CCN Initiated Member Disenrollment Sample Clauses

CCN Initiated Member Disenrollment. The CCN may request disenrollment of a member with a written request to DHH providing the member’s name, Medicaid ID number, and detailed reasons for requesting the reassignment of the member. The CCN shall not request disenrollment for reasons other than those permitted under this Provider Agreement and/or in accordance with Louisiana Medicaid State Plan, rules, regulations and policy and procedures. With proper documentation, the following are acceptable reasons for which the CCN may submit involuntary disenrollment requests to DHH’s Enrollment Broker: • Fraudulent use of the CCN’s ID card. In such cases the CCN shall report the event to the Medicaid Program Integrity Section. • The member’s behavior is disruptive, unruly, abusive or uncooperative to the extent that enrollment in the CCN seriously impairs the organization’s ability to furnish services to either the member or other members and such behavior is not linked to the member’s diagnosis. o The CCN shall promptly submit such disenrollment requests to DHH. In no event shall the CCN submit a disenrollment request at such a date as would cause the disenrollment to be effective earlier than forty-five (45) calendar days after the occurrence of the event prompting the request for involuntary disenrollment. The CCN shall ensure that involuntary disenrollment documents are maintained in an identifiable member record. o All requests will be reviewed on a case-by-case basis and subject to the sole discretion of DHH. All decisions are final and not subject to CCN dispute or appeal. The CCN may not request disenrollment because of a member’s: • Health diagnosis; • Adverse change in health status; • Utilization of medical services; • Diminished mental capacity; • Pre-existing medical condition; • Refusal of medical care or diagnostic testing; • Uncooperative or disruptive behavior resulting from his or her special needs, unless it seriously impairs the CCNs ability to furnish services to either this particular member or other members as defined in this subsection; • Attempt to exercise rights under the CCN’s grievance system; or • Request of one (1) PCP to have a member assigned to a different provider out of the CCN. The CCN shall not attempt to discourage enrollment of prospective members or encourage disenrollment from the CCN of current members. DHH considers this a material violation and the CCN will be subject to intermediate sanctions. Disenrollment shall be assisted and completed by the Enrollment Br...
Sample 1
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Related to CCN Initiated Member Disenrollment

  • Disenrollment Adverse Benefit Determination taken by the Division, or its Agent, to remove a Member's name from the monthly Member Listing report following the Division's receipt and approval of a request for Disenrollment or a determination that the Member is no longer eligible for Enrollment in the Contractor.

  • Enrollment The School shall maintain accurate and complete enrollment data and daily records of student attendance.

  • Re-enrollment Any eligible employees who wish to join the Sick Leave Bank after their first year of eligibility will contribute two (2) days upon joining. Such membership may only be made during the month of October using the appropriate forms. The two (2) required days of leave shall be donated from their account upon enrollment in the Classified Employee Council (CEC).

  • Enrollment Process The Department may, at any time, revise the enrollment procedures. The Department will advise the Contractor of the anticipated changes in advance whenever possible. The Contractor shall have the opportunity to make comments and provide input on the changes. The Contractor will be bound by the changes in enrollment procedures.

  • Initial Enrollment Upon retirement, each new retiree who is eligible to enroll in plans under the Health Benefits Program shall receive uninterrupted coverage under the plan in which he or she was enrolled as an active employee, provided the employee submits all necessary applications and other required documentation in a timely fashion.

  • School-Initiated Closure Should the School choose to voluntarily surrender this Contract before the end of the Contract term, it may do so in consultation with the Commission at the close of any school year and upon written notice to the Commission given at least ninety (90) days before the end of the school year.

  • Proposing Integration Activities in the Planning Submission No integration activity described in section 6.3 may be proposed in a CAPS unless the LHIN has consented, in writing, to its inclusion pursuant to the process set out in section 6.3(b).

  • Eligible Employee For purposes of the SIMPLE 401(k) Plan provisions, any Employee who is entitled to make Elective Deferrals under the terms of the SIMPLE 401(k) Plan.

  • Other Payroll Deductions In addition to the above, the City will deduct from an employee's payroll check, upon authorization by the employee, amounts payable to causes or organizations selected by the Union. At any one time, no more than ten (10) such causes or organizations may be identified by the Union as authorized to benefit from such payroll deductions unless otherwise authorized by the City in its sole discretion. The Union will notify the City of the causes and organizations to be so authorized. Payroll deductions shall be governed by the ability of the City Auditor's payroll system to handle same.

  • SALARY DETERMINATION FOR EMPLOYEES IN ADULT EDUCATION PCA Article B.3 does not apply in School District No. 34 (Abbotsford).

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