Regional Generic Provider Agreement - Ohio Department of Job and ...
Regional Generic Provider Agreement - Ohio Department of Job and ...
Regional Generic Provider Agreement - Ohio Department of Job and ...
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Appendix D<br />
Covered Families <strong>and</strong> Children (CFC) population<br />
Page 3<br />
ODJFS will provide information on what services the MCP will not cover <strong>and</strong> how<br />
<strong>and</strong> where the MCP’s members may obtain these services in the applicable<br />
Consumer Guides.<br />
15. Membership Selection <strong>and</strong> Premium Payment<br />
a. The managed care enrollment center (MCEC): The ODJFS-contracted MCEC will<br />
provide unbiased education, selection services, <strong>and</strong> community outreach for the<br />
Medicaid managed care program. The MCEC shall operate a statewide toll-free<br />
telephone center to assist eligible individuals in selecting an MCP or choosing a<br />
health care delivery option.<br />
The MCEC shall distribute the most current Consumer Guide that includes the<br />
managed care program information as specified in 42 CFR 438.10, as well as ODJFS<br />
prior-approved MCP materials, such as solicitation brochures <strong>and</strong> provider<br />
directories, to consumers who request additional materials.<br />
b. Auto-Assignment Limitations – In order to ensure market <strong>and</strong> program stability,<br />
ODJFS may limit an MCP’s auto-assignments if they meet any <strong>of</strong> the following<br />
enrollment thresholds:<br />
• 40% <strong>of</strong> statewide Covered Families <strong>and</strong> Children (CFC) eligible<br />
population; <strong>and</strong>/or<br />
• 60% <strong>of</strong> the CFC eligibles in any region with two MCPs; <strong>and</strong>/or<br />
• 40% <strong>of</strong> the CFC eligibles in any region with three MCPs.<br />
Once an MCP meets one <strong>of</strong> these enrollment thresholds, the MCP will only be<br />
permitted to receive the additional new membership (in the region or statewide, as<br />
applicable) through: (1) consumer-initiated enrollment; <strong>and</strong> (2) auto-assignments<br />
which are based on previous enrollment in that MCP or an historical provider<br />
relationship with a provider who is not on the panel <strong>of</strong> any other MCP in that region.<br />
In the event that an MCP in a region meets one or more <strong>of</strong> these enrollment<br />
thresholds, ODJFS, in their sole discretion, may not impose the auto-assignment<br />
limitation <strong>and</strong> auto-assign members to the MCPs in that region as ODJFS deems<br />
appropriate.<br />
c. Consumer Contact Record (CCR): ODJFS or their designated entity shall forward<br />
CCRs to MCPs on no less than a weekly basis. The CCRs are a record <strong>of</strong> each<br />
consumer-initiated MCP enrollment, change, or termination, <strong>and</strong> each MCEC<br />
initiated MCP assignment processed through the MCEC. The CCR contains<br />
information that is not included on the monthly member roster.