Department will assign recipients to HMOs using a pre-assignment system." Virginia Contract, page 88.

"2.6 Enrollment Process: ...If the client does not exercise his/her right to choose a managed care plan, DSHS will assign the client, and any family members, to a plan with providers near where the client lives.

DSHS will make every effort to enroll all family members with the same managed care plan. If a family member is covered through a private third party, including the Basic Health Plan, DSHS will make every effort to enroll the remainder of the family with the same managed care plan if the plan contracts with DSHS to provide managed care. If the plan does not contract with DSHS, the remaining family members will be enrolled with a single, but different managed care plan of the client's choice." Washington Contract, page 6.

"AMENDMENT 1
1. The purpose of this amendment is to add coverage for Children's Health Insurance Program (CHIP) clients...

4. The following terms and conditions of this contract for Healthy Options do no apply to CHIP members: ...
b. Section 2.4, Exemptions from Enrollment. The CHIP RFQQ defines the requirements related to managed care enrollment for CHIP clients...

5. The following terms and conditions of this contract are modified as follow for CHIP enrollees:
a. Section 2.5, Enrollment Period. Enrollment is continuously open, as described in Section 2.5, for CHIP clients residing in counties with one managed care plan or none. CHIP clients residing in counties where two plans are available are subject to the enrollment provisions of the CHIP procurement, as modified by item 2 of this amendment." Washington Contract, Amendment 1, pages 1-2.

"3.12 Open Enrollment
The Managed Care Plan shall conduct continuous open enrollment during which the Managed Care Plan shall accept recipients eligible for coverage under this contract in the order in which they are enrolled without regard to health status of the recipient or any other factors.

The Managed Care Plan shall not discriminate in enrollment activities on the basis of health status or the recipient's need for health care services, and shall not attempt to discourage or delay enrollment with the Managed Care Plan of eligible Medicaid recipients.

The Managed Care Plan will accept individuals who are eligible in the order in which they apply, without restriction unless authorized by the Regional Administrator (42 CFR 434.25) and up to the limits set forth in Section 3.20 Maximum Enrollment Levels of this contract…" West Virginia Contract, pages 14-15.

"4.7 Reinstatement Processing
Medicaid recipients who lose eligibility for the West Virginia Mountain Health Trust program and regain eligibility within 90 days will be automatically re-enrolled in the same Managed Care Plan in which they were previously enrolled, unless the recipient chooses another Managed Care Plan…" West Virginia Contract, page 32.

"VII. ENROLLMENT AND DISENROLLMENT
A. ENROLLMENT-The HMO shall accept as enrolled all persons who appear as enrollees on the HMO Enrollment Reports and newborns as defined in Article I... The Department reserves the right to assign a Medicaid recipient to a specific HMO when the Medicaid recipient fails to choose an HMO during a required enrollment period.

The HMO shall designate, in Article XV, and its attached Addendum XXII, of this Contract, their maximum enrollment level for the different contiguous service areas of the HMO throughout the State. The HMO shall accept as enrolled all persons who appear as enrollees on the HMO Enrollment Reports and newborns up to the HMO specified enrollment level for a particular service area. The number of Medicaid enrollees may exceed the maximum enrollment level by 5% on a temporary basis. The Department does not guarantee any minimum enrollment level…" Wisconsin Contract, page 54.