Section 56440 - Disenrollment of Members(a) A request for disenrollment by a PCCM plan member shall be submitted to the Department by the PCCM plan within five working days after either the date the member submits a signed disenrollment request directly to the PCCM plan or the postmark date for disenrollment requests sent by U.S. mail.(b) Disenrollment of members for the following reasons shall be processed by the Department: (1) The member's eligibility as a Medi-Cal beneficiary for enrollment in the PCCM plan is terminated.(2) The enrollment is in violation of sections 56400, 56402, 56404, or 56406.(3) Change of a member's place of residence outside the PCCM plan's service area.(4) The member requests disenrollment.(c) Requests for disenrollment in which the member states a reason for disenrollment shall be referred to the PCCM plan's grievance process in addition to submission to the Department as required in (a) above.(d) Requests for disenrollment initiated by the PCCM plan shall be processed through the PCCM plan's grievance procedure and shall be based on the breakdown of the PCCM plan/member relationship. (1) If the grievance procedure does not resolve the problem, the PCCM plan shall submit a written request to the Department for disenrollment of that member.(2) The Department shall approve a PCCM plan-initiated disenrollment request only if efforts by the PCCM plan to counsel or modify the members behavior, including referral for mental health services, when appropriate, have been unsuccessful or are impossible or impractical given the circumstances, and if one or more of the following circumstances is documented:(A) the member is repeatedly verbally abusive to PCCM plan providers, ancillary or administrative staff or other PCCM plan members.(B) The member physically assaults a PCCM plan provider or staff person or PCCM plan member.(C) The member is otherwise repeatedly disruptive to PCCM plan operations.(D) The member repeatedly uses providers not affiliated with the PCCM plan for nonemergency services, causing the PCCM plan to be subjected to repeated provider demands for payment for services or other demonstrable degradation in the PCCM plan's relations with community providers.(e) The Department shall, on an annual basis, develop a disenrollment processing schedule that assures that disenrollment occurs in compliance with applicable federal and state law and regulation. The Department shall revise the schedule, as necessary, to assure compliance, and shall provide reasonable notice to PCCM plans of the annual schedule and revisions to the schedule.Cal. Code Regs. Tit. 22, § 56440
1. New section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 7-9-90.
2. New section refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed by operation of law on 11-6-90.
3. Request to readopt section on an emergency basis pursuant to Government Code section 11346.1 granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 11-6-90 order transmitted to OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5. New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No. 18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 3-25-91 order including amendment of section transmitted to OAL 7-19-91 and filed 8-19-91 (Register 92, No. 1). Note: Authority cited: Sections 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14088.16 and 14088.5, Welfare and Institutions Code.
1. New section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 7-9-90.
2. New section refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed by operation of law on 11-6-90.
3. Request to readopt section on an emergency basis pursuant to Government Code section 11346.1 granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 11-6-90 order transmitted to OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5. New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No. 18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 3-25-91 order including amendment of section transmitted to OAL 7-19-91 and filed 8-19-91 (Register 92, No. 1).