Enrollee ability to change providers
AL | CA | FL | GA | IN | IA | KS | MS | MT | NE | NY | NC | OK | PA | WV"Section Twelve: Recipient Enrollment/Assignment
A. Enrollment
To facilitate enrollment into the Patient 1st system, recipients are assigned to a PMP. Federal law requires that recipients be given the ability to change PMP providers on a monthly basis (refer to Section Thirteen for further information). Dependent upon when a person becomes Medicaid eligible, they may not yet be enrolled in Patient 1st." Alabama PMP, page 19."Section Thirteen: Recipients Request Changes in Primary Care Providers Recipients always have the ability to change their PMP to their provider of choice. Recipients can change PMPs by calling the 1-800 line or mailing a written request to the Agency. The Agency monitors the reasons for change as part of the program compliance protocol.
Enrollments and disenrollments to effect a change in PMP are effective the first of a month following the date of the change if the request for change is received by the Agency by the 20th of the month. If requests for changes are received after the 20th, the change is effective the 1st of the following full calendar month. Please see Attachment Eight for a copy of the PMP change form that can be utilized by the recipient." Alabama PMP, page 20.
"L. Rescission Period
Allow for a three day rescission period for Medi-Cal beneficiaries who sign an enrollment form." California Contract, page 21."Article VII - Eligibility and Enrollment...
D. Disenrollment
Disenrollment may take place under the following conditions, subject to approval by the Department. 1. Disenrollment of a member is mandatory when:
a. Disenrollment is requested by the member. This type of disenrollment shall also be referred to 56440 (c) and the Contractor's grievance procedures, except when the member declines to state a reason." California Contract, pages 48-49."16. Patient Choice of MediPass Provider...
c. Patients will be permitted to change MediPass primary care providers or group providers upon request using established procedures." Florida Agreement, page 10."907. Request for Change of Assignment
Any selection or assignment of a member to a PCP may be changed at the request of the member or the PCP. Requests for a change by the PCP can be made by calling Provider Services at 404-xxx-xxxx or 1-800-xxx-xxxx, or by the member by calling Member Services at 404-xxx-xxxx or 1-800-xxx-xxxx. If the member is in the PCP's office and specifically requests a change, the PCP may call the GBHC Provider Services line.However, the member must request the actual change. Requests for change of PCP assignment will take from ten (10) to forty-five (45) days, depending on when the request for change is made. Until the change is actually made in the system, the member must continue to receive services from the assigned PCP. Under extreme circumstances, the PCP may authorize the provision of services by the newly selected PCP, e.g., the PCP nor member want to continue their doctor-patient relationship." Georgia Agreement, page IX-4.
"4. Recipient Lock-in Period
Hoosier Healthwise recipients may request a PMP change at any time if they can demonstrate just cause or every six months without demonstrating just cause (as defined in the Hoosier Healthwise Provider Manual). If a change is approved by the program, the current PMP must continue to perform PMP functions for assigned recipients for up to 45 days or until the recipients have been linked to another PMP, whichever comes first." Indiana Addendum, page 2."9. Recipients may request a change in patient manager or may request a change to another form of managed health care." Iowa Agreement, page 5.
"A. Each consumer shall be assigned to a case manager for six (6) month intervals and may select a different case manager only:
1. During open enrollment
2. Upon confirmation by SRS of a good cause reason for disenrollment
3. Due to loss of eligibility". Kansas Contract, page 6."4.14 Changes In Primary Care Providers
In certain circumstances the PCP for a client may be changed. Enrollments and disenrollments to effect a change in PCP are effective the first of a month following the date of the change or the first of the next month if the approval occurs after eligibility changes for the first of the month have been processed.4.14.1 Client Request
By notifying the EDS Managed Care Unit, a client may change PCPs if:1. the patient/PCP relationship is not mutually acceptable;
2. the location of the PCP or the home or work place of the client changes and travel time and distance now makes access to the PCP difficult or impossible;
3. the medical care needed by the client can be better managed by another type PCP. (See Attachment E for examples of information needed from PCPs if care is better managed by a physician who is not a PCP.)
The Managed Care Enrollment Clerk Specialist requests the client to choose another PCP and follows the same procedures as described above for enrollment." Mississippi Manual, page 84.
"VII. GENERAL TERMS AND CONDITIONS...
2. Recipient Selection of Providers...
c. Recipients shall be permitted to change PCPs upon request, using established procedures." Montana Agreement, page 7."2.21 Client Rights: Prior to any termination, the Department shall provide a hearing and inform clients of their rights to disenroll without cause, and provide an opportunity for the client to enroll with another Contractor...
3.7.2 Client Notice of Right to Change: Through the EBS functions, and written materials and notice, the client shall be kept informed of his/her right to change PCP and/or Contractor." Nebraska Contract, page 15, 27.
"(ii) An Enrollee subject to Lock-in may initiate disenrollment for any reason during the first thirty (30) days after the Effective Date of Enrollment if the enrollee chose to enroll in the plan or during the first sixty (60) days after the Effective Date of Enrollment if the enrollee was auto-assigned to the plan and after the twelfth month after the Effective Date of Enrollment.
(iii) An Enrollee subject to Lock-in may initiate disenrollment during the remainder of the twelve (12) month period beginning thirty (30) days after the Effective Date of Enrollment if the Enrollee becomes eligible for exclusion or an exemption from Medicaid managed care as set forth in Section 6 of this Agreement or for good cause, as set forth in 18 NYCRR Section 360-10.15.
A. LDSS shall determine whether the Enrollee is excluded or exempted from Medicaid Managed Care pursuant to Section 6 of this Agreement;
B. An Enrollee shall initiate a disenrollment for 'good cause' by filing a complaint with the LDSS as specified in 18NYCRR 360-10.13." New York Contract, page 21."a. Recipients may choose from among participating providers who are available to their service area when those providers' enrollment limits have not been exceeded...
d. Enrollees shall be permitted to change primary care provider according to Carolina ACCESS policy." North Carolina Agreement, page 4."3.2 Changing PCP/CMs
A. The Authority shall change a recipient's enrollment from the Contractor to another PCP/CM:
1) without cause up to 4 times a year, upon the recipient's request." Oklahoma Agreement, page 12."3. Recipient Changes
The Contractor must develop and implement a plan to:
a. Disenroll recipient immediately when they become ineligible based on LCHP waiver requirements.
b. Reassign, at recipient request, effective no later than on the first day of the second month. The recipient may request a PCCNI change at any time for any reason. The contractor must ensure services are delivered during the period of time between the request for a change or disenrollment and the effective date of the change or disenrollment.
c. Notify and reassign recipients due to provider terminating from program." Pennsylvania Program Standards, Rider 2."VI. GENERAL TERMS AND CONDITIONS: ...
A. Assignment of Enrollees: ...
2. Recipient Choice...
c. Recipients shall be permitted to change PAAS providers upon request, using established procedures." West Virginia PAAS, page 6.