The EEU will assume primary responsibilities for administering the disenrollment process. Responsibilities will include: final approval of a change in service status; final authorization of disenrollment from the DSAMH LTC system; and the processing of disenrollment information to the Division of Social Services/Medicaid Office for Medicaid beneficiaries.
A program participant may be disenrolled from the DSAMH LTC system under the following circumstances:
In order to effect a disenrollment, the EEU will request that the primary service provider submit a DSAMH LTC Client Discharge Summary. The DSAMH LTC Discharge Summary will include: a summary of the enrollee's treatment plans; medications; and other pertinent information required to promote the most successful transfer for the client. The Discharge Summary will provide recommendations on treatment and support required to continue the consumer's recover, including the methods to be used for ongoing self-care and relapse prevention. As part of this process, the EEU will confirm the consumer's Medicaid eligibility before referring a consumer back to the DSHP MCO or a treatment provider for the basic benefit and will change the SPI flag in the MMIS for Medicaid beneficiaries.
When management of the consumer's behavioral health care is to be returned to a Medicaid DSHP MCO, the EEU will ensure that the Primary Service Provider coordinates with the consumer's/client's MCO to effect a clinically appropriate transition of care.