048-27 Wyo. Code R. §§ 27-6 - Participant Disenrollment Procedures

(a) Involuntary disenrollment. All involuntary disenrollments must meet the criteria set forth in 42 C.F.R. § 460.164 and be approved by the Department or its designee prior to thirty (30) day notification to the participant of involuntary disenrollment.

(b) A participant shall be determined to be no longer eligible for PACE program services and therefore involuntarily disenrolled when:

(i) The participant moves out of the PACE provider service area or is out of the service area for more than thirty (30) consecutive days, unless the PACE provider agrees to a longer absence due to extenuating circumstances;

(ii) The participant has a demonstrated history of ongoing, willful non-compliance with an essential treatment plan or engages in disruptive or threatening behavior that jeopardizes his or her health or safety or the safety of others;

(iii) The PACE provider's agreement with CMS and the Department is not renewed or is terminated; or

(iv) The PACE provider is unable to offer health care services due to the loss of contracts with outside providers.

(c) Voluntary disenrollment. A PACE participant may request voluntary disenrollment from the program at any time. The PACE provider shall assist any participant who wishes to return to fee-for-service by making appropriate referrals and helping the participant to complete release of information requests in advance of disenrollment so that medical records can be made available to new providers.

(d) Continuation of PACE services. The PACE program provider shall continue to provide all needed services until the date of disenrollment.

Notes

048-27 Wyo. Code R. §§ 27-6

Adopted, Eff. 7/12/2016.