Existence of algorithm for allocation of enrollees

AZ | HI | ME | MO | NE | NJ | NY | NC | OK | PA | RI

"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...

AHCCCSA assigns MN/MI members to an available health plan based on family continuity or through AHCCCSA's auto assignment algorithm. These members do not get a choice of available contractors until their annual enrollment period." Arizona Contract, page 19.

"61. AUTO-ASSIGNMENT ALGORITHM
Members who do not have the right to choose a contractor or members who have the right to choose but do not exercise this right, are assigned to contractors through an auto-assignment algorithm. The algorithm is a mathematical formula used to distribute members to various contractors in a manner that is predictable and consistent with AHCCCSA goals. The algorithm favors those contractors with lower capitation rates…AHCCCSA may change the algorithm at any time during the term of the contract and frequently does so in response to contractor specific issues of non-compliance (e.g. imposition of an enrollment cap)…AHCCCSA is not obligated to adjust for any financial impacts this may have on the contractor." Arizona Contract, page 53.

"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.

“AUTO-ASSIGNMENT ALGORITHM For QUEST Health and Dental RFP
Enrollees who do not choose a health or dental plan are assigned to contractors through an auto-assignment algorithm. The algorithm is a mathematical formula used to distribute enrollees to the various contractors in a manner that is predictable and consistent with QUEST goals. The algorithm favors those contractors with lower capitation rates.

All contractors within a given service area will have a placement in the algorithm and will receive enrollees accordingly. What varies, however, is the number of enrollees each contractor receives through the algorithm. A contractor with a more favorable placement in the algorithm will receive proportionally fewer enrollees.

A contractor's placement in the algorithm is based upon its FINAL capitation rates bid..." Hawaii RFP, Amendments, unnumbered page.

"SRS Responsibilities...
SRS will employ an algorithm to assign, to an HMO or a PCCM, any eligibles who do not make a voluntary selection." Kansas Contract, pages 50-51.

“II. DEFINITIONS.
A. The following terms used in this Contract shall be interpreted as defined herein, except to the extent that the context may clearly require otherwise: ...

4. Automatic Assignment Algorithm (Auto-assignment) is the process used to enroll recipients into a managed care organization in the event that they do not make a voluntary selection in a timely manner.” Maine Contract, page 2.

"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.

"4.1 Plan Selection...
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.

"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.

"9.14.4 Auto-Assignment Priorities: The following priorities shall apply:
(a) The Department's auto-assignment algorithm shall give priority to provider-client proximity and shall maintain family members with the same PCP/plan, if appropriate; and
(b) For a client in the Blind/Disabled and Department Ward/Foster Care categories, the EBS shall facilitate an assignment by 'pre-nominating' a PCP/plan by taking into consideration eligibility and claims history information known about the client." Nebraska Contract, page 40.

"ARTICLE 7
ENROLLMENT...
7.5 The contractor shall accept enrollment of Medicaid eligible persons within the defined enrollment areas in the order in which they apply or are auto-assigned to the contractor (on a random basis with equal distribution among all participating HMOs)…" New Jersey Contract, pages 40-41.

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

C. Auto-Assignment Process (Mandatory Program Only):
SDOH Responsibilities: ...
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). The auto-assignment process also considers previous enrollment history…" New York Contract, Appendix H, pages H-1-H-5.

"2.4 Member Enrollment and Disenrollment
2.4.1 Eligibility Determination and Enrollment...
If recipients do not voluntarily select a Plan, the State will assign recipients to a Plan on the basis of a pre-determined algorithm. The algorithm is described in Section 5.2 of the RFP…" Oklahoma RFP, page 15.

"C. HealthChoices Program...
10. Automatic Assignments in to HMOs
The Department will employ an algorithm to assign to HMOs any program eligibles who do not make a voluntary selection…The assignment will count towards the HMO's targeted percentage using the algorithm. A description of this algorithm is provided as Appendix G…" Pennsylvania RFP, pages 6-10.

"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. Specifically, the State will assign eligibles equally proportionally to all Health Plans for which any applicable enrollment cap has not been reached." Rhode Island RFP, page 12.