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"6.9.5 Membership Services
Contractor shall develop and distribute a Membership Services Guide that includes the following information: ...
M. Procedures for Disenrollment, including an explanation of the Member's right to disenroll without cause at any time, subject to any restricted disenrollment period." California Contract, pages 135-136.
"XVIII. MEMBER RIGHTS AND
D. Member Information...
3. The Contractor shall include in its Member handbook and marketing information a provision clearly stating that Enrollment in the Contractor's Plan is voluntary unless assignment is made by the Department, and shall also include information about how to request Disenrollment." Colorado Contract, pages 58-60.
MEMBER HANDBOOK REQUIREMENTS
To inform Members of their rights and responsibilities, the Plan shall publish and distribute to all Members a Member Handbook that shall include but is not limited to the following information: ...
11.Enrollment procedures of the Contractor, including how to change primary care providers, and disenrollment information as required in Section II of the contract to ensure that disenrollees who wish to file a Grievance are afforded appropriate notice and opportunity to do so and Members are informed about how to access the Department concerning disenrollment." Colorado Contract, Exhibit E, page 1.
"4. Evidence of coverage
a. Within ten (10) business days of the date on which the District notifies Provider that an individual has been enrolled with Provider, Provider shall issue to each enrollee the following:
(2) a Member Handbook written at the 5th grade reading level and containing at a minimum the following information:
(k) an explanation of the enrollee's right to disenroll from Provider and the procedures for disenrolling." District of Columbia Contract, pages 16-18.
"18. Member Notification...
a. Prior to, or upon enrollment, the plan shall provide the following information to all new members of the plan:...
a member services handbook...
(2) Notification that recipients can change their managed care selection.
(a) The member services handbook shall include the following information: ...
Member rights and procedures for disenrollment, including the agency's toll-free telephone number for choice counseling and disenrollment." Florida Contract, pages 36-37.
"24. Disenrollment. The agency
shall be responsible for processing disenrollments.
a. Prior to the agency's choice counseling contractor implementing disenrollment services, the following provisions shall apply to voluntary disenrollments...
(2) The plan's responsibility for all disenrollments is to:
(a) Promptly advise members on how they may disenroll, either through the plan's disenrollment process or through the agency's choice hotline.
(b) At the time of enrollment for new members, notify each member of the right to disenroll at any time and how to initiate the disenrollment process...
(e) Ensure disenrollment forms are sent to members within three working days of the request..." Florida Contract, pages 42-43.
"2.14 Enrollment ...
5. Upon enrollment, the contractor shall provide the following information to the new enrollee: ...
f. Member Handbook, which shall include the following: ...
(7) Description of disenrollment rights and procedures." Florida Mental Health RFP, page 37.
"40.540 Option to Disenroll
Upon Medicare Eligibility Determination
Individuals can be eligible for and participate simultaneously in Medicaid and Medicare...
Members of the BHMC plan who become Medicare eligible after July 1, 1997 will have the option of remaining in the plan or reverting to the Medicaid fee-for-service program.Shortly before a member reaches sixty five years of age, DHS shall notify the member, in writing, of their option to disenroll, contingent upon Medicare eligibility." Hawaii Behavioral Health RFP, page 43.
Enrollment, Coverage and Termination of Coverage...
(b) Enrollment Process." Illinois HMO Contract, page 11.
"(5) Every Eligible Enrollee shall
be notified at the time of Enrollment of the right to voluntarily terminate
the Enrollment at
any time and that such disenrollment shall be effective in accordance with
42 C.F.R. 434.27...
(11) The Contractor must provide new Beneficiaries with the following materials no later than ten (10) business days following receipt of the Prelisting:
(A) The Beneficiary handbook in conformance with Article V(w) and a membership packet of information detailing all aspects of the Contractor's Plan, which must include, at a minimum...disenrollment procedures." Illinois HMO Contract, page 14.
"18.104.22.168 Enrollee Education
The MCO will be responsible for developing and maintaining enrollee education programs designed to provide the enrollees with clear, concise, and accurate information about the MCO's health plan. Enrollee education materials should include, but are not limited to the following:
* An enrollee handbook which describes in full detail the terms and nature of services offered by the MCO, including . disenrollment... For a complete description of the information that must be included in the enrollee handbook, refer to Chapter 4 of the MCO Procedure Manual and the readiness review criteria located in the Procurement Library." Indiana RFP, pages 4-26 - 4-27.
"4.12 Enrollee Information...
The HMO shall mail an Enrollee handbook to the Enrollee within ten calendar days of enrollment notification to the HMO, which, at a minimum, shall include: ...
- voluntary disenrollment policies ." Iowa Contract, page 30.
"STANDARD ENROLLEE HANDBOOK
In addition to the above language required by this addendum, the HMO shall also include, in the Enrollee handbook, language about the enrollee's right to request HMO disenrollment and how to initiate disenrollment proceedings. Also, where a section 1915(b) Freedom of Choice waiver has been obtained, the Enrollee must be informed of any restrictions on requests to disenroll from the HMO." Iowa Contract, pages 82, 85.
"O. MEMBER HANDBOOK.
At a minimum, the member handbook should include: .
* Disenrollment policies and procedures." Kansas Contract, page 21-23.
Notification will be sent to each Medicaid beneficiary after 6 months enrollment in a managed care program stating that he or she may change programs or plans within the next thirty (30) days without good cause." Kansas Contract, page 50.
"3.2 MEMBER SERVICES...
B. ORIENTATION OF NEW MEMBERS...
2. Member Packet. The Contractor shall also provide each Enrollee's household, within five (5) calendar days of an Enrollee's effective date of enrollment, with a member packet, which shall include, at a minimum: ...
c. the member handbook. The handbook shall include, at a minimum, information on: ...
xii. a statement notifying the Enrollee of the right to request disenrollment at any time..." Maine Contract, pages 14-15.
"Section 3.2.4. Significant Events.
HEALTH PLAN must notify STATE as soon as possible of significant events
affecting the level of service
either by HEALTH PLAN or its providers or subcontractors. Such events include:
2) Notice to Enrollees. The HEALTH PLAN shall provide prior written notification to Enrollees that will be affected by a Material Modification. Such prior written notice shall be approved by the STATE. The notice must inform each affected Enrollee that: . the Enrollee has the opportunity to disenroll and change health plans up to 120 days from the date of notification." Minnesota Contract, page 29.
"2.8 ENROLLEE HANDBOOK
Mail a Medicaid-specific ENROLLEE handbook to a new ENROLLEE'S household within seven working days of initial enrollment notification to the CONTRACTOR, which at a minimum, shall include:...
(5) enrollment and disenrollment policies." Montana Contract, page 51.
"STANDARD ENROLLMENT HANDBOOK
The following standard language must be included in MEDICAID ENROLLEES' member handbook unless alternate language is approved by the DEPARTMENT in writing...
Most [CONTRACTOR/Plan name] ENROLLEES have the right to request disenrollment. To disenroll from [CONTRACTOR/Plan name] call an ENROLLEE services representative at [phone number], or call the MEDICAID hotline at 1-800-362-8312.Disenrollment may take up to two months to become effective.
The only exception is adults on
BASIC MEDICAID; they must sign up for an HMO if one is available, and can
only disenroll if
they are choosing another HMO in their ENROLLMENT AREA or for good cause.
If you are on BASIC MEDICAID,
you may be able to disenroll for good cause for only one of the following
* you are terminally ill
* you are medically needy (in other words, you have to spend a certain amount on medical bills each month before you are eligible for MEDICAID)
* you are a resident of Montana Developmental Center in Boulder, Orchard View in Polson, or Eastmont Service Center in Glendive
* you will be on MEDICAID less than three months
* you are in a managed care program under a private insurance program
* you are on the MEDICAID restricted care program
* you petition to be exempt and the MEDICAID Managed Care staff determines it would be a hardship for you to sign up for HMO.
* You are under treatment by a physician or mid-level practitioner who is not affiliated with a MEDICAID HMO and both patient and PROVIDER believe that a disruption of the patient/PROVIDER relationship may adversely affect treatment or cause unnecessary hardship to the patient; provided that good cause to disenroll for this reason shall exist only until the end of treatment or until the PROVIDER contracts with an HMO, whichever first occurs, and in no case for more than 4 months.
If you think you should be
able to disenroll for good cause, please put your request in writing and
mail it to:
MEDICAID Managed Care, PO Box 254, Helena, MT 59624." Montana Contract, pages 61-62.
"11.3 Enrollment Activities: The
EBS shall complete the following enrollment activities for mandatory clients
(and also for potential
mandatory clients, if requested), in coordination with the plan and the Department:
(a) Educate clients concerning the full range of Medicaid benefits, including all NHC options and covered services, including...
(12) An explanation of transfers and disenrollment." Nebraska Contract, pages 61-62.
A. Enrollment Sessions. DHCFP will conduct enrollment orientation sessions prior to enrollment of participants in
the Contract. Recipients will scheduled to attend an orientation session where they are requested to select a Contractor. The content of the enrollment sessions includes information as follows: ...
8. Inform recipients they may disenroll with cause at any time and without cause within the first 90 days of enrollment in the HMO, at least every 12 months;
9. Instructions for disenrolling from one HMO and choosing another, including the explanation that if another HMO is not chosen, the State will select one for the recipient...
DHCFP will draft, print and distribute the enrollment information, excluding Contractor marketing materials." Nevada Contract, pages 46-47.
"D. COMMUNICATION OF POLICIES
Upon enrollment, participants are provided a written statement that includes information on the following: ...
8. Procedures for disenrollment..." Nevada Contract, pages 66.
Functions and Duties of the State
In consideration of the Agreements of Contractor contained in Article II, the State agrees: ...
3.2 ENROLLMENT...The State shall inform each person of his/her right to voluntarily terminate enrollment in accordance with Section 6.4." New Hampshire General Service Agreement, page 5.
11.2 The contractor will prepare. marketing materials for distribution to enrollees or, where applicable, an authorized person, and will include basic information about its plan. All marketing materials and presentations must, at a minimum: .
H. Explain an enrollee's rights to disenroll or transfer at any time for cause; disenroll or transfer in the first 90 days after the latter of the date the individual is enrolled or the date they receive notice of enrollment and at least every 12 months thereafter without cause." New Jersey Contract, pages 63-64.
12.1 Prior to the effective date of enrollment, the contractor shall provide each enrolled case or, where applicable, an authorized person, with a. member handbook, the content and format of which shall have.in writing, the correct use of the contractor's plan, and other relevant information, including but not limited to: ...
12.2 The contractor shall inform each enrollee or, where applicable, an authorized person in writing at the time of enrollment of his or her rights to terminate enrollment and any other restrictions on the exercise of those rights to conform to 42 U.S.C. 1396b(m)(2)(F)(ii). The initial enrollment information and the contractor's member handbook shall be adequate to convey this notice and shall have DMAHS approval prior to distribution." New Jersey Contract, pages 68-70.
"2.A.6.e Member Handbook
The CONTRACTOR is responsible for providing members with a member handbook...
The handbook must include: ...
2.A.6. e.xi Information on the member's right to terminate enrollment and the process for voluntarily disenrolling
from the plan/and." New Mexico Contract, pages 20-21.
New York State Department of Health
Member Handbook Guidelines...
k)... Disenrollment Procedures
i) Where appropriate, explanation of Lock-In requirements, and initial grace period when person may change plans...
iii) Procedures for disenrollment." New York Contract, Appendix E, pages E-1-E-5.
"2.15 Enrollee handbook and
Upon request, the Contractor shall provide a Medicaid specific enrollee handbook, to potential enrollees and to the recipient household within one week of initial enrollment notification to the Contractor, which at a minimum, shall include: ...
(6) Voluntary and special disenrollment policies..." North Dakota Contract, Attachment C, pages 16-17.
"3.5 Enrollment, Disenrollment...
The Department shall present the Contractor's plan in an unbiased manner to eligible recipients in the Contractor's enrollment area. Such presentation shall ensure that recipients are informed prior to initial enrollment about the right to terminate enrollment voluntarily at any time, unless otherwise provided by federal law or waiver." North Dakota Contract, Attachment C, pages 28-29.
"5.2 Voluntary Disenrollment
All enrollees shall have the right to request termination or disenrollment from the Contractor pursuant to 42 CFR 434.27 (b) (1)." North Dakota Contract, Attachment C, page 34.
"ATTACHMENT E: STANDARD ENROLLEE
The following standard language must be included in Medicaid enrollees' member handbooks unless alternate language is approved by the Department. This language is not intended to be comprehensive: .
You have the right to request disenrollment. Disenrollment may take up to two months. Call [Contractor's name] at [phone number] for more information." North Dakota Contract, Attachment E, pages 1, 6-7.
"OHIO MANAGED CARE PROGRAM
OPEN ENROLLMENT PROCESS...
Open Enrollment Notification
MCP eligibles are notified in writing by ODHS of their ability to change MCPs, the options available, and the related procedure, at least thirty days prior to the beginning of an open enrollment month in their county of residence." Ohio RFP, Appendix C.
"5101:3-26-021 Managed care
(B) The following applies to all automatic disenrollments in both voluntary and mandatory counties: ...
(7) MCPs must:
(a) Provide information on disenrollment options, including reasons for just cause disenrollments as described in paragraph (C)(9)(a) of this rule, to eligibles and to enrollees as required in rules 5101:3-26-08 and 5101:3-26-082 of the Administrative Code." Ohio RFP, Appendix E, OAC 5101:3-26-021, pages 1-4.
"5101:3-26-08 MANAGED CARE
(2) All MCPs must make available in their marketing presentation and in EIES, where applicable, a solicitation brochure which contains, at a minimum: ...
(g) In voluntary counties, information that enrollment in a particular MCP is voluntary and that individuals may disenroll and enroll in another MCP or return to fee-for-service, and the procedure for doing this. In mandatory counties, information that the enrollee may voluntarily disenroll from his or her present MCP and enroll in another MCP and the procedure for doing this.
(h) INFORMATION on the right to disenroll within the first month of initial enrollment, the limitation on disenrollment to the two months of open enrollment as designated by the county, and the availability of, reasons for, and procedures to request just cause disenrollment in accordance with paragraph (C) of rule 5101:3-26-021 of the Administrative Code." Ohio RFP, Appendix E, OAC 5101:3-26-08, pages 1-5.
The following bullets outline the required elements of each Health Plan member handbook...
Member handbooks must contain the
following information (sections referenced can be found in the Health Plans
* Disenrollment procedures and timeframes." Oklahoma RFP, pages 164-165.
"C. HealthChoices Program...
4. Phase In of HealthPASS Members...
A client notice will accompany the pre-enrollment package distributed by the Benefit Consultant which explains how a recipient not mandatory until July 1, 1997, may disenroll should they choose not to remain voluntarily with their current plan or choose to enroll in a different HMO operating in the HealthChoices project area." Pennsylvania RFP, pages 6-7.
b. Enrollment Procedures
1. The CONTRACTOR shall give a full written explanation of the MCO's plan to enrollees after their enrollment in the plan. This written explanation shall, at a minimum, include:
(m) Notice to the enrollee of their right to disenroll from the TennCare program at any time with instructions to contact TENNCARE for disenrollment forms and additional information on disenrollment." Tennessee Contract, pages 34-39.
"Guidelines for Internal
Quality Monitoring Programs of Managed Care Organizations Contracting with
STANDARD IX: ENROLLEE RIGHTS AND RESPONSIBILITIES -
The organization demonstrates a commitment to treating members in a manner that acknowledges their rights and responsibilities.
D. Communication of Policies to
Enrollees/Members - Upon enrollment, members are provided a written statement
that includes information
on the following: ...
9. procedures for disenrollment." Tennessee Contract, pages QCM- 2-10.
"17. Enrollee Information
The Enrollee Information Packet must include at a minimum the following sections.
c. Choosing or Changing an HMO
i. Procedures to be followed if the enrollee wishes to change HMOs.
ii. A description of the right of the enrollee to convert his or her HMO coverage to an individual contract issued by the Contractor." Virginia Contract, pages 30-31.
"E. MEMBER INFORMATION [RR
4. Additional Requirements for Healthy Options, BHP Plus, and BHP/S Medical Members
The contractor's written information to HO, BHP-Plus, and BHP/S clients must include:
a) .how to request a disenrollment if they choose to do so." Washington Contract, QIP-2000 Standards, pages 26, 28.
"3.12 Open Enrollment...
Enrollees may terminate enrollment freely at any time, effective no later than the first day of the second month after the month in which he or she requests termination. The Managed Care Plan must inform recipients of their right to terminate enrollment through the enrollee handbook...
3.15 Enrollee Handbook and
The Managed Care Plan shall mail an enrollee handbook to the enrollee's household within one week of official enrollment notification to the Managed Care Plan. The enrollee handbook at a minimum, shall include: ...
* voluntary disenrollment polices: ." West Virginia Contract, pages 15-16.
"4.1.2 Marketing Materials...
22.214.171.124 Plan Description
The plan description must include the following: ...
f) A statement that the enrollee may disenroll from the MCP at any time, but must immediately enroll in another MCP and description of the procedure for doing this." West Virginia RFA, page 27.
"D. Communication of policies
to members - Upon enrollment, members are provided a written statement that
on the following: ...
9. Procedures for dissenrollement." West Virginia RFA, Appendix E, pages E10-E11.