County of San Diego Health and Human Services Agency HHSACounty Medical Services CMS Program Guide Discontinuance Number Page 150101 1 of 3 Background A CMS discontinuance policy has been established to Discontinue benefits for individuals who are not eligible for or who wish to discontinue their CMS benefits Provide correct CMS eligibility information on the Provider Online Verification POV website PolicyProcedure 150101A Discontinuance Requirement Discontinue CMS benefits if the recipient requests their benefits be discontinued is enrolled in MediCal is enrolled Medicare is enrolled in a Covered California Health Care Plan or in any health care coverage plan that meets the MEC requirement under ACA livesmoved outside San Diego County has income andor property which exceeds program limits has been confirmed as deceased failed to provide requested and required verifications that are otherwise unavailable to HHSA staff refer to 020603 150101B Discontinuance Request by the Recipient A recipient may request discontinuance of CMS benefits at any time by Submitting a signed statement indicating the request for discontinuance Making a verbal request for discontinuance Ask that the request for discontinuance be made in writing however is not necessary to wait for the written request before the case is discontinued 150101C Timely Notice Requirement Unless an exception applies when an action is taken to discontinue benefits notify the recipient timely and with an adequate NOA Issue CMS Discontinuance Notice of Action CMS131 at least 10 calendar days prior to the end of the month in which the CMS certification is to end Refer to 150101E for NOA deadline Exceptions A 10 day notice is not required under these circumstances however an adequate notice is required The recipient Has provided writtenverbal request to discontinue their benefits Is enrolled in MediCal Is enrolled in Medicare Is enrolled in a Covered California Health Care Plan or in any health care coverage plan that meets the MEC requirement under ACA Has been confirmed as deceased Is not a San Diego County resident County of San Diego Health and Human Services Agency HHSACounty Medical Services CMS Program Guide Discontinuance Number Page 150101 2 of 3 150101D Adequate Notice Requirement A written notice that informs the recipient of the following Action the County intends to take Reasons for the intended action Specific regulations supporting such action Explanation of the claimants right to request a county appeal hearing Circumstances under which benefits will be continued if a hearing is requested 150101E NOA Cutoff Date Requirement The CMS discontinuance CMS131 NOA must be mailed by the following deadline Calendar Day Month 18th All months except February 16th February Note If the deadline falls on a holiday or weekend the NOA must be mailed and dated the workday prior to the deadline date 150101F Discontinuance Action Upon receipt of information that causes a recipient to become ineligible for CMS or the recipient requests their CMS benefits be discontinued obtain supporting documentation as appropriate discontinue the case as outline in How To 1003 by updating the CMS IT system AuthMed with the discontinuance information narrate in case comments the circumstance supporting the case discontinuance Information should include but is not limited to the reasons for discontinuance and the effective date of discontinuance and ensure the recipient is given timely notice as appropriate of the discontinuance 150101G Discontinuance Action Not Required Check AuthMed to verify the existing certification period end date If the certification period is due to end at the same time the discontinuance NOA would be effective you do not need to discontinue the case However you must enter the information related to the reasons for ineligibility in case comments 150101H Applicant Contact After a Discontinuance Action Take the following actions when contact by the recipient is made after a discontinuance action When contact is made prior to the date of discontinuance rescind the discontinuance after the date of discontinuance advise the recipient of the option to submit an appeal to dispute the action andor reapply However you may rescind the discontinuance if good cause is determined County of San Diego Health and Human Services Agency HHSACounty Medical Services CMS Program Guide Discontinuance Number Page 150101 3 of 3 150101I Rescission of Discontinuance Upon receipt of information that requires the reinstatement of benefits rescind the discontinuance as outline in How To 1003 notify the recipient by sending Rescind Notice CMS110R when any of the following conditions apply o a County Administrative Hearing decision orders a reevaluation of CMS benefits o recipient contacts the County prior to or after the discontinuance date on the NOA and good cause is found o the recipient is eligible to Aid Paid Pending APP or o it has been determined that the discontinuance was in error reevaluate the case based on CMS eligibility criteria Impact No impact to other programs References None Release Date December 23 2014 Sunset Date This policy will be reviewed for continuance by January 1 2017