Current through Register Vol. 41, No. 3, September 23, 2024
A.
All eligible enrollees shall be assigned in managed care through the department
or the central processing unit (CPU) under contract to DMAS. FAMIS MOMS
individuals, during the preassignment period to an MCHIP, shall receive
Medicaid-like benefits via fee-for-service utilizing a FAMIS MOMS card issued
by DMAS. After assignment to an MCHIP, benefits and the delivery of benefits
shall be administered specific to the managed care program in which the
individual is enrolled.
1. MCHIPs shall be
offered to enrollees in all areas.
2. All enrollees shall be assigned to that
contracted MCHIP.
3. Enrollees
shall be assigned through a random system algorithm.
4. Enrolled individuals will receive a letter
indicating that they may select one of the contracted MCHIPs that serve such
area. Enrollees who do not select an MCHIP as described above, shall be
assigned to an MCHIP as described in subdivision 3 of this
subsection.
5. Individuals assigned
to an MCHIP who lose and then regain eligibility for FAMIS MOMS within 60 days
will be reassigned to their previous MCHIP.
B. Following their initial assignment to an
MCHIP, those enrollees shall be restricted to that MCHIP until their next
annual eligibility redetermination, unless appropriately disenrolled by the
department.
1. During the first 90 days of
managed care assignment, an enrollee may request reassignment for any reason
from that MCHIP to another MCHIP serving that geographic area. Such
reassignment shall be effective no later than the first day of the second month
after the month in which the enrollee requests reassignment.
2. After the first 90 calendar days of the
assignment period, the enrollee may only be reassigned from one MCHIP to
another MCHIP upon determination by DMAS that good cause exists pursuant to
subsection C of this section.
C. Disenrollment for good cause may be
requested at any time.
1. After the first 90
days of assignment in managed care, enrollees may request disenrollment from
DMAS based on good cause. The request must be made in writing to DMAS and cite
the reasons why the enrollee wishes to be reassigned. DMAS shall establish
procedures for good cause reassignment through written policy
directives.
2. DMAS shall determine
whether good cause exists for reassignment.
Statutory Authority: §
32.1-325 of the Code of Virginia; 42 USC §
1396 et
seq.
