Common use of Possible PO-Requested Disenrollment Clause in Contracts

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.