loading…
loading…
loading…
make a reasoned choice about their coverage options. As indicated in § 1.2(A)(25) of this Part, the person-centered planning process plays a critical role in ensuring that beneficiaries are aware of the full range of service delivery options available to them based on their level of need and personal goals. Accordingly, prospective participants are sent a written communication informing them of the option to enroll in an MMP, as well as information on the availability of independent enrollment options counseling and other supports to help beneficiaries make informed enrollment decisions. Eligible individuals who opt- out of or do not enroll in an MMP have the option to enroll in PACE if eligible, or receive all Medicaid covered services – including LTSS – on a fee-for-service basis, unless they are otherwise eligible for another Medicaid delivery system. B. Communications with MME beneficiaries who qualify to participate in the MMP includes information about each of the following: 1. Enrollment Opt-In and Opt-Out Process – Participation in an MMP is voluntary. MME beneficiaries eligible for passive enrollment are informed that they may choose to opt out of enrollment in the MMP and are provided with instructions on how to proceed. MME beneficiaries eligible for passive enrollment who opt-out may choose any of the alternative service delivery options for which they may qualify. Eligible beneficiaries who are not passively enrolled are provided with instructions on how to enroll in an MMP. 2. Decision Timeframe – Eligible beneficiaries may enroll in an operational MMP at any time up until six (6) months prior to the end of the Federal demonstration under which the MMP was implemented. The Federal demonstration is scheduled to end on December 31, 2020. Information is provided about enrollment decision time-frames as follows: a. Passive Enrollment. Beneficiaries eligible for passive enrollment into the MMP are sent a first (1st) notification that they will be passively enrolled between sixty (60) and ninety (90) days prior to the effective date of enrollment; a second (2nd) reminder notification is sent to the beneficiary at least thirty (30) days prior to the effective date of enrollment. If the beneficiary makes an enrollment choice within the specified timeframe, EOHHS initiates enrollment accordingly. If a beneficiary does not respond within the specified timeframe, enrollment in the MMP proceeds in accordance with the terms specified in the initial communication from EOHHS. b. Opt-in Enrollment. MME beneficiaries who are eligible for the MMP but are not passively enrolled may be sent a notification that they have the option to enroll in an MMP. Opt-in enrollment requests received through the tenth (10th) day of the month will take effect on the first (1st) day of the following calendar month. Opt-in enrollment requests received on the eleventh (11th) day of the month or later