Effective Date of Disenrollment. All HSD approved disenrollment requests shall be effective on or before the first Calendar Day of the second month following the month of the request for disenrollment unless otherwise indicated by HSD. In all instances, the effective date shall be indicated on the termination record sent by HSD to the CONTRACTOR.
Effective Date of Disenrollment. All HCA approved disenrollment requests shall be effective on or before the first Calendar Day of the second month following the month of the request for disenrollment unless otherwise indicated by HCA. In all instances, the effective date shall be indicated on the termination record sent by HCA to the CONTRACTOR.
Effective Date of Disenrollment. Disenrollment shall be effective on the first day of the calendar month for which the Disenrollment appears on the HIPAA 834 transaction file. Requested Disenrollment shall be effective no later than the first day of the second month following the month the Member or the Contractor files the request. If the Department fails to make a determination within the timeframes the Disenrollment shall be considered approved.
Effective Date of Disenrollment. 1. The effective date for disenrollment must be on the last day of a month.
2. The effective date of the disenrollment is suspended if the Participant files a Complaint within ten (10) days from the mail date on the written notice of disenrollment.
3. The effective date of an approved disenrollment must be no later than the first day of the second month following the month in which the Participant requests disenrollment or the Contractor refers the request to the Department.
Effective Date of Disenrollment. All HCA approved disenrollment requests shall be effective on or before the first Calendar Day of the second month following the month of the request for disenrollment unless otherwise indicated by HCA. In all instances, the effective date shall be indicated on the termination record sent by HCA to the CONTRACTOR. The CONTRACTOR shall immediately update its enrollment roster based on any changes made in accordance with this Section 4.3 of this Agreement. In accordance with NMAC 8.308.7.10.a, the CONTRACTOR shall not, under any circumstances, disenroll a Member. HCA retains the sole authority to disenroll a Member from the CONTRACTOR and from the Turquoise Care program. The CONTRACTOR shall not request disenrollment because of a change in the Member’s health status, because of their utilization of medical or Behavioral Health services, their diminished mental capacity, or uncooperative or disruptive behavior resulting from their special needs (except when their continued enrollment seriously impairs the CONTRACTOR’s ability to furnish services to either that particular Member or other Members). Care Coordination The CONTRACTOR shall provide Care Coordination that complies with 42 C.F.R. § 438.208 and all requirements set forth in this Agreement. The CONTRACTOR’s Care Coordination program must be designed to cover a wide spectrum of episodic and chronic health care conditions for Members including those in the top ten percent of cost of Members, including those with special health care needs, with an emphasis on addressing health disparities, facilitating care transitions, helping Members with care navigation, removing barriers to care, proactive health promotion, health education, and disease management. The CONTRACTOR shall provide Care Coordination in consultation with a Member’s treatment team and direct engagement with Members resulting in improved Physical and Behavioral Health outcomes. The CONTRACTOR shall ensure those activities are performed by Care Coordinators who have expertise in Member self-management approaches, Member advocacy, navigating complex systems and communicating with a wide spectrum of professional and laypersons, including family members, physicians, specialists, and other health care professionals. The CONTRACTOR shall ensure that performing Care Coordination requirements does not impede a Member’s ability to timely access necessary services. The CONTRACTOR’s Care Coordination program must reflect the following principles: Person...
Effective Date of Disenrollment up to 11:59 p.m. on the last day, as determined by EOHHS, on which the Contractor is responsible for providing ACO Covered Services to an Enrollee and as reflected in the HIPAA 834 Outbound Enrollment File.
Effective Date of Disenrollment a. The effective date of an approved disenrollment shall be the last calendar day of the month in which disenrollment was made effective by the Agency or its enrollment broker. In no case shall disenrollment be later than the first calendar day of the second month following the month in which the enrollee or the Managed Care Plan files the disenrollment request. If the Agency or its enrollment broker fails to make a disenrollment determination within this timeframe, the disenrollment is considered approved as of the date Agency action was required.
b. When disenrollment is necessary because an enrollee loses Medicaid eligibility,
Effective Date of Disenrollment. 2.3.5.1. When a Member voluntarily Disenrolls from the Contractor’s Plan, the effective date of the Disenrollment shall be no later than the first day of the second month following the month in which the Member requested the Disenrollment.
2.3.5.2. If a decision regarding the Member’s Disenrollment is not made by the Department, or its designee, by the first day of the second month following the month in which the Member requested the Disenrollment, the Disenrollment shall be considered approved.
2.3.5.3. Disenrollment Postponed Due to Inpatient Hospital Stay
2.3.5.3.1. If a current Member of a Contractor’s Plan is an inpatient of a Hospital at 11:59 p.m. the day before his/her Disenrollment from the Contractor’s Plan is scheduled to take effect, Disenrollment shall be postponed until discharged from the Hospital.
2.3.5.3.2. When the Member is discharged from the Hospital the new Disenrollment date shall be the last day of the month following discharge.
2.3.5.3.3. The Department shall respond to the Contractor in writing within five (5) Business Days of Contractor’s request to postpone Enrollment.
2.3.5.4. Member Moves Outside of Service Area
2.3.5.4.1. When the Contractor determines a Member is no longer a permanent resident or has resided outside of its Service Area for ninety (90) consecutive days or more, the Contractor shall notify the Department.
2.3.5.4.2. When the Department is notified and confirms that a Member is no longer a permanent resident in the Contractor’s Service Area or has resided outside of its Service Area for ninety (90) consecutive days or more, the Member shall be Disenrolled from the Contractor’s Plan effective the first day of the next month.
Effective Date of Disenrollment. 2.3.5.1. When a Member voluntarily Disenrolls from the Contractor’s Plan, the effective date of the Disenrollment shall be no later than the first day of the second month following the month in which the Member requested the Disenrollment.
2.3.5.2. If a decision regarding the Member’s Disenrollment is not made by the Department, or its designee, by the first day of the second month following the month in which the Member requested the Disenrollment, the Disenrollment shall be considered approved.
2.3.5.3. Disenrollment Postponed Due to Inpatient Hospital Stay
Effective Date of Disenrollment. Disenrollment will become effective on the first day of the second month following receipt by DHS of all documentation necessary, as determined by DHS, to process the disenrollment, provided disenrollment was requested at least 30 calendar days prior to that date, except for disenrollment pursuant to Subsection 6.7.1, for which disenrollment will be effective the beginning of the month in which a transplant is approved. Except as provided in Section 6.4, Enrollment shall cease no later than midnight on the last day of the second calendar month in which the Member’s disenrollment request and all required supporting documentation are received by DHS. On the first day after membership ceases, Contractor is relieved of all obligations to provide Covered Services to the Eligible Beneficiary under the terms of this Contract. Contractor agrees in turn to return to the State any capitation payment forwarded to Contractor for persons no longer enrolled under this Contract.
