Member Initiated Disenrollment and Change of CCN. A member shall remain in the CCN unless the member submits a written, electronic or oral request to disenroll, transfer to another CCN for cause or the member becomes ineligible for Medicaid and/or CCN enrollment. The member may disenroll from the CCN by: • Requesting disenrollment, without cause, at any time during the ninety (90) days following the date of the member’s initial enrollment or re- enrollment with the CCN; • Requesting disenrollment, with cause, after the first 90 days through a written, electronic or oral request to disenroll. or transfer to another CCN; or • Becoming ineligible for Medicaid/CHIP and/or CCN enrollment. Oral requests to disenroll shall be confirmed by the Enrollment Broker by return call with written documentation, or in writing to the requestor. If a member’s request to disenroll is not acted on within sixty (60) days, the request for disenrollment shall be considered approved. A member who is a voluntary enrollee (See §6.1 of this Provider Agreement) may request disenrollment from a CCN without cause at any time.
Member Initiated Disenrollment and Change of CCN. A member shall remain in the CCN unless the member submits a written, electronic or oral request to disenroll, transfer to another CCN for cause or the member becomes ineligible for Medicaid and/or CCN enrollment. The member may disenroll from the CCN by: • Requesting disenrollment, without cause, at any time during the ninety (90) days following the date of the member’s initial enrollment or re- enrollment with the CCN; • Requesting disenrollment, with cause, after the first 90 days through a written, electronic or oral request to disenroll. or transfer to another CCN; or • Becoming ineligible for Medicaid/CHIP and/or CCN enrollment. Oral requests to disenroll shall be confirmed by the Enrollment Broker by return call with written documentation, or in writing to the requestor. If a member’s request to disenroll is not acted on within sixty (60) days, the request for disenrollment shall be considered approved. A member who is a voluntary enrollee may request disenrollment from a CCN without cause at any time. A member who is a mandatory enrollee may request disenrollment from the CCN as follows: • For cause, at any time: The following are considered cause for disenrollment by the member: o The member moves out of the CCN’s service area; o The CCN does not, because of moral or religious objections, cover the service the member seeks; o The member needs related services (for example, a cesarean section and a tubal ligation) to be performed at the same time; not all related services are available within the CCN’s network of providers; and the member’s PCP or another provider determines that receiving the services separately would subject the enrollee to unnecessary risk; and o Other reasons, including but not limited to, poor quality of care, lack of access to services specified under the Provider Agreement, or lack of access to providers experienced in dealing with the member’s health care needs. • Without cause, at the following times: o During the ninety (90) days following the date of the member's initial enrollment with the CCN or the date the Enrollment Broker sends the member notice of the enrollment, whichever is later; o At least once a year during the annual open enrollment period thereafter; o Upon automatic reenrollment under 42 CFR §438.56(g), if a temporary loss of Medicaid eligibility has caused the member to miss the annual disenrollment opportunity; or o If DHH imposes the intermediate sanction provisions specified in 42 CFR §438.702(a)(3). •...
