Common use of Disenrollment from Managed Care during a CDTF Stay Clause in Contracts

Disenrollment from Managed Care during a CDTF Stay. Children who are enrolled voluntarily in STAR+PLUS can move to FFS during a CDTF Stay. STAR and STAR+PLUS Members also can move to FFS during a CDTF stay under the limited circumstances described in Section 5.02. (e), regarding disenrollment at the MCO’s request. The following table describes how payment responsibility is divided between entities, beginning on the effective date of the Member’s FFS coverage. Scenario CDTFCharge All OtherCovered Services 1 Voluntary Child Member Moves from STAR+PLUS to FFS (Includes Change Based on SSI Status) Former STAR+PLUS MCO FFS The responsible party will pay the CDTF charge until the earlier of: (1) date of Discharge from the CDTF, or (2) loss of Medicaid eligibility.

Disenrollment from Managed Care during a CDTF Stay. Children who are enrolled voluntarily in the STAR Medicaid Rural Service Area or STAR+PLUS can move to FFS during a CDTF Staystay. STAR and STAR+PLUS Members also can move to FFS during a CDTF stay under the limited circumstances described in Section 5.02. (e), regarding disenrollment at the MCO’s request. The following table describes how payment responsibility is divided between entities, beginning on the effective date of the Member’s FFS coverage. Scenario CDTFCharge All OtherCovered Services 1 Voluntary Child Member Moves from STAR+PLUS STAR MRSA to FFS (Includes Change Based on SSI Status) Former STAR+PLUS STAR MCO FFS The responsible party will pay the CDTF charge until the earlier of: (1) date of Discharge from the CDTF, or (2) loss of Medicaid eligibility.