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BAM 120 3 of 12 MSA/MDHHS COORDINATION BPB 2026-007 4-1-2026

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

The Quality Improvement Section, Medical Services Administration, reviews the request for disenrollment documentation and decides whether to approve the HMO’s request for disenrollment. Do not request a change to the MCO Program Enrollment Type (PET) code when a beneficiary enters LTC. The HMO is responsible for requesting the disenrollment. Exception: A beneficiary might be enrolled in managed care after admission to LTC. In such cases, contact MSA at 517-241-8759 to request removal of the managed care PET code. MSA is responsible for: • Ending the managed care PET code on Bridges. • Adding the LTC PET code and the Provider ID on Bridges. The authorization begin date for the LTC PET code is the day after the MCO PET code end date. • Forwarding a copy of the DCH-1185, Request to Disenroll from Health Plan to Nursing Facility, to the local MDHHS. Note: All DCH-1185s for recipients in Wayne County will be forwarded to the medical district. That office is responsible for obtaining the case record from the appropriate district office. If notified that a beneficiary in managed care has entered LTC before there is notice of the HMO disenrollment, you may begin actions necessary to determine continued eligibility (request verifications). However, not all case actions can be completed until the DCH-1185 is received from MSA. MDHHS is responsible for: • Determining continuing eligibility. Computing the post-eligibility patient-pay amount. • Entering the post-eligibility patient-pay amounts after MSA has entered the LTC PET code in Bridges. Use standard negative action procedures to begin the patient-pay amount; see BEM 547.