440 DISENROLLMENT

440.1 An enrollee shall be disenrolled from an MCO for the following reasons: A. Administrative error on the part of the Department, the Department’s designee, or the MCO, including but not limited to enrollment of a person who does not reside in the MCO’s service area; or, B. A change in the enrollee’s residence to an area not in the MCO’s service area; or, C. When an enrollee’s coverage is terminated as described in section 440.1A. 440.2 If an enrollee is disenrolled from an MCO for any of the reasons stated in section440.1 and there is another participating MCO available in the enrollee’s county of residence, the enrollee shall be allowed to select a new MCO. 440.3 If the enrollee is enrolled in a MCO as defined in section 50.15B and a MCO as defined in section 50.15A becomes available in the child’s county of residence, the enrollee will be disenrolled from the MCO as defined in section 50.15 B and enrolled in the MCO as defined in section 50.15A. 440.4 An enrollee may be disenrolled from both an MCO and/or the Children’s Basic Health Plan for the following reasons: A. Fraud or intentional misconduct, including but not limited to knowing misuse of covered services, knowing misrepresentation of membership status; or, B. An enrollee’s receipt of other health care coverage will terminate a member’s coverage at renewal; or, C. The admission of an enrollee into any federal, state, or county institution for the treatment of mental illness, substance use disorder, or into any correctional facility; or, D. Ineligibility for the program, based on the guidelines set forth in the Children’s Basic Health Plan eligibility rules; or, E. Failure to comply with cost sharing requirements (copayments) set forth in the Children’s Basic Health Plan cost sharing rules; or, F. There is not another participating MCO as defined in section 50.14 available in the enrollee’s county of residence. 440.5 If an eligible person or an eligible person’s family displays an ongoing pattern of behavior that is abusive to provider(s), staff or other patients; or, disruptive to the extent that the provider’s ability to furnish services to the child or other patients is impaired, the eligible person may be disenrolled from his/her managed care organization. If there is another participating MCO available in the eligible person’s county of residence, the Department may allow the eligible person to select a new MCO. If there is not another MCO available in the eligible person’s county, the eligible person may be disenrolled from the Children’s Basic Health Plan.