MENROLLINENT: LDSS. Responsibilities:
1. The LDSS will accept requests for disenrollment directly from Enrollees and may not require Enrollees to approach the MCO for a disenrollment form. Where an LDSS is authorized to mandate enrollment, all requests for disenrollment must be directed to the LDSS or the enrollment broker. LDSSs and the enrollment broker must utilize the State approved Disenrollment forms.
2. Enrollees may initiate a request for an expedited disenrollment to the LDSS. The LDSS will expedite the disenrollment process in those cases where an Enrollee's request for disenrollment involves an urgent medical need, a complaint of non-CONSENSUAL ENROLLMENT OR, IN New York City and other local districts. Where homeless individuals are exempt, homeless individuals in the shelter system. If approved, the LDSS will manually process the disenrollment through the PCP Subsystem.
3. The LDSS will process routine disenrollment requests to take effect on the first (1st) day of the following month if the request is made before the fifteenth 15th day of the month. In no event shall the Effective Date of Disenrollment be later than the first (1st) day of the second month after the month in which an Enrollee requests a disenrollment
4. The LDSS will disenroll Enrollees automatically upon death or loss of Medicaid eligibility. All such disenrollments will be effective at the end of the month in which the death or loss of eligibility occurs or at the end of the last month of guaranteed eligibility, where applicable.
5. In districts where the LDSS has the authority to operate a mandatory program, and in voluntary counties that enforce lock-in, the LDSS will disenroll Enrollees who request disenrollment upon determination that they meet good cause requirements as specified in Section 73 and 8.7 of this Agreement. The LDSS will provide Enrollees with notice of their right to request a fair hearing if their disenrollment request is denied. This notice must outline the reason(s) for the denial.
6. The LDSS will promptly disenroll an Enrollee whose managed care eligibility or health status changes such that he/she is deemed by the LDSS to meet the exclusion criteria. The LDSS will provide Enrollees with a notice of their right to request a fair hearing.
7. In instances where an Enrollee requests disenrollment due to exclusion, the LDSS must notify the Enrollee of the approval or denial of EXCLUSION/DISENROLLMENT status, including fair hearing rights if disenrollment is denied.
8. The LDS...
