Common use of Positive Clause in Contracts

Positive. This includes a member with a diminished mental capacity, who is uncooperative and displays disruptive behavior due to the member’s special needs. The County will notify the Department’s Medicaid Fiscal Agent in writing of all disenrollments and the reason for disenrollment. The Department must ensure that members with medical status codes that are not eligible for County enrollment are appropriately disenrolled according to Department policy. If a member is disenrolled from WM because of a loss of BadgerCare Plus eligibility for a period of two months or less, WM will allow voluntary re-enrollment into the program. This section does not prevent the County from assisting in the disenrollment process for individuals who the Department determines should be assigned a different medical status code. Members may disenroll for other reasons, such as poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in serving the member’s health care needs. When a member’s change in circumstance has been identified and verified by the County, the County must provide prompt written notification and proof of the change to DHS or the appropriate entity as designated by DHS. Changes in circumstance include: