Possible PO-Requested Disenrollment Clause Samples

The "Possible PO-Requested Disenrollment" clause allows the purchasing organization (PO) to request the removal or disenrollment of a participant, member, or entity from a program or agreement. In practice, this clause typically outlines the circumstances under which the PO can initiate disenrollment, such as non-compliance with terms, performance issues, or other specified reasons, and may detail the process for notification and effective dates. Its core function is to provide the PO with a formal mechanism to manage participation and address issues proactively, thereby protecting the integrity and objectives of the program or agreement.
Possible PO-Requested Disenrollment. If the PO 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 a PO-requested disenrollment, the Department will expect the PO 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. When the PO becomes aware that a member intends to change her or his residence, the PO shall, in addition to updating its records when the change of address occurs, do the following: For Moves Within a PACE Service Area: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that may result from the move. Complete the PACE Member Requested Disenrollment or Transfer Form (F-02484). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. For Moves to Another Service Area Served by the PO: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that will result from the move. Complete the PACE Member Requested Disenrollment or Transfer Form (F-02484). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. Inform the member that options counseling is available from the ADRC or Tribal ADRS (if applicable) in the county to which the member is moving should the member wish to consider a change in long term care program. For Moves to a County without PACE Benefit: Unless the move is due to a PO-initiated placement in a nursing home or community residential facility, inform the member that she or he will be disenrolled and lose eligibility for PACE. Explain to the member that the PACE benefit is not available in the county to which the member intends to move. Explain that it is likely, but not certain, that the receiving county can provide services to the member through another program, but if it cannot Department Review‌‌ she or he may be placed on waiting list for home and community- based services; and that if the member is in the special home and...
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Possible PO-Requested Disenrollment. If the PO 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 a PO-requested disenrollment, the Department will expect the PO 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 the member’s outcomes can be met and health and safety assured with reasonable cost and effort, which could include a SDS plan. 1. PACE Organization Responsibilities a. For Moves Within a PACE Service Area: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that may result from the move. Complete the PACE Member Requested Disenrollment or Transfer Form (F-02484). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. b. For Moves to Another Service Area Served by the PO: Inform the member of any changes in IDT staff, service providers or other aspects of the member's care plan that will result from the move. Complete the PACE Member Requested Disenrollment or Transfer Form (F-02484). Do not disenroll the member; only a transfer of Medicaid eligibility between income maintenance consortia is necessary if applicable. Inform the member that options counseling is available from the ADRC or Tribal ADRS (if applicable) in the county to which the member is moving should the member wish to consider a change in long-term care program.
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Possible PO-Requested Disenrollment. If the PO 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 a PO-requested disenrollment, the Department will expect the PO 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.
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Related to Possible PO-Requested Disenrollment

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