Voluntary Disenrollment. If you wish to cancel your benefits by disenrolling, you should discuss this with a program representative at your center. You will be asked to sign a Department approved disenrollment form (see Appendix H), which will indicate that you will no longer be entitled to services through LIFE. You may voluntarily disenroll from LIFE without cause at any time. Your disenrollment will be effective the first day of the month following the date your LIFE Provider receives notice of your voluntary disenrollment. You may not disenroll from LIFE at a Social Security office. Choosing to enroll in any other Medicare or Medical Assistance Program benefit, including the Hospice benefit after you enrolled in LIFE, is considered a voluntary disenrollment from LIFE. Your social worker will assist you in returning to the appropriate Medicare and/or Medical Assistance Program. The Medicare or Medical Assistance Program you enroll into upon disenrollment from LIFE may not provide you with the full range of services available to you through LIFE. Involuntary Disenrollment Your LIFE Provider can terminate your benefits, if: • You move out of the LIFE service area. • You consistently do not comply with your individual care plan and/or terms of this agreement and are competent to make decisions for yourself. • You or your caregiver engage in disruptive or threatening behavior. • You fail to pay, or fail to make satisfactory arrangements to pay, any premium due to LIFE, any applicable Medical Assistance spend down, or any amount due under the post-eligibility treatment of income process after a 30-day grace period. • You are out of the service area for more than 30 consecutive days without prior approval from your LIFE Provider. • You no longer meet the eligibility requirements for the program. • The agreement with the CMS and the Department is terminated. • LIFE loses the contracts and/or licenses enabling it to offer health care services. Note: In Pennsylvania, individuals who reside in personal care boarding homes are not nursing home eligible. Therefore, any individual who relocates to a personal care boarding home will be involuntarily disenrolled from the LIFE Program. Before you are involuntarily disenrolled from LIFE, the Department must approve the involuntary disenrollment. You will then be provided with a 30 calendar day written notice by your LIFE Provider. Your disenrollment will be effective the first day of the month following the month in which your 30 calendar day a...
Voluntary Disenrollment. 1. A Participant may disenroll voluntarily from ACAP at any time without cause. To disenroll, the Participant or, if appropriate, the Participant's representative must notify a member of the Contractor's staff. The Contractor must use the Voluntary Disenrollment Letter in Appendix J to notify the Participant and, if appropriate, the Participant's representative of the last day the Participant can receive Authorized Services.
Voluntary Disenrollment. The contractor shall assure that enrollees who disenroll voluntarily are provided with an opportunity to identify, in writing, their reasons for disenrollment. The contractor shall further:
Voluntary Disenrollment. 2.3.6.1.1. The Contractor shall have a mechanism for receiving timely information from CMS and RI EOHHS or its vendor about all disenrollments from the Contractor, including the effective date of disenrollment. All disenrollment-related transactions will be performed by RI EOHHS.
Voluntary Disenrollment. All legal guardians for members enrolled in FCMH shall have the right to disenroll their child from the PIHP at any time for any reason. The PIHP will promptly forward to the enrollment specialist all requests from the member’s parent/legal guardian for disenrollment. Disenrollment requests will be processed as soon as possible and will be effective the last day of the month. Payment(s) made for the member disenrolled the last day of the month will be recouped based on a daily rate. The PIHP must direct all members with disenrollment requests to the Department’s Enrollment Specialist for assistance and/or for choice counseling.
Voluntary Disenrollment. Participants may only voluntarily disenroll from the CHC program if: • They are eligible for and transition to LIFE, • They are moving to a zone in which CHC is not yet operational, or • They are choosing to no longer receive any MA covered services.
Voluntary Disenrollment. You may choose to disenroll from PACE CNY at any time for any reason. If you want to disenroll, please let a PACE CNY staff member know. Your effective date of disenrollment will be coordinated between Medicare and/or Medicaid depending upon your eligibility. You may discuss the timing of your disenrollment with your interdisciplinary team to ensure that your coverage is not interrupted. You cannot be put back on another Medicare and/or Medicaid plan until the first of the month after disenrolling. PACE CNY will be responsible for coordinating your Medicare and /or Medicaid benefits until the end of the month in which you disenroll. During this disenrollment period, PACE CNY will continue to provide your authorized services. You must pay any monthly charge until the disenrollment is complete. If you choose to disenroll, PACE CNY will work with you to make referrals to appropriate medical providers in your community, and we will make medical records available in a timely manner. If applicable, we will work with Medicaid to help you transition to an appropriate Managed Long Term Care Plan. Electing enrollment in any other Medicare or Medicaid prepayment plan or optional benefit, including hospice benefit or Part D plan, after enrolling as a PACE CNY participant is considered voluntary disenrollment from PACE CNY.
Voluntary Disenrollment. You may voluntarily disenroll from CHA PACE without cause, effective on the first of the subsequent month, at any time. You must notify CHA PACE if you wish to disenroll. You will need to sign a disenrollment form indicating that you will no longer be eligible for services through CHA PACE. CHA PACE staff will assist you with enrolling in a new health plan. The effective date of your disenrollment will be the first day of the month following receipt of your request. You cannot disenroll at a Social Security Office.
Voluntary Disenrollment. The CICO shall have a mechanism for receiving timely information about all Disenrollments from the CICO’s plan, including the effective date of Disenrollment, from CMS and SCDHHS or its authorized agent. All Disenrollment-related transactions will be performed by SCDHHS or its authorized agent consistent with the Medicare-Medicaid Plan Enrollment and Disenrollment Guidance. Enrollees may elect to voluntarily disenroll from the CICO or the Demonstration at any time and enroll in another CICO, a Medicare Advantage plan, PACE (if eligible and resides within the appropriate geographic area); or may elect to receive services through Medicare fee-for-service and a prescription drug plan and to receive Medicaid services in accordance with the South Carolina State Plan and any waiver programs (if eligible). Disenrollment requests received by SCDHHS or its authorized agent, or by CMS or its CICO, either orally or in writing, by the last calendar day of the month will be effective on the first calendar day of the following month. The CICO may not request Disenrollment on behalf of an Enrollee. The CICO shall be responsible for ceasing the provision of Covered Services to an Enrollee upon the effective date of Disenrollment. The CICO may not interfere with the Enrollee’s right to disenroll through threat, intimidation, pressure, or otherwise. Discretionary Involuntary Disenrollment: 42 C.F.R. § 422.74 and Sections 40.3 and 40.4 of the Medicare-Medicaid Plan Enrollment and Disenrollment Guidance provide instructions to the CICO on discretionary involuntary disenrollment. This Contract and other guidance provide procedural and substantive requirements the CICO, SCDHHS, and CMS must follow prior to involuntarily disenrolling an Enrollee. If all of the procedural requirements are met, SCDHHS and CMS will decide whether to approve or deny each request for involuntary disenrollment based on an assessment of whether the particular facts associated with each request satisfy the substantive evidentiary requirements. Basis for Discretionary Involuntary Disenrollment: Disruptive conduct: When the Enrollee engages in conduct or behavior that seriously impairs the CICO’s ability to furnish Covered Items and Services to either this Enrollee or other Enrollees and provided the CICO made and documented reasonable efforts to resolve the problems presented by the Enrollee. Procedural requirements: The CICO’s request must be in writing and include all of the supporting documentation ou...
Voluntary Disenrollment. A participant can choose to voluntarily disenroll from PACE services at any time. PACE organization staff notify the APD/AAA case manager of the participant’s decision to disenroll. The PACE organization staff must provide the APD/AAA case manager with documentation stating the reason for the disenrollment as well as any health-related information necessary to ensure continued eligibility and transition service planning.
