US · guidance
CMS Pub. 100-16, ch. mc86c17d, § 50.3.3.1
Proposed Notice for Disenrollment for Cause
Once the grievance process has been completed or the member has chosen not to use this
process, the cost plan must submit a proposed disenrollment notice to the Regional Office
stating reasons for the termination of enrollment and the proposed effective date. Also,
the cost plan must summarize the case and submit documentation to the Regional Office,
including:
• The reason that the plan is requesting disenrollment for cause;
• A summary of plan efforts to explain these issues to the member and the other
types of options presented before disenrollment was considered;
• A description of the member’s age, diagnosis, mental status, functional status, and
social support system; and
• Separate statements from primary providers describing their experiences with the
member.
History
(Rev. 38, 10-31-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
f9f5996804073d7e070d98a8c176e1f09745f47ff349239985e339605c8e129c
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