N.J. Admin. Code § 10:74-6.1

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:74-6.1 - Enrollment

(a) Prior to implementation, the contractor shall obtain written approval from the Division of the method of enrollment and the enrollment forms to be used in enrolling Medicaid/NJ FamilyCare beneficiaries. The contractor shall adhere to the enrollment procedures required by the Division and detailed in the MCO contract.

(b) The contractor shall enroll Medicaid/NJ FamilyCare beneficiaries in the order in which they apply, or are assigned by the Division (in those Medicaid/NJ FamilyCare and Plan A cases where a selection is not made) without restrictions, up to contract limits.

(c) Enrollment shall be for the entire Medicaid/NJ FamilyCare "case" (family household).

(d) Enrollment shall be for an initial period not to exceed 12 months and in accordance with Section 1932(a)(4) of the Social Security Act ( 42 U.S.C. § 1396u- 2(a)(4) ), with the exceptions indicated in N.J.A.C. 10:74-7. This fact shall be clearly stated on the enrollment package.

(e) For any person who applies for participation in the managed care program and who is hospitalized at the time this coverage becomes effective, such coverage shall not commence until the date such person is discharged from the hospital.

(f) Medicaid/NJ FamilyCare-Plan A enrollees shall be subject to a 12-month enrollment lock-in period and may initiate disenrollment/MCO transfer during the first three months after the effective date of initial managed care enrollment and every 12 months thereafter without cause.

(g) All other Medicaid/NJ FamilyCare enrollees (non-Plan A) shall be subject to a 12-month enrollment lock-in period.

(h) Enrollment lock-in shall not apply to beneficiaries who are aged, blind, and disabled, clients of DDD, or to CP&P clients.

N.J. Admin. Code § 10:74-6.1

Amended by 51 N.J.R. 1359(a), effective 8/19/2019