DISENROLLMENT

Senior CommUnity Care health plan is voluntary, and you have the option of disenrolling from Senior CommUnity Care should you choose. Your benefits under Senior CommUnity Care will be discontinued if you choose to disenroll from the health plan (voluntarily) or if you no longer meet the conditions of enrollment (involuntarily). The effective date of termination of benefits is midnight on the last day of the month.

Until the termination becomes effective, Senior CommUnity Care will continue to be responsible for your care; and you will need to continue paying your usual monthly fee, if you have one. The process of returning to Medicaid system usually takes 15 to 45 days.

The PACE organization must work with CMS and the State administering agency to reinstate the participant in other Medicare and Medicaid programs for which the participant is eligible.

READ MORE ABOUT THE DISENROLLMENT PROCESS

A. Voluntary Disenrollment: If you wish to disenroll, you need to contact the Senior CommUnity Care Social Worker. You will need to sign a disenrollment form prior to the date of your disenrollment. This form will indicate that you will no longer be entitled to service from Senior CommUnity Care after midnight on the last day of the month following the 15 to 45 day notice period. Your voluntary disenrollment is effective on the first day of the month following the date the PACE organization receives your notice of voluntary disenrollment. Additionally, electing enrollment in any other Medicare or Medicaid prepayment plan or optional benefit, including the hospice benefit, after enrolling as a PACE participant is considered a voluntary disenrollment from PACE.

 

B. Involuntary Disenrollment: Senior CommUnity Care wants to keep you as a member and will work with you to resolve problems. If we are no longer able to provide appropriate care, Senior CommUnity Care can terminate your membership by providing you with a notice in writing. Your involuntary disenrollment occurs after the PACE organization meets the requirements set forth in this section and is effective on the first day of the next month that begins 30 days after the day the PACE organization sends notice of the disenrollment to you. All involuntary disenrollments must be approved by the Colorado Department of Health Care Policy & Financing, and reviewed by the State Administering agency to determine in a timely manner that the PACE Organization has adequately documented acceptable grounds for disenrollment.

 

C. Reasons you may be required to disenroll:

  • If you move out of the Senior CommUnity Care service area or if you are out of the Senior CommUnity Care service area for more than 30 days without prior approval from the Interdisciplinary Team.

  • The participant or the participant’s caregiver engages in disruptive or threatening behavior; a participant whose behavior jeopardizes his or her health or safety, or the safety of others; or a participant with decision-making capacity who consistently refuses to comply with his or her individual plan of care so that the Interdisciplinary Team is unable to safely provide services to you or other participants.

  • If you fail to pay or fail to make satisfactory arrangements to pay any amount due Senior CommUnity Care after the 30-day grace period. Please note: If you are going to be disenrolled due to failure to pay the monthly fee, you can remain enrolled simply by paying the monthly fee. You must make this payment before the end of the month of your disenrollment.

  • If Senior CommUnity Care loses its contracts or licenses enabling it to offer health care services.

  • If you are determined to no longer meet the State Medicaid skilled nursing facility level of care requirements and are no longer deemed eligible by the Single Entry Point.

 

For disenrollments due to any of the stated reasons, the participant may submit evidence as to why they should not be disenrolled through the feedback process (Section XIV).

 

Once again, please note that involuntary disenrollment requires approval from the Colorado Department of Health Care Policy & Financing. The effective date of termination of benefits is midnight of the last day of your covered month. You are required to use Senior CommUnity Care’s services until termination becomes effective.

 

IMPORTANT NOTE: Participants may not enroll or disenroll from Senior CommUnity Care through the Social Security Administration office.

Last Updated on June 8, 2021 by admin