Membership Modeling and Enrollment Process Overview
Detailed flow charts and timelines outlining the enrollment process for membership modeling, including adjustments, conversions, and plan relinquishments from August 1 to September 30. The process involves various GSAs and plans, with specific criteria for enrollment, dual alignment, and conversions. Images provide visual aids for understanding the complex process.
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Presentation Transcript
Membership Modeling Membership Timeline Flow Charts Enrollment Enrollment August 1 through September 30 Adjustments CRS, SMI Dual Alignment Conversion Conversion Examples Charts/Graphs Relinquishing Plan < 45% - GSAs 2 and 4 Two new plans GSA 6 Relinquishing Plan > 55% GSA Relinquishing Plan > 45% and < 55% Santa Cruz and GSA 14 Pima County
Membership Modeling Timeline August 1 Freeze Auto Assignment and Choice for Relinquishing Contractors (exceptions: GSA 6 where both incumbents are relinquishing, GSA 12 due to capped contract) May 1 September 1 Test for Small Contractors for Enhanced Auto Assignment October 1 Adjustments, Conversion, Enhanced Auto Assignment Test for Small Contractors for Conversion (exception: GSA 12 due to capped contract)
Enrollee Enrollment Flow Chart NB, FC, Reenrollment, etc.? Yes No August 1 to September 30? Follows Plan No Yes Proceed to August 1 to September 30 Enrollment Chart Choice? Yes No Follows Choice Auto Assignment A
A Enrollment August 1 to September 30 August 1 to September 30 Enrollment GSA ? GSAs 2, 4, 8, 10, 14 and Santa Cruz GSAs 6 and 12 Choice? Freeze Enrollment and Auto Assignment Yes No Follows Choice Auto Choice? Assignment Yes No Follows Choice Auto Assignment
October 1 Adjustments Membership CRS ? No Yes Move to CRS SMI? No Yes Duals ? GSA? All GSA 12 No Yes Other GSAs Proceed to Dual Alignment Proceed to Conversion Proceed to Dual Alignment Move to Mercy Maricopa Integrated Care C B B
B Dual Alignment Dual Alignment Aligned with Medicare Plan? Yes No Plan Aligned Plan Continuing? Continuing? Yes No Yes No Proceed to Conversion Remain with Plan Proceed to Conversion Align with Plan C C
C Conversion Conversion Plan Continuing or Capped? No Yes Identify threshold and small plans Remain with Plan Move members to small plans based on size and threshold Conversion complete? No Yes All plans at Threshold? Ready for CYE14 Enrollment Yes No Auto Assign
Conversion Example Relinquishing Plan < 45% GSAs 2 and 4 Relinquishing Incumbent New GSA Total Membership at 9/30 22,000 52,000 74,000 Adjustment CRS -300 -900 -1,200 Adjusted Total 21,700 51,100 72,800 - Dual Alignment -700 -1,300 -2,000 + Dual Alignment 2,000 2,000 Conversion -21,000 21,000 0 Membership 10/1 0 51,800 21,000 72,800
Conversion Example Relinquishing Plan < 45% GSAs 2 and 4 60 Thousands Conversion Group 50 40 Dual Alignment (in) 30 20 Dual Alignment (out) 10 0 Adjustment - CRS Relinquishing Incumbent New -10 -20 Membership 9/30 -30
Conversion Example Two New Plans GSA 6 Relinquishing A Relinquishing B New Plan A New Plan B GSA Total Membership 9/30 16,000 15,000 31,000 Adjustment CRS -200 -200 -400 Adjusted Total 15,800 14,800 30,600 - Dual Alignment -500 -400 -900 + Dual Alignment 900 900 Conversion Group -15,300 -14,400 -29,700 Conversion to Small (45%) Auto Assignment (50/50 Modeled) Membership 10/1 6,075 6,975 13,050 8,325 15,300 8,325 15,300 16,650 30,600 0 0
Conversion Example Two New Plans GSA 6 20 Thousands Auto Assignment (50/50 Modeled) Conversion to Small (45%) 10 Conversion Group Dual Alignment (in) 0 Relinquishing A Relinquishing B New Plan A New Plan B Dual Alignment (out) -10 Adjustment - CRS Membership 9/30 -20
Conversion Example Relinquishing Plan > 55% GSA 8 Incumbent Relinquishing New GSA Total 18,000 28,000 46,000 Membership 9/30 -250 -500 -750 Adjustment CRS 17,750 27,500 45,250 Adjusted Total -100 -50 -150 - Dual Alignment 25 125 150 +Dual Alignment -27,450 -27,450 Conversion Group Conversion to Small (45%) Auto Assignment (50/50 Modeled) 3,025 20,575 23,600 1,925 1,925 3,850 22,625 22,625 45,250 Membership 10/1
Conversion Example Relinquishing Plan > 55% GSA 8 30 Thousands Auto Assignment (50/50 Modeled) 20 Conversion to Small (45%) 10 Conversion Group Dual Alignment (in) 0 Relinquishing Small Incumbent New Dual Alignment (out) -10 Adjustment - CRS -20 Membership 9/30 -30
Example of One New Plan Relinquishing Plan > 45% and < 55% Santa Cruz and GSA 14 Relinquishing Incumbent New GSA Total 15,500 14,500 30,000 Membership 9/30 -225 -250 -475 Adjustment CRS 15,275 14,250 29,525 Adjusted Total -525 -100 -625 - Dual Alignment 25 600 625 + Dual Alignment -14,750 -14,750 Conversion Group Conversion to Small (45%) Auto Assignment (50/50 Modeled) 12,900 12,900 925 925 1,850 0 15,100 14,425 29,525 Membership 10/1
Example of One New Plan Relinquishing Plan > 45% and < 55% Santa Cruz and GSA 14 20 Thousands Auto Assignment Conversion to Small (45%) 10 Conversion Group 0 Relinquishing Incumbent New Dual Alignment (in) Dual Alignment (out) -10 Adjustment - CRS -20 Membership 9/30
Conversion GSA 10 Pima County GSA Total 163,000 Incumbent A 60,000 Incumbent B 35,000 Incumbent C 24,000 Incumbent D 27,000 Relinquishing New E Membership 9/30 17,000 Adjustment CRS Adjusted Total -300 -1,200 58,800 -800 -400 -500 -3,200 159,800 16,700 34,200 23,600 26,500 - Dual Alignment -250 -75 -455 -415 -355 -1,550 + Dual Alignment 1,365 35 60 90 1,550 Conversion Group Membership 10/1 -16,450 16,450 16,450 0 0 60,090 33,780 23,245 26,235 159,800
Conversion Example GSA 10 Pima County 70 Thousands 60 Conversion 50 40 Dual Alignment (in) 30 20 Dual Alignment (out) 10 0 Relinquishing Incumbent A Incumbent B Incumbent C Incumbent D New E Adjustment - CRS -10 -20 Membership 9/30 -30
