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Enrollment termination feature #407

brainwane opened this Issue Sep 11, 2017 · 6 comments


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brainwane commented Sep 11, 2017

Let a provider use the PSM to tell the state Medicaid agency that s/he would like to terminate (end) an active enrollment.

This may be more of a provider management module feature.


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cecilia-donnelly commented Sep 12, 2017

See two items in the RTM, both from the VT Provider Manual:

  • psm-FR-5.2 The PSM shall allow providers to terminate their enrollment on a specified date.
  • psm-FR-5.3 The PSM shall require providers to give 30 days notice before terminating enrollment.

Providers should see a button labeled "Terminate Enrollment." They'll have a datepicker to choose a date on which to terminate their enrollment. They won't be able to terminate their enrollment immediately, though the exact amount of notice they need to give will be configurable (configuring that might be a different issue). That is, the datepicker will have the next month (for example) grayed out, meaning that the first date they'd be able to choose on which to terminate their enrollment would be 30 days away.


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cecilia-donnelly commented Oct 5, 2017

I talked to some state people about this:

  • How does termination of enrollment work in your state?

  • state 1: provider makes request to fiscal agent in writing on letterhead

    • individual who leaves a group provider could terminate the person as an affiliated provider with their group (as part of provider maintenance) (if a provider has own office and chooses to enroll as an individual, then they'd have to do the letterhead to unenroll as an individual, but if the only enrollment is as part of a group then the group can terminate them)
  • state 2: Same! The provider is an individual, but the facility is their practice, group, hospital - can be removed from practicing at those locations for any reason -- group is terminating them because they no longer have their specialty, some compliance action, something else

    • their individual approval (enrollment) might stay valid or not depending on the reason for termination from the group (e.g. compliance would affect both)
    • multiple levels of approval: credentials allow them to practice, abide by medicaid rules to bill for medicaid, but they have reqs based on specialty, which might mean that they have facility reqs too (for a specialty), like that they have the right equipment
    • So the situations are:
      • specialty termination, where they can no longer practice as a Dental Surgeon at that facility because of lack of equipment, but they can still do General Dentristry
      • facility termination, where no providers practice at that facility anymore
      • provider in facility, where one provider leaves a facility (but might stay in other facilities or private practice)
      • whole provider, where the provider terminates all their groups/facilities and individual enrollment
  • state 3: don't necessarily terminate when they leave a group, the provider themselves tells them that they want to terminate

    • notify within 30 days of any changes
    • put in writing what day, so they know when to terminate them
  • Terminating is just putting them in a different status,right? Not deleting?

    • they're always in the system, but they'd fill out a new application after termination (you never know what changed)
    • compliance incident wouldn't lead to termination right away
      -- they can be suspended, unsuspended, back to active
  • Termination is neither common, nor rare -- providers move out of state, retire, etc.


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chj124 commented Oct 6, 2017

state1: termination from group still requires letterhead notice

as mentioned, information should never be deleted. Status's can change.

Records can be moved to history tables based on users policy.
Records can be moved to archival storage based on users policy.
Records can be purged from archival storage based on users policy.


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cecilia-donnelly commented Dec 6, 2017

@jasonaowen mentions that we haven't discussed how this will work for a group provider -- the situations in which we've brought it up all have to do with an individual.


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jasonaowen commented Dec 7, 2017

Here are some (very rough) mock-ups of what this might look like:


Does this look like a useful flow? Do we want/need both pages? Do any of you have suggestions as to what the disclaimer text on page 2 should look like?


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cecilia-donnelly commented Dec 8, 2017

The disclaimer text is a good idea, @jasonaowen!

"I understand and acknowledge that by terminating my enrollment in Medicaid I forfeit my right to bill {state} for Medicaid patient claims after {end date}. I understand that I may not be eligible to re-enroll after this termination." <-- seem reasonable? I imagine states will have real language they want to use here.

I picture "terminate" appearing here too:

Rather than a text area, we should have a dropdown with reasons like "retirement," "moving," "other." I know at least one state has a set of codes to populate that dropdown, so a potential enhancement would be to make the options rules-driven. I don't think that's necessary for the first iteration of this feature, though.

jasonaowen added a commit that referenced this issue Dec 13, 2017

WIP add voluntary termination
Start working on the voluntary termination feature, where a provider can
choose to end their enrollment with at least 30 days' notice.

Create a new controller, a new view, and a new endpoint to begin the

- wire up controller
- add some useful data to the model
- use that data in the breadcrumbs
- throw an error if you try to terminate another provider's enrollment
Not done:
- add any links to the new endpoint
- add any content to the new endpoint (ie forms)
- verify that an admin can't "self-terminate" a provider's enrollment
- show a proper error message on access denied, rather than a stack

Issue #407 Enrollment termination feature

@cecilia-donnelly cecilia-donnelly removed this from the December deliverables milestone Dec 15, 2017

@kfogel kfogel added REQ-1 and removed REQ-1 labels Feb 27, 2018

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