Auto Enrollment Scenarios - NC

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Auto Enrollment ScenariosDecember 30, 2020

ContentsPageTopic3Member Enrollment Diagram4Auto-Enrollment: Algorithm5Auto-Enrollment: Rule 2 EBCI Tribal Option Detail6Auto-Enrollment Example Scenarios during Crossover7Individual Auto-Enrollment: with PCP in-network8Individual Auto-Enrollment: with PCP not in-network for any PHP10Mother, Son Auto-Enrolled: Enrolled in same PHP12Mother, Son Auto-Enrolled: Enrolled in different PHP15Tribe/IHS Individual Auto-Enrollment: Dual Eligible enrolled in Tribal Option16Tribe/IHS Individual Auto-Enrollment: Tribal Exempt Status enrolled in Tribal Option17Tribe/IHS Individual Auto-Enrollment: Tribal Exempt Status enrolled in Medicaid Direct2

Member Enrollment DiagramSelectionBeneficiary contacts theEnrollment Broker (calls, web,smart phone application) andfinds their Primary Care Provider(PCP) who contracted with Prepaid Health Plan (PHP) or is inthe Tribal Option (TO).Transmit RecordState transmits beneficiaryrecords to PHPs or TO for thosewho chose and for those whoare auto-enrolled. Recordsinclude historical PCP and newPCP selections.XNO SelectionBeneficiary does NOT make anactive selection of a health planand/or Primary Care Provider(PCP) through the EnrollmentBroker.Auto-EnrollmentState uses six-step enrollmentalgorithm to assign ManagedCare eligible beneficiaries to aPHP or TO.NoMemberSelected aPCP?YesCommunicateHealth plan sends WelcomePackets and Medicaid IDcards to beneficiaries.PCP/AMH AssignmentHealth plans will run the algorithm to assign abeneficiary to a PCP when beneficiaries: Did not select a PCP at eligibility applicationor through Enrollment Broker at the time ofhealth plan selection.3

Health Plan Auto-Enrollment: AlgorithmIf a member does not choose a PHP or the EBCI Tribal Option , they are auto-enrolled according to the funnel below.1Geographic LocationIn which region does the beneficiary live?2Special Population *Is the beneficiary in a special group?Historical Primary Care Physician(PCP)3Does the beneficiary have a historicalPCP on record?4Family Health PlanAssignmentIs a family member alreadyassigned to a health plan?5* Rule 2 will also apply to certain Tailored Planpopulations in the future.** This rule only applies for autoenrollments after Managed Care Launch.At Crossover members will not have previousprevious PHP enrollmentsPrevious Health PlanEnrollment **What is the beneficiary’smost recent health plan?6Round RobinAssign to nextPHP1- Determines where the beneficiary lives,determines the region and removes health plansnot contracted in that region2- Determines if the beneficiary is part of a special populationand should be assigned to a specific type of health plan. Ifbeneficiary is a newborn, they are enrolled with theirmother’s health plan. If beneficiary is a Tribal/IHS Memberthey follow the Rule 2 EBCI Tribal Option Detail.3- Determines which health plan networks include the beneficiary’scurrent Primary Care Provider (PCP). If only one health planidentified, beneficiary is enrolled. If more than one, proceed throughrules.4- Determines if a family member is already enrolled in a health plan. If the familymember is enrolled, and the beneficiary’s historical PCP is also in-network, thebeneficiary is enrolled to the family member’s plan.5- Determines if the beneficiary has been enrolled with a health plan in the last 12 months.If so, the enrollment with the last health plan is continued.6- If none of the above result in enrollment, the beneficiary is enrolled in the health plan which hasbeen least recently assigned by the round robin (maintaining the in-network PCP, where applicable).4

Health Plan Auto-Enrollment: Rule 2 EBCI Tribal Option Detail2a If member is a Tribal member orEBCI/IHS eligible member, proceedto 2b. If not, skip Rule 2 and go toRule 3.Special Population *Is beneficiary a Federally recognized Tribal member or EBCI/IHSeligible member?2bCounty of ResidenceIn which county does the beneficiary live?2cMost Recent Primary CarePhysician (PCP)Does the beneficiary have ahistorical or current PCP onrecord? If member lives in Cherokee, Graham, Haywood, Jacksonor Swain counties** proceed to Rule 2c. If not,beneficiary remains in NC Medicaid Direct. If EBCI Tribal Option PCCM Network includes thebeneficiary’s most recent PCP or beneficiary does not have aPCP, proceed to Rule 2d. If not, beneficiary remains in NCMedicaid Direct.2d* Rule 2 will also apply to certain Tailored Planpopulations in the future.EBCI TribalOption Auto-enrolled in Tribal Option.** Tribal members living in Buncombe, Clay,Henderson, Macon, Madison, or Transylvaniahave the option of Tribal Option, but are notauto-enrolled to it.5

Auto-Enrollment Example Scenarios 1-2:Individual Auto-Enrolled

Scenario 1: Individual Beneficiary Auto-Enrolled with existing PCPBarbara Smith is a current Medicaid beneficiary who is part of the mandatory Standard Plan population. She lives in Region 4 andOak Heath Practice has been her PCP for five years. Oak Health Practice contracted with health plans A and B. While Barbarareceived communications encouraging plan selection with NC Enrollment Broker, she did not select a health plan before OpenEnrollment closed. NC Medicaid enrolls her to a PHP using the auto-enrollment process. Rules in italics apply.1GeographyBarbara lives in Region 4.All health plans areavailable in Region 4.2Previous EnrollmentBarbara does not have previousenrollment in a health plan.Barbara’s health plan Optionsremain A & B.PHP APHP BPHP CPHP DPHP E3Barbara is not a part of a SpecialPopulation (like newborn). Allhealth plans remain availablefor Barbara.PHP APHP BPHP CPHP DPHP E5Special PopulationPrimary Care PhysicianBarbara’s PCP, Oak Health Practice,is in-network with health plans Aand B. Other health plans areremoved for Barbara.PHP APHP BPHP CPHP DPHP E4Family AssignmentBarbara is an individual and doesnot have associated family.Barbara’s health plans Optionsremain A & B.PHP APHP BPHP CPHP DPHP EPHP APHP BPHP CPHP DPHP ERound RobinBarbara’s Enrolled!The auto-enrollment process knows the lastplan used for enrollment between A and B,was A. The next available plan is B. Barbara isenrolled with health plan B.Barbara is enrolled in health plan B. Herenrollment and PCP information is transmittedto health plan B. Barbara will be assigned toher PCP, Oak Health Practice, by health plan B.Barbara will receive her Welcome Packet andnew Medicaid ID Card.6PHP APHP BPHP CPHP DPHP EPHPBOak Health Practice

Scenario 2: Individual Beneficiary Auto-Enrolled without existing PCPRita Turner is a current Medicaid beneficiary who is part of the mandatory Standard Plan population. She lives in Region 4 andhas had Salus Heath Practice as a PCP for 10 years. Salus Health Practice has not contracted with any health plans. While Ritareceived communications encouraging plan selection using the NC Enrollment Broker, she did not select a health plan OpenEnrollment ended. NC Medicaid enrolls Barbara to a PHP using the auto-enrollment process. Rules in italics apply.1GeographyRita lives in Region 6.All health plans exceptPHP C are available inRegion 6.2Previous EnrollmentRita does not have previousenrollment in a health plan. Rita’shealth plans Options remain A, B,D and E.PHP APHP BPHP CPHP DPHP E3Rita is not a part of a SpecialPopulation (like newborn). Allhealth plans except PHP Cremain available for Rita.PHP APHP BPHP CPHP DPHP E5Special PopulationPrimary Care PhysicianRita’s PCP, Salus Health Practice, isnot in-network with any healthplans. No additional health plansare removed for Rita.4Family AssignmentRita is an individual and does nothave associated family. Rita’s healthplans Options remain A, B, D and E.PHP APHP BPHP CPHP DPHP EPHP APHP BPHP CPHP DPHP EPHP APHP BPHP CPHP DPHP ERound RobinBarbara’s Enrolled!The auto-enrollment process knows amongplans A, B, D and E; Plan E was least recentlyassigned through auto-enrollment and is thenext available plan. Rita is enrolled withhealth plan E.Rita is enrolled in health plan E. Herenrollment information is transmitted to healthplan E. Rita will be assigned to a new PCP innetwork for health plan E. Rita will receive herWelcome Packet and new Medicaid ID Card.6PHP APHP BPHP CPHP DPHP EPHPEOak Health Practice

Auto-Enrollment Example Scenarios 3-4:Mother, Son Auto-Enrolled

Scenario 3A: Mother, Son Auto-Enrolled – Simon BakerMichelle Baker and her child, Simon (10), are mandatory Standard Plan Medicaid beneficiaries living in Region 3. At eligibility application, Michelleselected Mountain Heath Practice as her Primary Care Provider (PCP) and Children’s Pediatrics for Simon. Mountain Health Practice has contracted withall health plans, while Children’s Pediatrics has contracted with only health plans A and C. While Michelle received communications encouraging planselection using the NC Enrollment Broker, she did not make health plan selections for her family prior to the end of Open Enrollment. NC Medicaid willenroll Michelle and Simon to a health plan using the auto-enrollment process. When determining enrollment, NC Medicaid processes by age, startingwith the youngest person. Rules in italics apply.1GeographySimon lives in Region 3.All health plans areavailable in Region 3.2Previous EnrollmentSimon does not have previousenrollment in a health plan.Simon’s health plan options remainA and C.PHP APHP BPHP CPHP DPHP E3Simon is not part of a SpecialPopulation (like newborn). Allhealth plans remain available.PHP APHP BPHP CPHP DPHP E5Special PopulationPrimary Care PhysicianSimon’s PCP, Children’s Pediatrics,is in-network with health plans Aand C.PHP APHP BPHP CPHP DPHP EPHP APHP BPHP CPHP DPHP E6Round RobinThe auto-enrollment process knows the lastplan used for enrollment between A and C,was C. The next available plan is A. Simon isenrolled to health plan A.PHP APHP BPHP CPHP DPHP E4Family AssignmentSimon is the youngest in his family,Michelle has not been enrolled with aPHP. Simon’s options remain PHP Aand PHP C.PHP APHP BPHP CPHP DPHP ESimon’s Enrolled!Simon is enrolled to health plan A. Simon’senrollment and PCP information is transmitted tohealth plan A. Simon will be assigned to his PCP,Children’s Pediatrics, by health plan A. Michellewill receive a Welcome Packet and new MedicaidID Card for Simon.PHPAChildren’s Pediatrics

Scenario 3B: Mother, Son Auto-Enrolled – Michelle BakerMichelle Baker and her child, Simon 10, are mandatory Standard Plan Medicaid beneficiaries living in Region 3. At eligibility application, Michelle selectedMountain Heath Practice as her Primary Care Provider (PCP) and Children’s Pediatrics for Simon. Mountain Health Practice has contracted with all healthplans, while Children’s Pediatrics has only Contracted with only health plans A and C. While Michelle received communications encouraging plan selectionusing the NC Enrollment Broker, she did not make health plan selections for her family prior to the end of Open Enrollment. The Department will enrollMichelle and Simon to a health plan using the auto-enrollment process. When determining enrollment, the Department processes by age, starting withthe youngest person. Since Simon was enrolled, Michelle will be enrolled next. Rules in italics apply.1GeographyMichelle lives in Region 3.All health plans areavailable in Region 3.2Michelle is not part of aSpecial Population (likenewborn). All health plansremain available.PHP APHP BPHP CPHP DPHP E5Previous EnrollmentMichelle was enrolled to healthplan A based on Family Assignment.Previous enrollment does notapply.PHP APHP BPHP CPHP DPHP ESpecial Population3Primary Care PhysicianMichelle’s PCP, Mountain HealthPractice, is in-network with allhealth plans.PHP APHP BPHP CPHP DPHP EPHP APHP BPHP CPHP DPHP E4Family AssignmentMichelle’s son, Simon, has been enrolled inhealth plan A. Michelle also will beenrolled to health plan A since MountainHealth Practice is in-network and Simon isalready enrolled.PHP APHP BPHP CPHP DPHP ERound RobinMichelle’s Enrolled!Michelle was enrolled with healthplan A based on FamilyAssignment. Round robin does notapply.Michelle is enrolled to health plan A. Michelle’senrollment and PCP information is transmitted to healthplan A. Michelle will be assigned to her PCP, MountainPediatrics, by health plan A. Michelle will receive aWelcome Packet and new Medicaid ID Card.6PHP APHP BPHP CPHP DPHP EPHPAChildren’s Pediatrics

Scenario 4A: Family Auto-Enrolled – Alex CortezFreda Cortez and her child, Alex (3), are new mandatory Standard Plan Medicaid beneficiaries living in Region 5. At eligibility application, Freda selectedWomen’s Heath Practice as her Primary Care Provider (PCP) and Ocean Pediatrics for Alex. Women’s Health Practice contracted with all health plansexcept C, while Ocean Pediatrics only contracted with C. While Freda received communications encouraging plan selection with the NC Enrollment Broker,she did not make health plan selections for Alex before Open Enrollment ended. NC Medicaid will enroll Freda and family to a health plan using the autoenrollment process. When determining enrollment, NC Medicaid processes by age, starting with the youngest person. Rules in italics apply.1GeographyAlex lives in Region 5. Allhealth plan are available inRegion 5.2Alex is not part of a SpecialPopulation (like Newborn). Allhealth plan remain available.PHP APHP BPHP CPHP DPHP E5Previous EnrollmentAlex was enrolled to health plan C.Previous enrollment does notapply.PHP APHP BPHP CPHP DPHP ESpecial Population3Primary Care PhysicianAlex’s PCP, Ocean Pediatrics, is innetwork with health plan C. Alexis enrolled with health plan C.PHP APHP BPHP CPHP DPHP EPHP APHP BPHP CPHP DPHP E6Round RobinAlex was enrolled with health plan C.Round robin does not apply.PHP APHP BPHP CPHP DPHP E4Family AssignmentAlex is the youngest in her family,Freda has not been enrolled with ahealth plan. Alex’s option remainsPHP C.PHP APHP BPHP CPHP DPHP EAlex’s Enrolled!Alex is enrolled to health plan C. Alex’s enrollmentand PCP information is transmitted to health planC. Alex will be assigned to her PCP, OceanPediatrics, by health plan C. Freda will receive aWelcome Packet and new Medicaid ID Card forAlex.PHPCCostal Pediatrics

Scenario 4B: Family Auto-Enrolled – Freda CortezFreda Cortez and her child, Alex (3), are new mandatory Standard Plan Medicaid beneficiaries living in Region 5. At eligibility application, Freda selectedWomen’s Heath Practice as her Primary Care Provider (PCP) and Ocean Pediatrics for Alex. Women’s Health Practice has contracted with all health plansexcept C, while Ocean Pediatrics has only contracted with C. While Freda received communications encouraging plan selection using the NC EnrollmentBroker, she did not make health plan selections for Alex prior to the end of Open Enrollment. The Department will enroll Freda and family to a health planusing the auto-enrollment process. When determining enrollment, the Department processes by age, starting with the youngest person.Since Alex was already enrolled, Freda will be enrolled next. Rules in italics apply.1GeographyFreda lives in Region5. All health plans areavailable in Region 5.2Special PopulationFreda is not part of a SpecialPopulation (like newborn). Allhealth plans remain available.PHP APHP BPHP CPHP DPHP E5PHP APHP BPHP CPHP DPHP EPrevious EnrollmentFreda does not have previousenrollment in a health plan.Freda’s health plan options remainA, B, D, and E.PHP APHP BPHP CPHP DPHP E3Primary Care PhysicianFreda’s PCP, Women’s Health Practice,is in-network with all Health Plansexcept C. Freda’s health plan optionsremain A, B, D, and E. PHP A4Family AssignmentFreda’s child Alex has been enrolled withhealth plan C, but Women’s HealthPractice is not in-network with C.PHP APHP BPHP CPHP DPHP EPHP BPHP CPHP DPHP E6Round RobinThe auto-enrollment process knows the lastplan used for enrollment between A, B, D,and E, was B. The next available plan is D.Freda is enrolled with health plan D.PHP APHP BPHP CPHP DPHP EFreda’s Enrolled!Freda is enrolled in health plan D. Freda’senrollment and PCP information is transmitted tohealth plan D. Freda will be assigned to her PCP,Women’s Health Practice, by health plan D. Fredawill receive a Welcome Packet and new Medicaid IDCard for herself.PHPDWomen’s Heath

Auto-Enrollment Example Scenarios 5-7:Tribe/IHS Individual Auto-Enrolled

Scenario 5: Tribe/IHS Individual Beneficiary Auto-EnrolledTricia Walker is an EBCI/HIS-eligible member and dually eligible Medicaid beneficiary (Tribal – Excluded population). Shelives in Region 1 in Cherokee county and has had Blue Ridge Health Practice as a PCP for five years. Blue Ridge hascontracted with health plans A and B and is a part of Cherokee Indian Hospital Association (CIHA). The Departmentenrolls Tricia to the EBCI Tribal Option using the auto-enrollment process. Rules in italics apply.12GeographyTricia lives in Region 1. All health plansexcept PHP C are available in Region 1.EBCI Tribal OptionMedicaid DirectPHP APHP BPHP CPHP DPHP E2cSpecial Population2bTricia is not a federally recognized Tribal memberbut is ECBI/IHS eligible and a dual eligible. She isexcluded from Standard Plans and enters the Rule2 EBCI Tribal Option Detail. EBCI Tribal Option andNC Medicaid Direct remain available.Primary Care PhysicianTricia’s PCP, Blue Ridge Health Practice,is part of CIHA and within the EBCITribal Option Network. She is enrolledto EBCI Tribal Option.EBCI Tribal OptionMedicaid DirectPHP APHP BPHP CPHP DPHP EEBCI Tribal OptionMedicaid DirectPHP APHP BPHP CPHP DPHP ECounty of ResidenceTricia lives in Cherokee County, one of fivecounties where the EBCI Tribal Optionnetwork is available. EBCI Tribal Optionand NC Medicaid Direct remain available.EBCI Tribal OptionMedicaid DirectPHP APHP BPHP CPHP DPHP ETricia’s Enrolled!Tricia is enrolled in EBCI Tribal Option. Herenrollment and PCP information is transmitted toEBCI Tribal Option. Tricia will be assigned to herPCP, Blue Ridge Health Practice, by EBCI TribalOption. Tricia will receive her Welcome Packetand new Medicaid ID Card.EBCITribalOptionBlue Ridge Practice

Scenario 6: Tribe/IHS Individual Beneficiary Auto-EnrolledPerry Singer is a federally recognized Tribal member who is exempt from Standard Plan. She lives in Region 1 and doesnot have a PCP. While Perry received a letter communicating her options to enroll in EBCI Tribal Option, NC MedicaidDirect or a Prepaid Health Plan, she did not select a health plan prior to the end of Open Enrollment. NC Medicaidenrolls Perry to EBCI Tribal Option using the auto-enrollment process. Rules in italics apply.12GeographyPerry lives in Region 1. All health plansexcept PHP C are available in Region 1.EBCI Tribal OptionMedicaid DirectPHP APHP BPHP CPHP DPHP E2cSpecial Population2bPerry is a federally recognized Tribal member anddid not select a PHP during Open Enrollment. AllPHPs are removed. EBCI Tribal Option and NCMedicaid Direct are options.County of ResidencePerry lives in Swain County, which is oneof five counties where the EBCI TribalOption network is available.EBCI Tribal OptionMedicaid DirectPHP APHP BPHP CPHP DPHP EEBCI Tribal OptionMedicaid DirectPHP APHP BPHP CPHP DPHP EPrimary Care PhysicianPerry does not have a PCP. She isenrolled to EBCI Tribal Option.EBCI Tribal OptionMedicaid DirectPHP APHP BPHP CPHP DPHP EPerry’s Enrolled!Perry is enrolled in EBCI Tribal Option, and she isauto-assigned to CIHA as her PCP. Her enrollmentand PCP information is transmitted to the EBCITribal Option. Perry will receive her WelcomePacket and new Medicaid ID Card.EBCITribalOptionBlue Ridge Practice

Scenario 7: Tribe/IHS Individual Beneficiary Auto-EnrolledEmma Redmond is a federally recognized Tribal member who is exempt from Standard Plan. She lives in Region 1 andhas Maple Health as her PCP. While Emma received a letter communicating her options to enroll in EBCI Tribal Option,NC Medicaid Direct or a Prepaid Health Plan, she did not select a health plan prior to the end of Open Enrollment. TheDepartment enrolls Emma to EBCI Tribal Option using the auto-enrollment process. Rules in italics apply.1GeographyEmma lives in Region 1. All health plansexcept PHP C are available in Region 1.EBCI Tribal OptionMedicaid DirectPHP APHP BPHP CPHP DPHP E2Special PopulationEmma is a federally recognized Tribal member anddid not select a PHP during Open Enrollment. AllPHPs are removed. EBCI Tribal Option and NCMedicaid Direct are options.EBCI Tribal OptionMedicaid DirectPHP APHP BPHP CPHP DPHP EEmma’s Enrolled!Emma continues her enrollment in MedicaidDirect and will continue to get services the wayshe does today. She will receive a confirmationnotice that there is no change to her health plan.EBCITribalOptionBlue Ridge Practice2bCounty of ResidenceEmma lives in Clay County, which is notone of five counties where the EBCI TribalOption network auto-enrollment isperformed.EBCI Tribal OptionMedicaid DirectPHP APHP BPHP CPHP DPHP E

4 Auto-Enrollment: Algorithm 5 Auto-Enrollment: Rule 2 EBCI Tribal Option Detail 6 Auto-Enrollment Example Scenarios during Crossover 7 Individual Auto-Enrollment: with PCP in-network 8 Individual Auto-Enrollment: with PCP not in-network for any PHP 10 Mother, Son Auto-Enrolled: Enrolled in same PHP

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