Common use of Possible MCO-Requested Disenrollment Clause in Contracts

Possible MCO-Requested Disenrollment. If the MCO decides that it cannot establish a cost-effective care plan for supporting a member’s outcomes and assuring health and safety during the absence, it may request Department approval for disenrollment. In considering whether to allow an MCO-requested disenrollment, the Department will expect the MCO to demonstrate that it is unable to continue to support the member’s outcomes and assure the member’s health and safety with reasonable cost and effort. The member will be given the opportunity to challenge this contention and demonstrate that her/his outcomes can be met and health and safety assured with reasonable cost and effort, which could include a SDS plan. MCO Responsibilities When a Member Changes County of Residence Definition Geographic Service Region (GSR) means a county or group of counties for which the MCO has applied and been certified by the Department to provide the Family Care benefit, the Family Care-Partnership benefit, or both.

Possible MCO-Requested Disenrollment. If the MCO decides that it cannot establish a cost-effective care plan for supporting a member’s outcomes and assuring health and safety during the absence, it may request Department approval for disenrollment. In considering whether to allow an MCO-requested disenrollment, the Department will expect the MCO to demonstrate that it is unable to continue to support the member’s outcomes and assure the member’s health and safety with reasonable cost and effort. The member will be given the opportunity to challenge this contention and demonstrate that her/his the member’s outcomes can be met and health and safety assured with reasonable cost and effort, which could include a SDS plan. MCO Responsibilities When a Member Changes County of Residence Residence‌ Definition Geographic Service Region (GSR) means a county or group of counties for which the MCO has applied and been certified by the Department to provide the Family Care benefit, the Family Care-Partnership benefit, or both.