Common use of Re-enrollment Clause in Contracts

Re-enrollment. A FCMH member who voluntarily disenrolled from the PIHP can re-enroll if s/he meets the covered population eligibility criteria as specified in the contract and remains in an eligible out-of-home care setting. A FCMH member who disenrolled from the PIHP after discharge from an out-of-home care setting is not eligible to re-enroll. The need for the PIHP to perform a comprehensive assessment on the re-enrolling member depends on how long s/he was disenrolled from the PIHP. a. If the member is re-enrolled less than six months after the member’s last disenrollment from the PIHP, the PIHP does not have to perform a comprehensive initial health assessment. The PIHP may use the previously developed comprehensive health care plan for that member. The comprehensive health care plan must be reviewed and updated if indicated. b. If the member is re-enrolled at least six months after the member’s last disenrollment from the PIHP, then the PIHP must perform a comprehensive initial health assessment of the member. The PIHP must develop a new comprehensive health care plan for that member.

Re-enrollment. A FCMH member who voluntarily disenrolled from the PIHP can re-enroll if s/he meets the covered population eligibility criteria as specified in the contract and remains in an eligible out-of-home care setting. A FCMH member who disenrolled from the PIHP after discharge from an out-of-home care setting is not eligible to re-enroll. The need for the PIHP to perform a comprehensive assessment on the re-enrolling member depends on how long s/he was disenrolled from the PIHP. a. 1. If the member is re-enrolled less than six months after the member’s last disenrollment from the PIHP, the PIHP does not have to perform a comprehensive initial health assessment. The PIHP may use the previously developed comprehensive health care plan for that member. The comprehensive health care plan must be reviewed and updated if indicated. b. 2. If the member is re-enrolled at least six months after the member’s last disenrollment from the PIHP, then the PIHP must perform a comprehensive initial health assessment of the member. The PIHP must develop a new comprehensive health care plan for that member.