Subsection 144-101-X-1.09 - DISENROLLMENT1.09-1 An enrollee can be disenrolled from the benefit for any of the following reasons: A. Failure to meet the eligibility requirements of the MaineCare Eligibility Manual;B. Refusal to sign the Informed Consent form;C. Refusal to discuss care management with the benefit's nurse coordinator; "Refusal" occurs when for at least a six-month (6) period and after at least two (2) contact attempts by the nurse coordinator, the enrollee does not respond, or the enrollee explicitly refuses to communicate with the nurse coordinator;
D. Noncompliance with the treatment recommendations/plan; "Noncompliance" occurs when for at least a six-month (6) period, an enrollee has refused to follow treatment recommendations or to comply with a recommended care plan developed by the provider primarily responsible for managing the enrollee's HIV/AIDS disease. Non-compliance assumes that the enrollee had adequate time to complete the treatment recommendations, or had the care plan explained to him or her, and had the opportunity to seek an alternative opinion. Non-compliance must be substantive and relates only to complying with a medication regimen, office visits, or laboratory monitoring.
E. A dated, signed written disenrollment request from the enrollee is received by the Department. All disenrollments for non-compliance will be reviewed and approved by the Department's Medical Director, the MaineCare Director, or a MaineCare designee.
1.09-2Notice of Disenrollment/Termination of Benefit, Appeal Rights and ReenrollmentA. If the enrollee meets the requirements for disenrollment/termination of the benefit, the Department must inform the enrollee in writing that the enrollee is in danger of having his or her benefits terminated. The letter must explain the reason for potential termination, provide sixty (60) days from the date of the letter for the enrollee to regain good standing, provide information regarding the three-month reenrollment wait period, provide the date the benefit will terminate should the enrollee fail to regain good standing, and inform the enrollee of their right to appeal the termination, as outlined in Chapter 1, Section 1 of the MaineCare Benefits Manual.B. If an enrollee's benefit is terminated for any reason besides failure to meet the benefit eligibility requirements, he or she cannot re-enroll in the benefit until three (3) full months have passed from the date the benefit ceased. The enrollee must complete a new application. If a waiting list exists, the enrollee will be placed on the waiting list according to the date the new application was received by the Office of Family Independence, but no earlier than three (3) full months after the benefit was terminated. C.M.R. 10, 144, ch. 101, ch. X, § 144-101-X-1, subsec. 144-101-X-1.09