New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 308 - MANAGED CARE PROGRAM
Part 7 - ENROLLMENT AND DISENROLLMENT
Section 8.308.7.10 - DISENROLLMENT
Current through Register Vol. 35, No. 18, September 24, 2024
A. Member disenrollment initiated by a MCO The MCO shall not, under any circumstances, disenroll a member. The MCO shall not request disenrollment because of a change in the member's health status, because of his or her utilization of medical or behavioral health services, his or her diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs.
B. Other HSD member disenrollment: A member may be disenrolled from a MCO or may lose his or her MAD eligibility if:
C. Effective date of disenrollment: All HSD-approved disenrollment requests are effective on the first calendar day of the month following the month of the request for disenrollment, unless otherwise indicated by HSD. In all instances, the effective date shall be indicated on the termination record sent by HSD to the MCO.