ALL of the following

• Adverse change in the member's health status
• Member's diminished mental capacity
• Member's utilization of medical services
• Missed appointments
• Uncooperative or disruptive behavior resulting from the member's special needs (except when enrollment seriously impairs the provider's ability to furnish services)
• Member exercises treatment decisions the provider or Plan disagrees with, including declining treatment or diagnostic testing

ALL of the following

• Follow-up and communication with the member or guardian (e.g., in-person discussions, phone calls) regarding the precipitating event(s)
• Provision of reasonable accommodations as appropriate (including for individuals with mental illness, developmental disabilities, or cognitive conditions)
• Provide resources to meet member needs (behavioral health services, care management, Community Partner involvement, referrals to state agencies, housing supports or Flexible Services)
• Furnish medically necessary services to the member through at least three (3) providers before Plan-level disenrollment is considered, unless circumstances warrant immediate termination
• Work with member to ensure awareness of voluntary PCP change and Plan Selection Period or Fixed Enrollment Exception options

ALL of the following

• Plan must contact the member and assist in assigning a new PCP of the member's choice within the network or assist in finding another Specialty or Ancillary provider
• Plan must send a Planned Action Notice informing the member of the good-cause basis for transfer and the right to appeal
• If member is unreachable after three (3) documented outreach attempts (at least one written) over three (3) consecutive days, assign the member to a Plan‑selected PCP meeting access and availability requirements

ALL of the following

• If serious efforts do not resolve concerns, Plan must send an Advance Notice describing the disruptive behavior and how it has impacted the Plan's ability to furnish services
• If interim efforts fail and Plan still wishes to disenroll, send a Notice of Intent informing member of Plan's intent to request EOHHS disenrollment and concurrently submit the request and documentation to EOHHS
• Plan must include copies of the Advance Notice and Notice of Intent in submissions to EOHHS

ALL of the following

• Member retains coverage while notices and requests are processed and must be informed of grievance/appeal rights and how to provide information
• If behavior stops after notice, Plan must notify member that enrollment will continue; if behavior resumes, the process restarts

ALL of the following

• Report any Primary Care Level member transfers to EOHHS in the form and format specified by EOHHS

ALL of the following

• Thorough, objective explanation of the reason for the request including how the member's behavior has impacted the Plan's ability to arrange for or provide services to that member or to other members
• Statements from provider(s), including all PCPs the member was assigned to, describing their experience with the member
• Any information provided by the member (e.g., complaints, statements)
• Member age, diagnosis, mental and functional status

ALL of the following

• Description of the member's social support systems and any other relevant information
• Outline of the serious efforts to resolve the problem with the member, including provision of reasonable accommodations

ALL of the following

• Documentation of Advance Notice and Notice of Intent
• Evidence establishing that the member's behavior is not related to the use, or lack of use, of medical, behavioral health or other services
• Description of any extenuating circumstances

ALL of the following

• EOHHS will confirm receipt and review all submitted documentation and may follow up as needed
• EOHHS will determine whether the provider and Plan have demonstrated that serious efforts to work with the member were taken
• EOHHS Customer Service may attempt to contact the member up to three (3) times to allow voluntary plan change before further consideration of involuntary disenrollment
• Decision timing: as soon as practicable for urgent requests (credible threat to physical safety); within twenty (20) business days for non‑urgent requests

ALL of the following

• Send Planned Action Notice with reason and appeal rights
• MassHealth will call and assist the member to select a new plan; if unreachable after three (3) attempts over three (3) consecutive days, EOHHS will auto‑assign the member to a Plan and give a new Plan Selection Period
• Member receives a thirty (30) day Continuity of Care period

ALL of the following

• Member may not be re‑enrolled into the same PCP panel or Plan earlier than one (1) year after disenrollment; EOHHS will attempt to prevent earlier re‑enrollment though exceptions may apply