B Changes That Do Not Require Program Contractor Agreement

Policy

The ALTCS local office may initiate some enrollment and fiscal county changes when information is received from the:

·         Customer;

·         Customer’s representative; or

·         Current program contractor.

The ALTCS local office may change the customer’s enrollment when:

·         A customer who is enrolled with DES/DDD loses developmentally disabled status;

·         A tribal contractor requests an enrollment change; or

·         The fiscal county changes.

1)    Loss of DD Status

Enrollment must be changed when a customer who is enrolled with DES/DDD loses developmentally disabled (DD) status:

·  If the customer is a Native American, the enrollment is changed based on the policy in MA1104.D.

·         All other eligible customers are enrolled with an EPD program contractor based on the customer’s county of fiscal responsibility.

2)    Tribal Contractor Requests Enrollment Change

When a Native American customer living within the bounds of the tribal nation, either in a medical institution or HCBS facility, moves to an HCBS facility outside the bounds of the tribal nation, the tribal contractor must determine if the customer should be enrolled with the program contractor in the new location.

To request an enrollment change, the tribal contractor must call or write the Division of Health Care Management (DHCM).  If the DHCM agrees with the recommendation, the tribal contractor sends an Electronic Member Change Report to the ALTCS local office instructing the Benefits and Eligibility Specialist to change the program contractor to the county where the customer now resides.  Agreement by the new program contractor is not required.

3)    Fiscal County Changes

If the fiscal county changes to a county that is not served by the current program contractor, enrollment is changed to a program contractor serving the county in which the customer’s home is located.