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. If you wish to cancel your benefits by disenrolling, you should discuss this with your social worker. You may disenroll from {PACE Organization} without cause at any time. You will need to sign a “Disenrollment Form” 30 days in advance of termination. This form will indicate that you will no longer be entitled to services through {PACE Organization} after midnight on the last day of the month following the 30-day notice. Involuntary Disenrollment We may terminate your enrollment with {PACE Organization} if: You move out of the {PACE Organization} service area {include zip codes or other identifying information here} or are out of the service area for more than 30 days without prior approval (see CHAPTER 6). You engage in disruptive or threatening behavior, i.e. your behavior jeopardizes the health or safety of yourself or others or you consistently refuse to comply with the terms of your Plan of Care or Enrollment Agreement, when you have decision-making capacity. Disenrollment under these circumstances is subject to prior approval by the DHCS and will be sought in the event that you, your friends or family members display disruptive interference with care planning or threatening behavior which interferes with the quality of PACE services provided to you and other PACE Participants. You are determined to no longer meet the Medi-Cal Nursing Home level of care criteria and are not deemed eligible. You fail to pay or fail to make satisfactory arrangements to pay any amount due to {PACE Organization} within the 30-day period specified in any Cancellation Notice (see CHAPTER 9). The agreement between {PACE Organization}, the Centers for Medicare and Medicaid Services and the DHCS is not renewed or is terminated. {PACE Organization} is unable to offer health care services due to the loss of our State licenses or contracts with outside providers. Both voluntary and involuntary disenrollments require a minimum 30- day advance notice. All rights to benefits will stop at midnight on the last day of the month following the end of the 30-day notice period (except in the case of termination due to failure to pay fees owed, see CHAPTER 9). We will coordinate the disenrollment date between Medicare and Medi-Cal, if you are eligible for both programs. You are required to use {PACE Organization} services (except for Emergency Services and Urgent Care provided outside our service area) until termination becomes effective. If you are hospitalized or undergoing a course of tr...
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. You may leave the program at any time for any reason. You may notify TH PACE of Pensacola either verbally or in writing. If you wish to leave the TH PACE of Pensacola program, you should talk about it with your social worker who will help you with returning to other Medicaid/Medicare services. You will be allowed to re-enroll in Medicare and/or Medicaid, and we will work with you to help you return to an appropriate healthcare program. You will not be able to be put back on another Medicaid/ Medicare service until the first of the month after disenrolling. TH PACE of Pensacola will be responsible for coordinating your Medicare/Medicaid benefits until the end of the month in which you disenroll. During this disenrollment period, TH PACE of Pensacola will continue to provide your authorized services. You must pay any monthly charge until the disenrollment is complete. If you choose to disenroll, TH PACE of Pensacola will work with you to make referrals to appropriate medical providers in your community, and we will make medical records available within 30 days. If you enroll in any other Medicaid or Medicare prepayment plan after enrolling in TH PACE of Pensacola (for example, Medicaid’s home- and community-based services program or a Medicare HMO) or optional benefit, including the hospice benefit, or a Medicare Part D prescription plan, you will be automatically disenrolled from TH PACE of Pensacola. Your voluntary disenrollment is effective on the first day of the month following the date TH PACE of Pensacola receives your notice of voluntary disenrollment. INVOLUNTARY DISENROLLMENT TH PACE of Pensacola will do everything possible to avoid involuntary disenrollment. We will provide you with reasonable notice before we take any action to disenroll you from our PACE program. TH PACE of Pensacola can terminate your benefits through written notification to you if:
