Page 22
6. Placement in Eleanor Slater Hospital, Tavares, or out-of-State residential hospital; 7. Incarceration; 8. Changed State of residence; 9. Enrollment in PACE; and 10. Opt-out to fee-for-service. B. Beneficiaries who are involuntarily disenrolled because of incarceration are provided Medicaid coverage on a fee-for-service basis. Beneficiaries who are involuntarily disenrolled for any other reason and remain eligible for Medicaid coverage are enrolled in FFS. C. Medicare-Medicaid Plan Disenrollment Request – The Medicare-Medicaid plan may make a written request to EOHHS and CMS asking that a particular member be disenrolled. Any such request is only considered by EOHHS and CMS when made on the grounds that the member’s continued enrollment seriously impairs the entity’s capacity to furnish services to either the particular member or other members, the member knowingly provided fraudulent information on the MMP enrollment form that materially affected his/her eligibility to enroll in the MMP, or the member intentionally permitted others to use his/her member identification card to obtain services under the MMP. EOHHS and CMS do not permit disenrollment requests based on: 1. An adverse change in the member's health status; 2. The member's utilization of medical services; 3. Uncooperative or disruptive behavior resulting from the member's special needs; 4. The member exercising treatment decisions with which the MCO or the MCO’s provider(s) disagree; or 5. Diminished or diminishing mental capacity of the member. D. Beneficiaries who are involuntarily disenrolled based on a written request by the MMP receive their Medicaid benefits on a fee-for-service basis. E. Disenrollment Review – All disenrollments are subject to approval by EOHHS and CMS. Beneficiaries have the right to appeal EOHHS’ and CMS’ disenrollment decision (see Part 10-05-2 of this Title). EOHHS and CMS determine jointly the disenrollment date as appropriate. 1.7.7 Grievances, Appeals and Hearings