10- 144 C.M.R. ch. 707, § 3.0
The woman must complete, sign and return an Initial Enrollment Form to MBCHP. The date MBCHP receives the signed form will be the client's application date.
Eligibility can be retroactive up to 90 days prior to the application date, if requested at the time of the application and the applicant meets all eligibility requirements throughout the retroactive period.
MBCHP will send the client a notice of determination of eligibility for the Program no later than 30 days after receiving the signed Initial Enrollment Form.
Upon enrollment, the client selects a MBCHP Primary Care Provider and is eligible for 12-months from the Application Date, subject to restrictions in Program coverage as provided in Sections 2 and 6 of these rules. The term "MBCHP Primary Care Provider" means a provider that is under contract with MBCHP or has signed an MBCHP Provider Application/Agreement.
If an applicant is unable to access a particular MBCHP Primary Care Provider due to unavailable "slots", MBCHP will assist the applicant in selecting another MBCHP PCP who is available in her area.
If a client is requesting to change to another MBCHP Primary Care Provider due to any "good cause" reason, MBCHP will assist the client in selecting another MBCHP PCP who is available in her area.
Continued eligibility [as defined in Section 2 ] for program coverage will be determined annually.
No more than 45 days prior to the end of the 12-month coverage period, MBCHP will, by letter, inform client of the re-enrollment period.
The woman must complete, sign and return a MBCHP Re-enrollment Form before the indicated deadline.
In the case that a woman does not return the re-enrollment form before the indicated deadline due to a justifiable event causing the delay, the woman will be re-enrolled as of the date the form is received by MBCHP. If the lapse is 90 days or more, a re-enrollee may not obtain benefits more than 90 days retroactively from the date the form is received by MBCHP.
The MBCHP will terminate a client's Program Enrollment if the woman:
Requests termination from the Program;
No longer meets all of the criteria set forth in Section 2: Eligibility for Services;
Does not return the MBCHP Re-Enrollment Form by 30 days after the last day of the eligibility period [unless for good cause excused pursuant to Section 3.2.3 ]
Refuses to receive screening services and referrals through her MBCHP Primary Care Provider site.
10- 144 C.M.R. ch. 707, § 3.0