California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 4.1 - Two-Plan Model Managed Care Program › Article 7 - MARKETING, ENROLLMENT, ASSIGNMENT, AND DISENROLLMENT › Section 53889 - Enrollment/Disenrollment Processing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 An eligible beneficiary shall submit an enrollment or disenrollment request on
					 an original, signed enrollment/disenrollment form to the Health Care Options
					 Program by mail or in person at department-approved Health Care Options Program
					 sites. Expedited disenrollment requests may also be submitted by facsimile. An
					 eligible beneficiary also may request expedited disenrollment over the
					 telephone from the Health Care Options Program.
(b) An eligible beneficiary shall provide the
					 following information on the enrollment/disenrollment form when requesting
					 enrollment or disenrollment: first and last name of the beneficiary; sex; date
					 of birth; Social Security Number; Medi-Cal number; complete mailing address;
					 telephone number, if available; plan choice, if requesting enrollment; name and
					 address of doctor or clinic beneficiary is choosing as primary care provider;
					 language of the beneficiary; and the reason for disenrolling, if requesting
					 disenrollment. If the beneficiary is requesting enrollment or disenrollment for
					 any other eligible family member, the same information shall be provided for
					 the other eligible beneficiaries on the same form where indicated. The
					 beneficiary or authorized representative, as specified in (h), shall sign and
					 date the enrollment/disenrollment form.
(c) The Health Care Options Program shall
					 assist with, accept and process enrollment and disenrollment requests
					 regardless of the beneficiary's race, creed, color, religion, age, sex,
					 national origin, ancestry, marital status, sexual orientation, physical or
					 mental disability, or pre-existing medical conditions.
(d) The Health Care Options Program shall
					 ensure that beneficiaries are informed of their right to request a fair hearing
					 in accordance with sections
					 50951,
					 51014.1,
					 51014.2, and
					 53894.
(e) The Health Care Options Program shall
					 accept and process all completed enrollment and disenrollment requests,
					 including expedited disenrollment requests, from eligible beneficiaries within
					 two working days of receipt if such requests meet the conditions for plan
					 disenrollment specified in section
					 53891.
(f) Approval of enrollment and disenrollment
					 requests is conditioned upon receipt of a fully completed
					 enrollment/disenrollment form and all required supporting
					 documentation.
(g) The Health Care
					 Option Program shall notify beneficiaries in writing of the approval or
					 disapproval of enrollment and disenrollment requests, including expedited
					 disenrollment requests, within seven working days of receipt of the request.
					 This notice shall include the effective date of the enrollment and/or
					 disenrollment, as specified in (h) below.
(h) Enrollment and disenrollment requests may
					 be submitted by the beneficiary or other authorized individuals listed in (1)
					 through (7) below:
(1) Persons with legal
					 authority to act on the beneficiary's behalf. Such persons include, but are not
					 limited to, parents, legal guardians, publicly appointed guardians, and other
					 legally designated representatives.
(2) Department staff responsible for the
					 administration of the Two-Plan Model Program and Health Care Options Program
					 staff.
(3) County staff, including
					 but not limited to, social workers, probation officers, caseworkers, and other
					 local government personnel responsible for supervision or case management of
					 the beneficiary.
(4) Foster parents
					 or parents adopting a child in the Adoption Assistance Program.
(5) Medi-Cal managed care Two-Plan Model
					 Program contractors.
(6) Case
					 managers, physicians or medical staff of the Medi-Cal home and community-based
					 services waiver programs.
(7) Care
					 coordinators at Regional Centers for the Developmentally
					 Disabled.