New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 308 - MANAGED CARE PROGRAM
Part 7 - ENROLLMENT AND DISENROLLMENT
Section 8.308.7.11 - MASS TRANSFER PROCESS
Universal Citation: 8 NM Admin Code 8.308.7.11
Current through Register Vol. 35, No. 18, September 24, 2024
The mass transfer process is initiated when HSD determines that the transfer of MCO members from one MCO to another is in the best interests of the program.
A. Triggering a mass transfer: The mass transfer process may be triggered by two situations:
(1) a
maintenance change, such as changes in the MCO identification number or the MCO
changes its name or other changes that is not relevant to the member and
services will continue with that MCO; and
(2) a significant change in a MCO's
contracting status, including but not limited to, the loss of licensure,
substandard care, fiscal insolvency or significant loss in network providers;
in such instances, a notice is sent to the member informing him or her of the
transfer and the opportunity to select a different MCO.
B. Effective date of mass transfer: The change in enrollment initiated by the mass transfer begins with the first day of the month following HSD's identification of the need to transfer MCO members.
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