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1.7.3 MMP Service Delivery Option

MMP participating beneficiaries receive services through a managed care arrangement operating under contract with EOHHS and CMS. MMP enrollees receive services through a health plan offered by an MCO. The operations of the MMP are bound by a three (3) way agreement with EOHHS and CMS to integrate the full range of Medicare and Medicaid services (primary care, acute care, specialty care, behavioral health care, and LTSS) in accordance with a rate structure that includes Federal and State funding streams for all MME adults. Accordingly, the MMP must provide accessible, high-quality services and supports focused on optimizing the health and independence of one of the most fragile Medicaid populations. Enrollment in the MMP is voluntary. 1.7.4 MMP Enrollment A. The MMP offers MME beneficiaries the opportunity to obtain comprehensive integrated services through a single health plan. 1. Passive or Auto-Enrollment – Eligible beneficiaries may be passively enrolled by EOHHS, or auto-enrolled, in the MMP unless they are excluded from passive enrollment on the basis of one (1) of the following criteria: a. The MME beneficiary is enrolled in a Medicare Advantage plan that is not operated by the same MCO as the MMP; b. The beneficiary has been auto-enrolled by CMS into a Medicare Part D plan in the same calendar year that the MME would qualify for the MMP; c. The MME is currently enrolled in comprehensive health insurance coverage through a private commercial plan or group health plan provided through an employer, union, or TRICARE; or d. The beneficiary has affirmatively opted-out of passive enrollment into an MMP or a Medicare Part D plan. 2. Opt-in Enrollment – Eligible beneficiaries may be offered the option to opt into the MMP. MME beneficiaries who are not eligible for passive enrollment will be offered the opportunity to opt-in to an MMP by completing an application in writing or via phone. Individuals enrolled in PACE may elect to enroll and participate in the MMP if they choose to disenroll from PACE. 1.7.5 Enrollment Information A. EOHHS is responsible for ensuring that all MME beneficiaries who meet the criteria to participate in the MMP have access to the information necessary to