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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-57. ENROLLMENT AND DISENROLLMENT REQUIREMENTS AND PROCEDURES FOR BENEFICIARIES ELIGIBLE FOR THE MEDICAID MANAGED CARE PROGRAM FOR DISABLED CHILDREN AND YOUTHS |
Section 29-5701. ENROLLMENT
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5701.1The managed care provider shall accept and enroll each eligible child who chooses or is assigned to the managed care provider’s plan.
5701.2The following categories of children are not eligible to participate in the demonstration:
(a)Children eligible for a period that is retroactive;
(b)Children with restricted eligibility; and
(c)Children with dual eligibility for Medicare and Medicaid.
5701.3Except as provided in §5701.4, enrollment by an eligible child in the managed care provider’s plan shall be voluntary.
5701.4Eligible children who do not choose to remain in the Medicaid fee-for-service program within ten (10) days of being certified or recertified as eligible for Medicaid shall be assigned to the managed care provider using an automated, random assignment process.
5701.5By the fifteenth (15th) day of the month, the Department shall send a notification letter to the family or representative of each eligible child selected by the Department that month, advising the family or representative of their option to either:
(a)Enroll the child in the demonstration; or
(b)Choose to keep the child in the current Medicaid fee-for-service program.
5701.6The letter described will inform each family or representative that in the event the family or representative does not exercise the right to choose, the child will be assigned to the demonstration.
5701.7In the event that a family or representative of an eligible child does not exercise the right to choose within forty-five (45) days of the date of the notification letter, the child will be assigned to the demonstration. If a child has been autoassigned to the demonstration, the family or representative of the child may choose to keep the child in the current Medicaid fee-for-service program, for any reason, during the first forty-five (45) days of membership following autoassignment.
5701.8A family or representative who initially chooses to keep the child in the current Medicaid fee-for-service program will be allowed to enroll the child in the demonstration at any time.
5701.9The effective date of enrollment for children who are voluntarily enrolled or are autoassigned to the demonstration will be the first (1st) day of the second (2nd) month following the Department’s notification letter.